Harraton 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 carried out an announced assessment of 8 quality statements under the safe key question and found while there had been improvements in some areas since the last inspection in June 2023, there were still improvements required. All staff we spoke with gave positive feedback. They told us the last 12 months had been a challenge due to staff leaving, but they felt that they had a supportive team, an approachable manager, and that it was a good environment to work. Some staff did not have a Disclosure and Barring Service (DBS) check in place, one of whom worked in a clinical role. There was no risk assessment carried out to explain the rationale for not carrying out a DBS check. There was a lack of oversight to ensure mandatory training was kept up to date. We saw that systems and processes were not established and operated effectively to monitor the safety of environment. The cleanliness of the practice had improved and we saw infection control audits had been carried out at both sites. However, there was no process in place for checking equipment and that single use items remained in date and safe to use.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received no specific feedback from patients on this area. However, our observations raised some concerns regarding learning culture at the service which are detailed in other evidence categories. The practice did not have adequate processes in place to collect and learn from service users’ feedback. We found there was no patient participation group (PPG) in place to gather feedback from service users. A link for the Friends and Family test (FFT) was sent to service users via text message after each appointment to gain feedback, however due technical difficulties the practice could only access service user feedback for June 2024 only.

At our last inspection in June 2023, staff said they did not receive learning from significant events, there were no staff meetings where these or learning from them was discussed. At this assessment in June 2024, staff said significant events were discussed in meetings and the practice shared incidents and learning with staff. Staff gave examples of improvements made as a result of significant event analysis. However, our observations raised some concerns regarding learning culture at the service which are detailed in other evidence categories.

At our last inspection in June 2023, it was difficult to tell how significant events had been dealt with and any learning taken from them. At this assessment in June 2024, we received a SIRMS report which detailed the significant event analysis from Sept 2023 to March 2024. Actions and outcomes were documented. However, due to a lack of a complete up-to-date record of meeting minutes being available, the practice could not evidence that important matters were being discussed with the team, such as lessons learned. We also saw that multiple items, including items in the emergency equipment, were out of date in spite of there having been an emergency at the practice in October 2023 in which an inhaler administered to a patient from the emergency medicines was out of date. This suggested that sufficient learning from that event had not occurred.

Patient feedback we reviewed was mixed. Two of the three cases we received from patients spoke about difficulties with care being linked up with pharmacies. However, in the GP national patient survey, 75% of patients said they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. The practice did not have adequate processes in place to collect and act upon service users’ feedback.

At the last inspection in June 2023, staff told us laboratory and pathology results were not actioned in a timely manner; however, we did not find any evidence of this at our inspection. At this assessment in June 2024, we were again told that laboratory and pathology results were not actioned in a timely manner. We saw in minutes that this had been raised in a practice meeting in October 2023. However, again we saw no evidence of backlogs on the practice’s computer system.

We consulted with stakeholders. They continued to express concerns over the practice generally and how it was run and operated.

At the last inspection in June 2023, there were concerns that systems to keep patients safe were not adequate. For example, systems to check that patients had their care reviewed in a timely manner. At this assessment in June 2024, we found those concerns remained.

We could not collect the evidence to score this evidence category. Our observations raised some concerns regarding safeguarding at the service.

At this assessment in June 2024 we saw there was an understanding of safeguarding and how to take appropriate action. Staff liaised with external organisations as necessary to keep patients safe. All staff we spoke with were able to identify and discuss safeguarding concerns and processes. However, our observations raised some concerns regarding safeguarding at the service.

At the last inspection in June 2023, we saw that the designated safeguarding lead nurse for the local Integrated Care Board (ICB) had carried out an audit of safeguarding at the practice in November 2022. There was an action plan in place for improvement. At this assessment in June 2024, partners reported that there was still room for improvement in the way in which the practice handled safeguarding.

At the last inspection in June 2023, we found that the provider was the safeguarding lead; their deputy was supposed to be the advanced nurse practitioner, however at the time of our inspection this post was vacant. The provider divided their time between this practice and their other practice and was therefore not always on site, meaning there was not always a safeguarding lead for staff to access in-person. At this assessment in June 2024, we found that the provider was still the safeguarding lead, but there was now a deputy in place too. However, there was not a complete set of minutes for the safeguarding meetings which took place, and therefore the practice could not evidence there was always an appropriate safeguarding lead in attendance. There were also gaps in training, with some staff not having completed the safeguarding training required for their role.

