Roysia 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

There was a proactive and positive culture of safety based on openness and honesty, in which concerns about safety were listened to, safety events were investigated and reported thoroughly in most cases, and lessons were learnt to identify and embed good practices. Medicines and treatments met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen. Safety alerts were reviewed and actioned appropriately. Overall we found the providers monitoring of medicines was good.

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.

As part of the announced assessment of Roysia Surgery, the views of the practice team were sought as part of the evidence category of staff feedback. There were 13 responses reviewed by us and the feedback was all positive. Staff were able to report that they were aware of the incident reporting process and knew how to report concerns. Responses indicated that learning was shared from events to improve services. Staff attended meetings regularly, and discussed relevant issues, and information was also shared electronically via notifications on the practice IT systems. All responses highlighted that the practice was very focussed upon patient care and providing the best service to meet their needs. All staff complemented the managers and Malling Health staff, saying they were always made to feel supported, and that staff welfare was a paramount focus. Additionally, non-clinical staff and clinicians spoke positively about an inclusive and supportive leadership with a clear vision for the future.

We found that complaints were fully investigated, and learning was applied as appropriate. Patients received a full response to their complaint and the practice responses included details of the Parliamentary and Health Service Ombudsman. There had been 25 significant events in the previous year. Staff told us they knew how to identify and report concerns, safety incidents, and near misses. Learning from significant events and complaints was shared with staff and systems to identify trends in significant events and complaints were in place. Where changes had been implemented in response to learning, the effectiveness of the changes made were reviewed. Patients were supported to give feedback through complaints and compliments. We found that complaints were reviewed on a monthly basis to identify trends and that when it was appropriate to do so, learning was shared with staff. There was a system in place for staff to raise significant events that had occurred within the practice. Significant events were investigated, learning from them was shared with staff and systems to identify trends in significant events were in place. The practice was proactive in raising significant events and 13 significant events had been raised and investigated in 2024. We reviewed one of them and found that a thorough investigation had been completed and when changes had been implemented to avoid issues occurring again that the effectiveness of the changes made was reviewed.

Patients identified as frail, vulnerable and carers for others were given direct access to the practice and were overseen by a clinician and social prescriber. We saw there were robust processes for identifying vulnerable people. The practice would code the patient record, ensure same day appointments where applicable, liaise with any outreach worker and social workers known to the person. Patients suffering from Mental Health conditions were offered extended appointments as required. All conditions were coded on the patient record and there was a practice mental health register. Practice receptionists were aware that mental health concerns were treated as urgent and if an appointment was not to be offered, the reception team would contact the duty GP.

The provider worked with local care homes and we saw that the provider would inform each care home when a patients medicine review was due. They would arrange an appointment with the care home, patient and family members and complete a thorough review. There was also a dedicated telephone line for care homes to call the practice to obtain clinical advice, book appointments and discuss medicine queries or changes.

The practice held links with the community mental health team who ran clinics from the practice to support the completion of the Mental Health Physical Health Checks. This had a significant impact with people showing an increased completion rate of 86%. The person would then receive a GP mental health review as a final measure to ensure any vulnerable patient was supported. The practice had 6 traveller patients registered. These patients were coded on the front page to alert staff. The practice offered these patients extended appointments and offered flexibility to unscheduled requests. During any visits, staff would opportunistically use appointment time to review all areas required such as screening and vaccination. The provider was a veteran friendly practice and had 13 patients registered. Extended appointments would be offered to allow a supportive approach to discuss health and mental health concerns.

Staff we spoke to told us that they were able to raise concerns of safeguarding and could also tell us what would constitute a safeguarding concern. Staff training was up to date and any chaperone trained staff had the appropriate enhanced disclosure and barring checks required to complete this role. All staff could name the safeguarding leads at the practice, Malling Health and the local area escalation details.

There was a designated safeguarding lead and deputy lead. The provider had 2 monthly meetings to discuss all adults and children at risk. Their safeguarding register was always updated prior to the meetings and a health visitor would always attend. The practice took a pro-active approach to safeguarding and recounted a difficult case, from which they completed an internal serious case review in the event of any future learning. This was then shared with the practice and the wider Malling Health organisation. When a patient was reviewed, the lead GP would review the records and also the linked family records to ensure there were no red flag risks present. This was to ensure a thorough review. There was a comprehensive policy and there were clear signposted posters within the reception and waiting areas and a detailed safeguarding handbook. Safeguarding training and chaperone training were 100% compliant. In addition to this, the practice had implemented policies and procedures which demonstrated partnership working with the other agencies and local safeguarding teams.

