Elliott Chappell Health Centre Also known as St Andrews 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 a total of 4 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found safety was a top priority, and staff took all concerns seriously. Safeguarding systems, processes and practices had been implemented. Staff had received safeguarding training relevant to their role and understood how to report concerns. When things went wrong, staff acted to ensure people remained safe. Managers investigated all reported incidents to reduce the likelihood of them happening again. Staff training was appropriate and up to date and staff had received induction, annual appraisal and clinical supervision. There was a positive learning culture. Staff knew how to identify and report concerns, safety incidents and near misses. The practice learned and made improvements when things went wrong. Staff supported people to live healthy lives and provided them with support and information on their care and treatment.

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. The service displayed feedback forms in the practice and information on how to make a complaint was available on site and on the practice website.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority.

The provider had a significant event policy and complaints policy which was accessible to all staff members. The practice discussed events and incidents during team meetings and learning was shared with staff. The practice had a duty of candour policy and involved people when managing significant events and errors. The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

We did not receive any concerns from patients about delayed referrals or safe systems of care.

Staff had a good understanding of local referral processes and arrangements. Staff told us they attended regular multidisciplinary team meetings where patients who may be vulnerable or those receiving end of life care were discussed and any actions agreed were recorded in patient records.

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.

Staff told us they felt safe to work at the service. They said that facilities, equipment, and technology were well-maintained so they could work safely and deliver a good quality of care to their patients. Staff had completed safety training for example in fire health and safety awareness and resuscitation.

We carried out a walk around of the premises on our site visit and saw the environment was satisfactorily maintained, for example, the emergency equipment, medication, appropriate calibration of equipment and Portable Appliance Testing (PAT) had been satisfactory completed. The practice was clean, and we saw the premises was free from safety obstructions and was accessible. The premises was maintained by a third party provider and we saw that appropriate safety and cleanliness controls were in place. There was no potential risk to patients as all access to clinicians and patient services were on a ground floor level and the lift to the first floor was for staff and administration use only.

The service had monitoring systems in place which they reviewed regularly to ensure risk assessments and actions from the assessments were completed. The service had systems in place to report new and emerging risks should they occur. We saw that health and safety and fire risk assessments had been carried out. There was a fire procedure.

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.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Staff received regular training on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff managed medicines-related stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. As part of our assessment we interviewed the clinical lead GP and they were able to explain to us systems for the appropriate and safe use of medicines, including medicines optimisation.

Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. We saw that the service ensured medicines were stored safely and securely with access restricted to authorised staff. Staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had systems in place to receive, review and act on medicine alerts.

Accurate, up-to-date information about people’s medicines was available as clinicians and enhanced access staff had access to the patient’s clinical records. The provider was monitoring medicine prescribing in the form of audits. We carried out remote searches of clinical records as part of our assessment to check how the practice monitored patients’ health in relation to the use of high-risk medicines. We found that patients mostly received appropriate monitoring at the required intervals. For example; Our clinical searches highlighted an additional 79 patients prescribed Gabapentinoid which is an neuropathic pain medication required review. A sample of five of those patients showed they had received the required monitoring with the exception of two required a review. Clinical searches highlighted an additional 119 patients required monitoring for Direct Oral Anticoagulant (DOAC) which is medication to treat blood clots. A sample of five of those patients showed they had received the required monitoring with the exception of two were overdue a review. We were assured by the provider that some follow up reviews had been completed and all outstanding actions on all reviews would all be completed by 31 December 2024. We saw an action plan that confirmed this. The service completed regular monitoring of medicines which required refrigeration. The service did not dispense any medicines and did not hold any controlled drugs. Prescriptions were sent electronically to a pharmacy of the patient’s choice for dispensing. The provider had effective systems to manage and respond to safety alerts and medicine recalls.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages. There was a programme of regular clinical auditing of prescribing that focused on improving care and treatment. From the medicines optimisation (prescribing) data which is received by CQC from the NHS business services authority (NHSBSA) we saw that the practice data was either in line with national prescribing or for one outcome had lower prescribing, for example; Percentage of antibiotic items prescribed that are Co-amoxiclav, Cephalosporins or Quinolones from 1/07/2023 to 30/6/2024, expected average 7.6%, practice average 3.3%. Number of antibacterial prescription items prescribed per Specific Therapeutic group Agesex Related Prescribing Unit (STAR PU), expected average 0.54%, practice average 0.53%.