London Street 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 the quality statements in the safe key question. We found that services were not always delivered safely and in line with national guidance. There was a significant backlog of patient records requiring summarising. There was not sufficient guidance for staff to prioritise patient safely as part of the system of initial assessment operated by the practice. Some patients that had been prescribed high risk medicines were not monitored appropriately. Our rating for this key question remains requires improvement.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback was used by the provider to identify improvements to the service. There was a consistent approach to handling feedback and complaints.

Staff understood how to report learning or significant events. They told us these were discussed in meetings and relevant learning was shared with them.

There was a system for recording and acting on significant events. There was evidence of learning and dissemination of information following significant event reviews

Staff understood how to use the clinical system and book appointments as required, input key information regarding patient care and manage correspondence with external providers. There were systems for managing patients’ care across different services such as hospitals and care homes.

Local commissioners shared no concerns regarding the provider’s systems or pathways.

The practice was equipped to respond to medical emergencies. There were processes to manage patient correspondence and referrals. Staff however, did not have detailed guidance to assist them in operating the new triage system when patients contacted the surgery in person or by phone to book appointments. The new system was implemented in September 2024. The guidance available for reception staff to undertake triage (aside from a new automated digital tool) did not include reference to symptoms of sepsis, stroke or some other high-risk indicators. Staff awareness of high-risk symptoms was based on a limited training package which included inaccurate referral information based on a tool obtained from Australia. This tool had not been modified to include UK NHS information and staff guidance was insufficient. The triage system included a new automated triage tool which was an NHS approved system implemented by the practice to signpost patients to appointments or other services as necessary when booking appointments online. The system was able to allocate patients to specific appointments or refer patients externally, such as those needing emergency department care. The provider was partially monitoring this new system during its implementation to ensure it was safely referring patients externally and ensuring patients’ welfare was being protected. Internal appointment allocation was monitored informally by clinicians when they saw patients referred to specific appointments. However, there was limited oversight of patients referred externally by the automated system. In one example a patient had been advised to call 999 on 9 October but no welfare follow up with the patient had taken place. No auditing of the system had yet taken place to assess its performance. A risk assessment had been undertaken in August 2024 prior to the implementation of the system, but a number of the actions on the risk assessment stated they were in progress and it had not been updated.

Reviews of patient feedback did not indicate any concerns with safeguarding processes or sharing of information.

Partners and staff informed us they were trained to appropriate levels for their role. They understood where to find information on safeguarding and showed the inspection team the reference guidance, including safeguarding referral information.

We did not have any concerns on record or directly from stakeholders such as commissioners or the local authority regarding safeguarding processes at this GP practice.

Safeguarding systems, processes and practices were developed, implemented and communicated with staff. Clinical and support staff were trained to appropriate levels for their role in safeguarding adults and children. There were processes in place to identify vulnerable patients on the record system.

Patients were involved in reviews of their long term conditions and how to manage the associated risks. Patient feedback was considered and used to improve the management of services including alterations based on concerns raised by patients.

The nursing team informed us of the processes they used to ensure long term condition reviews were undertaken safely and risk prioritised appropriately. Support, non-clinical staff explained there was a process to prioritise and forward patient correspondence from external providers, such as hospitals, to clinicians where needed and to ensure actions were completed.

There were systems to manage referrals, prompts for patients to attend routine tests and reviews of their conditions and to ensure correspondence was prioritised appropriately. However, there was a backlog of patients’ clinical notes dating back from pre-digitised records. Much of this backlog related to existing patients registered at the practice so the provider had access to the patients’ archived paper records.

Staff had training in health and safety.

The practice was based in a site converted from its original purpose and it was an old building. There were adaptations to the premises to enable patients to access care such as a lift. Some parts of the building were in need of updating and minor maintenance improvements.

There were risk assessments related to the facilities including fire and risks associated with the premises and most related actions were completed. There were some outstanding actions from the fire and health and safety risk assessments, and the practice was in the process of planning or undertaking these. Service contracts were in place for clinical apparatus, fire safety equipment and electrical goods received portable appliance testing. Medical equipment was calibrated. However, the provider could not demonstrate they validated or calibrated their spirometer (used in respiratory care) in line with national guidance and in line with the manufacturer’s requirements.

People’s feedback about staffing was positive. In the 2024 GP national survey 80% of patients stated the healthcare professional they saw or spoke to was good at treating them with care and concern during their last general practice appointment compared with the local average of 87% and national average of 85%.

Staff told us they had the opportunity to undertake training related to their role. They told us they were provided with guidance documents such as long term condition review templates for nursing staff.

Staff were provided with protected time for learning and training resources. There was no formal supervision process for non-medical prescribers, but nurses were able to seek support. The service did not assure themselves that all clinical staff had immunisations recommended by national guidance (The Green Book). The respiratory lead nurse who undertook spirometry was not registered with the Association for Respiratory Technology and Physiology (ARTP),the professional body for respiratory practitioners in the UK. . This posed the risk that the nurse’s training was not up to date with all requirements related to spirometry.

Feedback from patients did not indicate any concerns regarding infection control.

The local Integrated Care Board (ICB) undertook an infection control audit in February 2024. The practice completed the resulting action plan to ensure appropriate standards of infection control were met. The nursing team informed us there were spot checks of cleanliness undertaken.

The premises were clean. The premises were a converted bank and many of the fixtures and fittings were dated and required maintenance to ensure hygiene could be maintained. Clinical waste was stored appropriately in the clinical rooms we checked.

Cleaning contracts and cleaning checking systems were in place. Clinical waste was processed in line with the infection control policy. There was a sharps injury protocol made available to staff for such an event where quick action may be required.

Patients’ feedback including feedback received via NHS reviews did not indicate any significant concerns regarding the management of their repeat prescriptions or medicines management.

Interviews with lead clinicians indicated there had been a lot of resource allocated to improving the monitoring of repeat prescribing. There had been new GPs recruited since the previous inspection and they were supported by a clinical pharmacist.

There was a system to keep prescription stationery secure. Medicines requiring cold storage were managed safely.

There were improved monitoring processes for patients who needed specific medicine reviews to ensure their prescribing was safe. The majority of patients were prescribed medicines in line with national guidance. However there were some patients who did not receive appropriate monitoring and their prescriptions continued to be issued without restriction placing them at risk of harm. The practice reviewed these patients and prompted them to attend for the monitoring and tests they required and time limited their prescriptions to encourage them to do so. The system for repeat prescribing had not ensured necessary mitigation was always in place when patients were at risk of harm related to their prescribed medicines.

We undertook extensive clinical searches on the patient record system to check whether patients received their medicines through repeat prescriptions safely. Our key findings identified significant improvements to the monitoring of patients’ prescribing. However, we identified the following concerns: -4 out of the 20 patients prescribed methotrexate were identified who had not had the required monitoring. -We identified 360 patients were prescribed ACE inhibitors or Angiotensin II receptor blocker (medicines used to treat high blood pressure and cardiac conditions) and out of those 13 had potentially not had the required monitoring. -4 out of 15 patients identified as having been prescribed Mirabegron who had not had a review in line with national guidance in last 12 months The practice took prompt action regarding these findings to reduce the risk to the relevant patients.