High 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 looked for evidence that people were protected from abuse and avoidable harm. At our last assessment, we rated this key question as requires improvement. At this assessment it was rated good. Our clinical searches were mostly positive and showed good care and appropriate monitoring of people prescribed high-risk medicines. Systems had been improved to ensure all safety alerts were acted on to ensure medicines were prescribed safely. Systems for safe recruitment and health and safety had been embedded. Since our last assessment, some improvements had been made to the governance systems for timely medicines reviews, coding and the management of actions from correspondence, however these needed to be sustained.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

We received no specific feedback from people regarding their experiences for this quality statement. A representative from the Patient Participation Group (PPG) told us the practice leaders took concerns seriously and made improvements to the practice in response.

Staff told us they knew how to identify and report concerns, safety incidents and near misses. Staff told us they were able to raise concerns when things went wrong, and shared examples of improvements made following incidents and complaints. Staff confirmed they attended regular meetings where learning events were discussed.

There were processes for staff to report incidents, near misses and safety events. Managers encouraged staff to raise concerns when things went wrong. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. The practice investigated, identified learning, and made any improvements that were required. Learning from incidents and complaints was shared with staff at meetings and resulted in changes that improved care for others. We reviewed a sample of the minutes of various practice meetings.

The practice did not always work with established and safe systems of care and did not always make sure there was continuity of care, particularly when people moved between different services.

There were processes in place to act on correspondence received by the practice, which included scanning, but these were not always effective. During the site visit, there were 1759 items awaiting scanning. Urgent scanning was prioritised and managed within 24 hours and an IT issue and staff sickness had impacted on the backlog. A practice audit in December 2024, identified hospital discharge summaries were not always actioned or completed in a timely manner. These included changes to medicines, requests for a clinical review and repeat blood tests. Our clinical searches found there was not an effective system for coding and coding was not always used consistently. In response, leaders arranged for staff to work the weekend to address the scanning backlog.

There were systems to register new people at the practice and summarise their medical records. Summarising is the process of extracting an accurate medical history from the medical notes of a new registered patient. The practice had identified a backlog and had recently restructured staffing to increase capacity for this role. A system was in place to monitor the backlog.

Effective arrangements were in place to manage referrals. Staff were clear about their role. Documented audits were also completed every 6 months to check arrangements in place were being followed. There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. We did not receive any concerns from people or system partners about delayed referrals or safe systems of care. Care home representatives said referrals were managed well.

The practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The practice shared concerns quickly and appropriately.

People who provided feedback for this assessment had no specific views or concerns in this area.

Staff were aware of the practice and local safeguarding policies, knew who the practice safeguarding leads were, and how to report any concerns. All staff had completed training relevant to their role. Staff confirmed they attended regular meetings where safeguarding discussions took place. We reviewed meeting minutes of regular safeguarding multidisciplinary team meetings. Practice staff and external partners such as social workers and health visitors attended. Vulnerable people, which included unaccompanied asylum seekers, were discussed and reviewed and multiagency actions agreed and followed up on.

The practice had systems, practices and processes in place to keep people safe and safeguarded from abuse. These were clearly communicated to staff. The persons GP and the GP safeguarding lead had oversight of safeguarding concerns and staff acted on concerns appropriately. There were system alerts to identify vulnerable people on their medical records. Practice staff were working in partnership with other organisations to review historical safeguarding coding to ensure their records were up to date. Practice leaders were currently reviewing their safeguarding processes to further improve these.

There were effective arrangements for supporting people to identify, mitigate and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People who provided feedback for this assessment had no specific views or concerns in this area. Care home representatives told us practice clinicians involved people, their carers and family, as appropriate, to ensure care and treatment met individuals’ needs and preferences. Staff told us they knew how to recognise people whose health was deteriorating and gave examples of when they had supported people who were distressed.

The practice had guidance for staff to identify people with immediate life-threatening conditions and people whose health was deteriorating. This included immediate advice to give people and how to escalate risk to an appropriate clinician. The practice had a duty GP every day who was available for advice and support as necessary. All staff had completed sepsis awareness training and basic life support and anaphylaxis training relevant to their role. Emergency equipment and medicines were available and checked regularly to ensure they were in date. The practice had completed a significant event analysis which related to managing an emergency situation. An action plan had been completed following this event.

