Wonersh Surgery

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• 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

We reviewed 2 quality statement in the Safe key question – Learning Culture and Medicines optimisation and found good practice. However, we found prescription stationary was not tracked within the practice and Patient Specific Directions (PSD) were not being adequately managed. The scores for the other quality statements are based on the previous rating for this key question. There was a culture of safety and learning. Staff we spoke with told us they were encouraged to raise concerns and felt supported in doing so. Incidents and complaints were appropriately investigated and reported. There was an effective system for reporting, recording, and learning from significant events and complaints. Risks were actively managed and viewed as opportunity to learn and improve. Our review of the remote searches of patient records showed that patients were being effectively and safely managed. There was a process for the management of medicines, including high risk medicines, with appropriate monitoring and clinical review prior to prescribing. Patients were involved in regular reviews of their medicines. Medicine management was effective. Expiry dates of medicines were monitored, recorded and all in date. Fridge temperatures were recorded daily, and no temperatures had gone out of range. Medicines were stored correctly either in locked cabinets or locked fridges. However, prescription stationary was not tracked. Organisations who stock prescription forms are responsible for their management and use. This includes controlling and recording prescription form movement, including recording serial numbers. PSDs did not hold sufficient information and did not form part of the patient record. All vaccines should be recorded in the patients notes together with the patients consent to administration.

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 saw evidence that where patients had complained or given feedback about their concerns, the provider had investigated the issue and where possible had made changes. We spoke with 3 members of the Patient Participation Group (PPG). They told us that the provider was very open to hearing the views of the PPG, as representatives of the practice’s patients, and were working together to identify key issues and find resolutions.

Staff we spoke with told us the provider learned and made improvements when things went wrong. Staff knew how to identify and report concerns and safety incidents. There was evidence of regular discussions for learning and the dissemination of learning between members of the team at practice meetings. Minutes were available for those unable to attend. Feedback we received from staff was positive about the learning culture within the practice.

There were systems for reviewing and investigating when things went wrong. The provider could demonstrate how they investigated, identified learning, and made improvements that were required. When things went wrong, staff apologised and gave patients honest information and suitable support. We noted an open culture in which all complaints were highly valued as being integral to learning and improvement. The provider had a complaints policy in place which clearly outlined the complaints process. The provider kept a record of all complaints received and any action taken as a result of complaints. There had been 23 significant events in the last 12 months, and we saw incidents were investigated fully. There was evidence that changes had been made as a result of identified learning. Meetings were held regularly where significant events were discussed for a wider learning. The provider had a protocol in place for actioning safety alerts. Alerts were disseminated to the required members of the team and where action was required, searches were conducted of clinical records to identify patients who may be affected. From a sample of patients’ records we reviewed, we found action had been taken on alerts received.

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.

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

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.

The National GP Patient Survey does not have questions specific to this question. We received 4 CQC Give Feedback on Care forms from patients. These were all positive about the provider, however, did not give specific details about this key question.

Staff we spoke with were knowledgeable about systems and processes within the practice that enabled positive patient care. Staff told of the process to ensure appropriate clinical oversight of test results. Regular searches and audits were in place to ensure the practice delivered timely reviews. Clinical staff were able to tell us about how they monitored patients’ health in relation to the use of medicines including high risk medicines. We interviewed the practice manager and registered manager. We found there was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that meets those needs and promoted equality. This included patients who were in vulnerable circumstances or who had complex needs. Through our discussions with the managers, they demonstrated they had the experience, capacity, and capability to ensure high quality care. They told us they prioritised safe, and compassionate care.

During the onsite inspection we found that the fridges were being monitored and recorded daily. Vaccines were appropriately stored and monitored in line with UK Health Security Agency (UKHSA) guidance to ensure they remained safe and effective. Staff we spoke with told us the actions they would take if the fridge temperature went out of range. The practice held appropriate emergency medicines, and a system was in place to monitor stock levels and expiry dates. Staff had the appropriate authorisations to administer medicines including Patient Group Directions. Prescription stationary was removed from clinical rooms overnight and stored in a locked cabinet. However, prescription stationary was not being tracked throughout the practice. We reviewed the providers prescribing and medication policy which included prescription security but found the provider was not working to this policy. Following our inspection, the provider demonstrated they took immediate action in response to our findings. These had only recently been implemented so there is not yet verified evidence to show they were working.

We reviewed Patient Specific Directions (PSDs). A PSD is an instruction to administer a medicine to a list of individually named patients where each patient on the list has been individually assessed by that prescriber. The provider did not have a PSD policy for staff to follow. We noted that PSDs did not contain sufficient detail and did not form part of the patient’s medical record. Following our inspection, the provider sent us evidence to provide assurances that they took these concerns seriously and were making the necessary improvements. There was a process for the safe handling of requests for repeat medicines and evidence of effective medicines reviews for patients on repeat medicines. Patients were appropriately involved in decisions about their medicines. The provider had a process and clear audit trail for the management of information about changes to a patient’s medicines including changes made by other services. There was a process for monitoring patients’ health in relation to the use of medicines including high risk medicines with appropriate monitoring and clinical review prior to prescribing. The provider monitored the prescribing of controlled drugs. The approach to medicines reflected current and relevant best practice and professional guidance. Medicines were appropriately prescribed in line with the relevant legislation, current national guidance, or best available evidence. Patient records were well written and held up-to-date information about people’s care in line with current national guidance. There was a system for recording and acting on safety alerts. Minutes of meetings demonstrated that all clinical staff were kept up to date with any changes to guidelines and best practice.

As part of the assessment, we conducted remote searches on the practice clinical system and reviewed a selection of patients’ records. Our review of the remote searches of patient records showed that patients were being effectively and safely managed. This included medicines that required monitoring and the follow up of abnormal test results. Our review of searches indicated patients care and treatment was managed in line with current guidance and that information, including, examination, management plans, safety netting and follow ups were adequately documented. Patients who were prescribed medicines were being monitored and reviewed in the required timescales. This ensured all information required was available for safe prescribing.