The Billesdon Surgery

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The practice had effective systems to assess, monitor and improve the quality and safety of the service. There were processes ensuring patients received high quality healthcare in relation to the use of medicines and ensure that patients received timely monitoring and reviews in line with guidance. There were comprehensive systems for safeguarding within the practice where staff monitored patients using a number of sources which may capture any vulnerabilities within their practice. The practice reported they included a wider scope of discussions during safeguarding meetings due to their population which made it more challenging to recognising potential safeguarding patients.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff we spoke with within the surgery were aware of the safeguarding lead, training requirements and processes. Staff were confident in recognising potential abuse and how they would escalate concerns to keep people safe.

Practice leaders told us that each patient with safeguarding concerns was reviewed at regular meetings. Discussions from these meetings were documented upon the patients' medical record so any external services, such as OOH could access the information.

The practice held appropriate policies for Adult and Child safeguarding processes within the practice. We saw the practice staff had received appropriate safeguarding training relevant to their role and there was good oversight of this. We saw evidence of safeguarding meetings which were attended by external health professionals to work together to support vulnerable people. At these meetings the practice also discussed and reviewed: - patients who had attended OOH multiple times - any children who had not attended planned hospital appointments -any significant events which involved safeguarding. -reviewed immunisation uptake

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients we spoke with during the inspection were positive about processes for medicines. Patients told us they were included in medication reviews regularly.

Clinical staff that we spoke with during the inspection were able to describe robust processes to support medicine prescribing and monitoring. Staff told us they completed regular audits and reviewed prescribing for example on antibiotic prescribing. We saw that the practice prescribed higher than average amounts of co-amoxiclav, cephalosporins or quinolones, however when the practice had investigated this they were all clinically appropriate. The practice had strong collaborations with staff from the primary care network, especially the pharmacy team. It was clear that these relationships were embedded within the practice and drove high quality care for patients in relation to medication reviews, medicine usage and supporting the dispensary.

Medicines were stored appropriately within the practice including emergency medicines and medicines which required refrigeration. There were records of checks completed to ensure medicines continued to be safe to use. The practice dispensary was reviewed as part of the inspection and was found to be well managed and had comprehensive systems and processes to ensure medicines were dispensed safely to patients. There was a proactive approach to managing and anticipating risks within the dispensary and systems had been put in place to provide extensive assurance for these. There was a suite of standard operating procedures to support processes within the practice and dispensary.

Our clinical review of the system found that medicines were appropriately prescribed and monitored within the practice. There were some examples where patients were not compliant with reviews or monitoring requests, however the practice could evidence them attempting to encourage the patients to attend. We reviewed methotrexate prescribing and found that patients were receiving the correct monitoring, either at the practice or via the hospital. We reviewed patients taking medicines that required regular monitoring and found that out of 997 patients prescribed particular medicines for treating blood pressure, two were overdue monitoring. However the practice had attempted to contact these patients. The practice had a log for monitoring safety alerts which were reviewed within the practice. There were clear records where safety alerts were reviewed and acted upon. We were told that not all safety alerts were recorded on the log and those not recorded were discussed in meetings however we did not receive any evidence to support this.

Medication reviews were completed to a high standard within the practice, which included details of discussions with patients within the records. The practice kept a comprehensive log of alerts and could demonstrate these were reviewed in a timely manner. There were appropriate management of long term conditions within the practice such as reviewed patient with asthma who had received courses of steroids, and patients with hypothyroidism and diabetes were being appropriately managed.