Data from the 2024 National GP patient survey showed that 94% of people that responded to the survey felt they had been involved as much as they wanted to be in decisions about their care and treatment. However, the practice did not have adequate processes in place to involve people in managing risk. We found there was no patient participation group (PPG) in place to gather feedback from service users. A link for the Friends and Family test (FFT) was sent to service users via text message after each appointment to gain feedback, however due technical difficulties the practice could only access service user feedback for June 2024 only.

Staff feedback was generally positive about how risk was managed. We were told that staff felt involved in and informed about decisions. However, our observations found concerns.

Our review of long-term condition records indicated that reviews were not always thorough or carried out on time, leading to some follow ups being missed. There were not sufficient processes in place to involve patients in decisions, for example there was no patient participation group and results from the practice’s Friends and Family Survey could only be provided for one month. There was not a comprehensive set of minutes of meetings which evidenced that people were regularly involved in managing risks.

Staff feedback about the environment was generally positive. However, our observations found concerns.

We saw there were numerous single use items that had passed their use by dates at Springwell House Surgery. The face masks expired in September 2022, the forceps expired in March 2024, the urine testing strips expired in May 2024, the stitch cutters expired in October 2021, the dressings expired in January 2024, and the swabs expired in April 2024. This placed service users at risk of harm as the manufacturers could not guarantee these items were safe for use beyond these dates. We saw carbon dioxide monitors and a sphygmomanometer that would be used during the provision of regulated activity had passed the date by which they should have been tested for electrical safety. This placed service users and members of staff at risk of harm. We saw a workforce first aid kit had passed its use by date. This placed employees at risk of harm as the manufacturers could not guarantee these items were safe for use beyond these dates. We saw a paediatric face mask had passed its use by date. This placed children who were service users at risk of harm as the manufacturers could not guarantee this item was safe for use beyond these dates. We saw there was a defibrillator on-site, but no adult defibrillator pads were available to be used with this. This placed adult service users at risk of harm in an emergency when the use of a defibrillator was required. We saw emergency medicines were not stored appropriately, as they were not easily accessible or easy to locate. Items were not stored together in one place. We saw Patient Group Directions (PGDs) used by registered staff to administer medicines were in place however, 2 PGDs (child diphtheria and pneumococcal) were out of date. Once expired, employees are not permitted to use a PGD without the need for a prescription.

We saw that systems and processes were not established and operated effectively to monitor the safety of environment. As such we found the issues detailed above. Fire drills had not been carried out at either site, and there was no sepsis strategy in place.

Patient feedback we viewed was positive about staff. Patients felt that staff were experienced and the right person to deliver their care. 93% had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment. However, our observations raised some concerns regarding staffing at the service.

At the last inspection in June 2023, we were concerned that there were not enough staff at the practice to provide adequate nursing appointments. At the time of our inspection there was one locum practice nurse working one and a half days per week. At this assessment in June 2024, we saw a new practice nurse had been appointed. All staff we spoke to gave positive feedback. They told us the last 12 months had been a challenge due to staff leaving, but they felt that new staff that had come in had adapted to their roles well. They said they felt they had a supportive team, an approachable manager, and that it was a good environment to work. They stated things had improved in some areas since the last inspection but that there was still room for further improvement. However, our observations raised some concerns regarding staffing at the service.

We found 4 members of staff did not have a Disclosure and Barring Service (DBS) check in place, one of whom worked in a clinical role. There was no risk assessment carried out to explain the rationale for not carrying out a DBS check. Following feedback to the practice, we saw that since the assessment in June 2024 the practice manager has carried out these checks. There was a lack of oversight to ensure mandatory training was kept up to date. The practice’s training matrix showed 1 GP had not completed any mandatory training, while another had completed only 8 of 20 mandatory modules. There were also 3 members of reception staff who had not completed all of their mandatory training. We have seen this has improved since the inspection but there are still some gaps. We saw there was no locum GP induction checklist. This placed service users at risk of harm as locum GP’s working in the service may not be familiar with or aware of local guidelines before providing care and treatment.