Staff were confident in the systems and processes to respond to the risk for a deteriorating patient. We were provided with an example of where such a risk had been managed well by the staff, including reception staff, nurses and GPs, to reach a positive outcome for the patient whereby they had received prompt and effective emergency care. Patients requesting care and treatment through the electronic request form were triaged by a GP to ensure they received priority care when needed. Staff were knowledgeable regarding identified risks within the practice. Information on how to reduce known risks was included in written risk assessments. Risks relating to individuals were recorded within their electronic records and the patient record system alerted staff to the risk on opening the record. Emergency medicines and equipment were available and staff were provided with training to use these effectively.

Leaders we spoke with explained how they had oversight of tasks and processes to ensure they detected and controlled risks in the care environment. Designated staff members were responsible for completing tasks such as health and safety, and fire risk assessments. Risk assessments were shared with relevant leaders and staff. Any specific learning from risk assessments were also shared with staff via staff meetings and emails to facilitate improvements. Staff and leaders we spoke with told us the practice had a strong team ethic and worked well together. Staff said they felt able to raise concerns without fear of retribution. Staff told us leaders were receptive to the ideas and changes were implemented and rolled out across Malling Health, not just at provider level. An example of this was a learning tool following significant event analysis.

The practice had an up-to-date staff immunisation policy and we saw evidence that staff had received vaccinations in line with this. All staff had completed annual fire safety training and face to face fire training was completed 2 yearly. We saw the practice conducted fire alarm and emergency lighting checks and commissioned an external company to service the fire extinguishers. The practice held appropriate emergency medicines. Risk assessments were in place to determine the range of medicines held and a system was in place to monitor stock levels and expiry dates. The practice was equipped to respond to medical emergencies. There was medical oxygen and a defibrillator on site. We saw there were systems to ensure these were regularly checked and fit for use. All medicines and equipment we checked were in date and stored securely. All staff received annual basic life support, anaphylaxis and sepsis training and training records showed 100% compliance.

Fire drills and fire alarms were regularly tested at the practice. Portable appliance testing and calibration testing of equipment had been carried out in the last 12 months. Risk assessments we reviewed identified potential hazards to individuals and the provider had implemented improvements to address concerns. For example, removal of clutter and this also tied in with an infection prevention and control audit.

The national GP survey demonstrated patients who returned completed questionnaires were satisfied with the staff who provided services to them at the practice. For example, 80% had confidence and trust in the healthcare professional they saw or spoke to during their last appointment, 90% said the healthcare professional they saw or spoke to was good at listening to them during their last appointment and 88% said the healthcare professional they saw or spoke to was good at treating them with care and concern during their last appointment.

At the time of our inspection, there was posting for a GP for 6 sessions. The mandatory training requirements had been decided by the provider and management teams and was identifiable on the electronic training system. The system ensured staff were made aware of the mandatory training required for their role and when this was due. Email prompts were sent 4 weeks prior to the training being out of date. The provider told us for staff education, they had implemented a situation, background, assessment, recommendation (SBAR) tool to review all learning to develop training sessions for staff. This SBAR training had increased clinical awareness for both clinical and non-clinical staff. We saw this was improving patient outcomes following this innovation.

Oversight of the training was the responsibility of a manager to ensure all staff kept up to date. Incomplete training was discussed individually with the staff member and plans, including support and time allocation, put in place to ensure this was completed. A review of nursing capacity and demand had been carried out and nursing staff had been recruited. Jobs were advertised internally and externally and all applicants followed a recruitment process. Records including a checklist, were maintained for all staff, to demonstrate the checks which had been made to evidence their suitability for the role. The practice was part of a primary care network made up of several GP practices. This meant the practice had access to additional roles. For example, social prescribers. (Social prescribers help to connect people to activities, groups, and services in their community to meet the practical, social and emotional needs that affect their health and wellbeing). The electronic and telephone systems enabled the practice to monitor and understand workload. This had led to increased staff. For example, a recent new salaried GP had been employed. The practice manager would support busier periods or cover for lunches to support telephone calls.

Staff told us there was an open culture and they had the opportunity to raise any issues and felt confident and supported in doing so. For example, staff identified that floors did not appear to be cleaned to a high standard. This was referred to the cleaning company and improvements were made.