Improvements had been made and the practice detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

All staff we received feedback from had suitable and sufficient equipment to undertake their role and were satisfied with the health and safety arrangements in place.

During the site visit, we observed fire exits were clear and fire safety equipment easily available and checked by an external company. People in the waiting room were easily visible to staff so they could identify and respond to any people whose health may be deteriorating. We noted an action identified in the wheelchair safety inspection record had been completed.

Arrangements were in place to ensure the premises were maintained. Legionella, health and safety and fire risk assessments had been completed. Most recommendations had been acted on, and where recommendations had not been completed this was documented and monitored. Checks of electrical safety and equipment calibration were also completed. There was a business continuity plan in place which was monitored and reviewed.

The practice used technology securely and effectively and conformed to relevant digital and information security standards with arrangements in place for the confidentiality of data management.

There were enough qualified and skilled staff, who received effective support, supervision and development.

Feedback from people and care home representatives was positive regarding the knowledge, skill and competency of clinical staff.

Staff told us whilst there had been a turnover of staff over the last 2 years which had impacted productivity, staffing was now more stable. Some staff were quite new in post and had received training and support but needed time to fully embed their roles. There were plans to recruit another GP and a prescribing paramedic had recently been appointed.

Improvements had been made for safer recruitment. All staff had a Disclosure and Barring (DBS) check, and 1 staff member had a risk assessment in place whilst an updated DBS check was obtained. The professional registration of clinical staff was checked at recruitment and on a regular basis.

All staff received an induction, adapted to their role. Arrangements were in place for the oversight of the completion of mandatory training which all staff had completed. The learning needs and development of staff was managed appropriately, and staff worked within their agreed areas of competence. Staff responsible for specific clinical interventions, for example reviews of people with long-term conditions, cervical screening, and childhood immunisation, told us they received specific training. There was documented oversight of non-clinical and clinical staff working in extended roles, which included for example, consultation and prescribing reviews, and call audits. There was a regular review of their practice supported by clinical supervision or peer review, audits, and protected time for case review. Practice leaders recognised oversight of this work was not consistently documented so acted and set up a form to improve their documentation. Managers met with staff regularly to complete appraisals and performance reviews.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Feedback we received from people was positive in respect of the cleanliness of the environment. Staff told us they had no concerns regarding infection, prevention and control (IPC) and told us about the effective systems in place for dealing with specimens and spilt bodily fluids.

During our on-site visit, we observed the practice to be clean and tidy. Cleaning schedules were in place and arrangements to effectively resolve any issues with the external cleaning company. We found actions identified from an internal IPC audit had been completed. An external IPC audit completed in February 2025 had an overall score of 96% compliance. The IPC lead told us the findings would be reviewed and an action plan agreed.

Policies and guidance was available for staff and all staff had completed training relevant to their role. The practice had a designated IPC lead who had protected time to undertake their role. There was oversight of the vaccination status of staff and risk assessments had been completed where appropriate.

The practice did not always make sure that medicines and treatments were safe and met people’s needs. We had positive feedback regarding medicines reviews and some negative feedback regarding repeat prescriptions.

Although improvements had been made to safety alert management and linking medicines to a diagnosis, our clinical searches showed the practice did not evidence that all people had a structured, comprehensive medicines review. The coding information used on the system was misleading and used inconsistently and resulted in people’s medicines not all being reviewed. 13 out of 322 people prescribed over 10 medicines had no medication review in the last 18 months. Of 5 people sampled, 1 had received a review. By the site visit date, 4 other people had been reviewed. 123 people were prescribed gabapentinoids had not been reviewed in the last 12 months. We sampled 5 people and at the site visit found action had been taken to review these people. The practice prescribing data for pregabalin or gabapentin was above the England average. The practice submitted a plan in response with some actions already completed.

However, there was an effective process for monitoring people’s health in relation to the use of medicines that require monitoring for example, methotrexate and azathioprine. Our clinical searches found appropriate monitoring and clinical review prior to prescribing the medicines for all people taking these medicines.

The provider did not have an effective system for the secure management and control of prescription stationery. Following the site visit, the provider submitted some assurance, however we were not fully assured their new process would ensure the security of all prescription stationery. We found medicines were stored securely. The stock and expiry dates of all medicines were regularly checked and stored safely. Controlled drugs were held on site; the provider said they would no longer hold controlled drugs and had arranged to destroy them.