Lawton House 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

We assessed all quality statements in this key question. Our rating for this key question is good overall. Managers investigated all reported incidents to reduce the likelihood of them happening again. Staff supported people to live healthy lives and provided them with support and information on their care and treatment. However, recruitment processes and medication optimisation processes were not always effective.

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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the PPG felt the provider took concerns seriously and proactively made improvements to the service.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the team discussed and learnt from clinical issues.

The provider monitored and reviewed safety using information from a variety of sources. There was a system for recording and acting on significant events. The incidents we reviewed had been investigated and learning shared as appropriate. Staff told us they knew how to report significant events.

People had no specific feedback on this area.

Managers and staff could explain how people moved between services. Staff understood their responsibilities for monitoring the progress of referrals.

Partners had no specific feedback on this area.

When people moved between services, there was a plan in place for what happened next, who would do what and all the practical arrangements were in place.

People had no specific feedback on this area.

There was an understanding from staff and leaders of safeguarding and how to take appropriate action. During staff meetings, the whole team discussed any safeguarding concerns. Staff knew who the lead for safeguarding was.

Partners had no specific feedback on this area.

There were systems, processes and practices to make sure people were protected from abuse and neglect within the practice. The safeguarding lead met with the health visitor in the area every six months to review safeguarding concerns, during the inspection the practice stated they would aim to increase the frequency of these meetings. Some non-clinical staff were only trained to level one in safeguarding children. Intercollegiate guidance states all staff who interact with children should be trained to level two. During the inspection the practice put in plans to train non-clinical staff to level two.

People knew what to do and who to contact when they realised that things might be at risk of going wrong or their health condition may be worsening.

Leaders told us training was given to reception staff to assess patients in order to differentiate between urgent and non-urgent patients. They also had support from an on duty GP if needed.

The practice had clear processes in place should a person call or attend the practice severely unwell.

Leaders and staff considered how environments could keep people safe from psychological harm as well as physical harm. Quiet private spaces were offered if patients asked to speak privately with staff.

Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care. Equipment used to deliver care and treatment was suitable for the intended purpose, stored securely and used properly.

The provider had appropriate health and safety, fire and premises risk assessments and action plans in place to keep the environment safe for people.

People felt they had considerate support delivered by competent people.

Staff and leaders told us staff received the support they needed to deliver safe care. This included supervision, support to develop, improve services and where needed, professional revalidation.

Recruitment checks were not always carried out in accordance with regulations. We reviewed 4 recruitment files, 2 were missing checks that should be carried out during recruitment, the practice provided evidence and context for these gaps during the inspection. Non-clinical staff appraisals were not up to date. During the inspection the provider provided evidence that 17 out of 20 non-clinical staff had their appraisals booked for November 2024. Staff received training appropriate and relevant to their role.

People had no specific feedback on this area.

Staff knew who the infection prevention and control lead for the practice was. They felt supported in understanding infection prevention and told us they received appropriate training, such as hand washing. Staff who handled clinical specimens knew how to do so safely.

The premises were clean, and equipment used was well maintained which helped to protect patients and visitors from the spread of infection. The chairs in the waiting room were wipeable, sufficient PPE and hand washing facilities were available in clinical areas. Clinical staff were observed as bare below the elbow as per guidelines.

There were clear roles and responsibilities around infection prevention and control. There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. The provider completed regular hand washing and infection control audits, the results of these were actioned to improve compliance.

People had no specific feedback on this area.

Staff received regular training on medicines management, and felt confident managing the storage, administration and recording of medicines.

Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff showed how they disposed of expired medications. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. We found that emergency equipment and medicines were stored in different locations in the practice, during the inspection these were all moved to one central location and staff informed.

The provider did not always have effective systems to manage and respond to safety alerts. Our clinical searches found 10 patients were prescribed mirabegron and had not had recent blood pressure tests, against the guidance in a Medicine and Healthcare Products Regulatory Agency (MHRA) alert. If this medication is not monitored properly it can lead to avoidable heart attack and stroke. We reviewed five patients’ records in more detail and found that the patients had potentially not had the appropriate monitoring. The practice reviewed the patients and booked them in for monitoring appointments. Staff did not have the appropriate authorisations to administer medicines. We examined five Patient group directions (PGD) and all contained information on nursing staff who were not correctly authorised to administer the named medicines. Nurses signed PGDs that did not have a signature from the authorising manager to administer the named medicine. During the assessment period the provider corrected these. Processes were not always effective to ensure people prescribed medicines with specific risks received recommended monitoring. Our searches found that 16 patients prescribed Methotrexate had not had the required monitoring, we reviewed 5 records in more detail and found all 5 were potentially missing monitoring data. Monitoring was required because Methotrexate is a high-risk medicine that can have serious side-effects. Following our inspection, the practice reviewed the patients and ensured monitoring was up to date. Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. During our clinical record review we reviewed 5 medication reviews that had been completed in the last 3 months. We found that medication reviews were undertaken by a clinician, reviewed all medications and ensured that annual reviews or monitoring were up to date. Staff managed medicines-related stationery appropriately and securely.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages. As part of the inspection a number of set clinical record searches were undertaken by a CQC GP specialist adviser remotely. The records of patients prescribed certain high-risk medicines were checked to ensure the required monitoring was taking place. These searches were visible to the practice. Our clinical searches found that there were 1602 patients prescribed ACE inhibitor or angiotensin II receptor blocker treatment. We reviewed 5 patient records. We raised all 5 patients as potentially missing the required monitoring. The practice reviewed these patients and found 4 had had the required monitoring. The practice tried to contact the final patient to be reviewed but had no response.