The practice policy for infection prevention and control was in date. Staff told us there was an open culture and they had the opportunity to raise any issues and felt confident and supported in doing so. For example, staff identified that the patient toilet could benefit from a dementia friendly toilet seat. This was referred to the maintenance team and improvements were made. During our site visit, we observed 3 clinical rooms. We saw the practice had maintained appropriate standards of cleanliness and hygiene. The arrangements for managing waste and clinical specimens kept people safe. We saw sharps bins were managed in line with guidance. We saw that cleaning schedules and Control of Substances Hazardous to Health (COSHH) risk assessments were maintained and checked by the provider. There was an up to date cold-chain policy (the system of transporting and storing vaccines within the recommended temperature range). Vaccines were appropriately stored and monitored in line with UK Health Security Agency (UKHSA) guidance to ensure they remained safe and effective. We reviewed the training records of 16 staff members and saw they had received appropriate training in infection prevention and control (IPC). The provider had a rolling programme of conducting IPC audits. This included general cleanliness of the premises, correct usage of sharps bins, ensuring hand washing posters were displayed, whether personal protection equipment were available in rooms, and whether equipment and the premises were in good condition. An IPC audit was completed in October 2024 and an action plan was implemented to address issues identified. For example, the audit identified there was to be a renewal of sensor taps to replace short handled elbow ones. We saw evidence the provider had communicated to relevant staff regarding these issues and saw communication to ensure appropriate action had been taken.

Staff were able to describe the system to identify patients who required monitoring based on the medicines they were prescribed. Our clinical searches showed no clinical concerns. For patients prescribed disease-modifying antirheumatic drugs the feedback from our GP specialist advisor (SPA) showed 1 patient required an unrelated diagnosis to be added to their record. There were 2 patients prescribed an ace inhibitor medicine were overdue bloods and 1 of these patients required a blood pressure reading. The provider had rectified these by the time of our onsite inspection. Our GP SpA reviewed The Medicines and Healthcare products Regulatory Agency (MHRA) alerts and saw 3 patients prescribed aldosterone antagonists that were overdue bloods. All 3 patients were only just overdue and practice had already made appointments. There was 1 patient on escitalopram at dose too high for their age. The provider had reviewed this before our onsite visit. Our clinical searches reviewed potential missed diagnosis of diabetes and saw 4 patients were not diabetic and 1 patient may have steroid induced diabetes. The provider was aware of these patients and had taken steps to address the records. We spoke with non-medical prescribers ( prescribing clinicians who are not GPs) who told us they were able to discuss their prescribing each day with a duty GP. Medication reviews were found to be robustly completed and our GP SpA found no issues of concern. Additionally, a review of people prescribed medicines to help atrial fibrillation showed no patients with outstanding monitoring.

Cold chain processes were observed at the practice, and we found the recording of fridge temperatures were well documented via an electronic system. Staff were knowledgeable regarding actions to take should the cold chain be compromised. We saw fridges were locked and maintained a safe stock level. We looked at the emergency medicines and equipment held by the practice and found it was stored securely. Other emergency medical equipment was stored elsewhere in the practice. We found equipment and medicines were monitored to ensure expiration dates did not expire. There was a monthly check list used that provided evidence that each individual item was being checked, during the monthly audit process. A defibrillator was kept on site, which contained the pads suitable for adults and children under the age of 8 years old. The practice carried out routine checks of the defibrillator to ensure it remained fully operational. The practice had a system and policy in place in the management and security of prescription stationary. Staff had the appropriate authorisations to administer medicines (including Patient Group Directions (PGDs). PGDs provide a legal framework that allows some registered health professionals to supply and/or administer specified medicines to a pre-defined group of patients, without them having to see a prescriber (such as a doctor or nurse prescriber). There was a separate folder for employed staff and locum staff to ensure all required signatures and renewals had clear oversight.

Our clinical searches looked at asthma patients prescribed 2+ courses of steroids. There were no issues of concern found. Chronic Kidney Disease (CKD) patients stages 4-5 showed no issues of concern. The provider had completed an audit of CKD patients during July to November 2024. They had identified 34 patients diagnosed and coded with CKD. With the coding associated advice regarding the condition was given to support the patient with self-care to improve their outcomes and avoidance of deterioration of kidneys. Additionally, 169 patients were identified for a robust recall placed on their record to enable appropriate monitoring of their condition throughout the year and were given appropriate advice to improve their health outcomes and avoidance of deterioration of their condition. Patients living with hypothyroidism showed no issues of concern. For diabetic patients requiring retinopathy eye screening, there were no issues of concern.