Cleanliness of the practice was not commented on by any patients in any forms of the feedback we saw. Patients had access to toilets on both sites. Drinking water was also available.

We saw that most staff had received training on infection prevention and control (IPC), although there were some gaps. Staff told us they were aware of their duties in terms of IPC and they knew who the infection control lead was.

At the last inspection in June 2023, we found that the premises at both surgeries were not safe for their intended use by patients. For example, at the entrance to Springwell House we found the path on the disabled entrance was overgrown with weeds and the paint on the handrail was flaking off. There were empty boxes piled at the front entrance to the practice and a broken pane of glass and a large pile of leaves. At the entrance to Harraton Surgery there were at least 14 bags of domestic rubbish on the ground in plastic bin liners. At this assessment in June 2024, we saw that work had been carried out to improve the cleanliness at both surgery sites. There were no longer empty boxes, domestic waste, or broken glass. Cosmetic improvements had been made to both sites and both surgeries were clean.

At the last inspection in June 2023, we were sent an infection control policy, a hand washing audit and a blank template for a nurse room cleaning schedule. We asked to be provided with the latest practice-initiated infection control audit, however this was not provided. The practice infection control policy included an example of a detailed infection control audit which the policy stated would be completed annually by the practice. At this inspection we saw infection control audits had been carried out at both sites.

Two of the 3 cases we received from patients spoke about difficulties with getting prescriptions, while only 1 of the 66 patients in the Friends and Family data we saw had concerns about medicines. However, our observations raised some concerns regarding medicines optimisation at the service.

Staff told us they had effective systems to manage and respond to safety alerts and medicine recalls. For example, they described how the primary care network pharmacist cascaded alerts to the team and the clinical staff to action. However, we saw there were lack of processes established to ensure long term conditions were monitored and treatment was not always monitored regularly or robustly.

We saw that systems and processes were not established and operated effectively to monitor the safety of environment. As such we found multiple single-use items which were out of date. The emergency trolley was kept in a room where cervical screening was carried out, meaning that patient privacy and dignity may be compromised in the event of needing to use the emergency equipment. A first aid kit and a paediatric oxygen mask had both past the dates by which their effectiveness could be guaranteed. There were no adult pads for the defibrillator. Two Patient Group Directions (PGDs) were out of date and therefore not suitable for use.

At the last inspection in June 2023, we saw that some patients had not been monitored correctly. There was also a significant number of patients who had a potential missed diagnosis of diabetes. At this assessment in June 2024, we found that some of these issues had improved. However, there remained a number of issues regarding monitoring of patients. For example, our search of the practice’s clinical system by a GP specialist advisor found that: Eight patients out of the 15 on methotrexate were overdue 12-weekly monitoring. For three of these, six-month monitoring was also overdue. The day of administration was also missing for four patients reviewed. One patient received a six-month supply, despite NHS England advice to issue no more than a three-month supply. This patient’s monitoring was overdue by two months. The practice was not always following up within 2 to 12 weeks of any HbA1c results above 47. This meant that patients at risk of diabetes were not being followed up and diagnoses could still be missed. SABA inhalers had been overprescribed for 19 patients. The search identified 2 female patients of childbearing age who had been prescribed Teratogenic drugs (medications which can cause birth defects) without an up-to-date annual risk acknowledgement form. Out of 3 patients reviewed on these medications, one did not have a documented adequate explanation for the need of robust contraception. Two out of the 3 patients we checked on the practice’s asthma register required an annual asthma review. Two patients who were taking anticoagulant medication were looked at, and both were found to have results which suggested their continuation on this medication should be reviewed, but this had been missed due to irregular monitoring. The results of our clinical searches suggested that processes in place for clinical monitoring of patients were inadequate.

Our monitoring showed that the practice was in line with national averages in terms of monitoring for breast and bowel cancer, and with childhood vaccination rates. However, they were below average in terms of numbers of patients screened for cervical cancer (69.3%. National target: 80%). We saw that monitoring of patients with some long-term conditions and certain types of medications needed to improve. The practice’s rate of antibiotic prescribing was also slightly above local and national averages.