What is the Quality of Safety at Wells Park Practice

Positive

"The registered person had systems or processes in place that operating ineffectively in that they failed to enable the registered person to assess monitor and mitigate the risks relating to the health safety and welfare of service users and others who may be at risk."

Positive

"Track record on safety The practice did not have a good track record on safety."

Positive

"• There was evidence that the practice took action to improve safety in the practice when significant events were assessed using the practice process."

Positive

"Risks to patients There were systems to assess monitor and manage risks to patient safety but they were not consistently implemented."

Positive

"• There was a strong emphasis on the safety and wellbeing of all staff."

Positive

"Managing risks issues and performance • Processes to identify understand monitor and address risks including risks to patient safety were not consistently effective."

Positive

"• The practice acted on and learned from external safety events as well as patient and medicine safety alerts."

Positive

"Practice leaders had oversight of safety alerts incidents and complaints."

Positive

"• There were risk assessments in relation to safety issues but they had not been used to address all risks effectively and in a timely way."

Neutral

"There were insufficient quantities of medicines to ensure the safety of service users and to meet their needs."

Positive

"The practice had a variety of other risk assessments in place to monitor safety of the premises such as control of substances hazardous to health and infection control and legionella Legionella is a term for a particular bacterium which can contaminate water systems in buildings."

Positive

"The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken."

Positive

"Our key findings across all the areas we inspected were as follows: • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events."

Positive

"• Lessons were shared to make sure action was taken to improve safety in the practice."

Positive

"Safety incidents were discussed at practice meetings with all staff involved in discussing what happened and actions to improve safety in the practice."

Positive

"When there were unintended or unexpected safety incidents patients received reasonable support truthful information a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again."

Positive

"• When there were unintended or unexpected safety incidents patients received reasonable support truthful information a verbal and written apology."

Positive

"We reviewed safety records incident reports national patient safety alerts and minutes of meetings where these were discussed."

Positive

"The practice had systems in place for knowing about notifiable safety incidents When there were unexpected or unintended safety incidents: • The practice gave affected people reasonable support truthful information and a verbal and written apology."

Positive

"There was a health and safety policy."

Neutral

"It covered such topics as safeguarding infection prevention and control fire safety health and safety and confidentiality."

Positive

"Kindness respect and compassion Staff treated patients with kindness respect and compassion."

Positive

"• Staff treated patients with kindness respect and compassion."

Positive

"• The practices GP patient survey results were generally in line with local and national averages for questions relating to kindness respect and compassion."

Positive

"Privacy and dignity The practice respected patients’ privacy and dignity."

Positive

"• Staff recognised the importance of people’s dignity and respect."

Positive

"• Staff took steps including working with other agencies to protect patients from abuse neglect harassment discrimination and breaches of their dignity and respect."

Positive

"• Arrangements to ensure that staff had received were up to date as to their roles and accountabilities including in respect of safeguarding and infection prevention and control were not effective."

Positive

"Most were positive about the standard of care received and said that staff were helpful caring and treated them with dignity and respect."

Positive

"• Patients said they were treated with compassion dignity and respect and they were involved in their care and decisions about their treatment."

Positive

"• Patients said they were treated with compassion dignity and respect and they were involved in decisions about their care and treatment."

Positive

"They also told us they were satisfied with the care provided by the practice and said their dignity and privacy was respected."

Positive

"Results from the national GP patient survey showed patients felt they were treated with compassion dignity and respect."

Positive

"Nine cards contained mixed feedback positive about most aspects of care received but were negative about telephone access and appointment availability reception staff or individual experiences with doctors not showing dignity and respect."

Positive

"• We saw staff treated patients with kindness and respect and maintained patient and information confidentiality."

Positive

"• Curtains were provided in consulting rooms to maintain patients’ privacy and dignity during examinations investigations and treatments."

Positive

"• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care."

Positive

"Governance arrangements • Structures processes and systems to support good governance and management were not consistently effective."

Positive

"Governance arrangements The practice had a clear and well documented governance framework which supported the delivery of the strategy and good quality care."

Positive

"• There was an overarching governance framework which supported the delivery of the strategy and good quality care."

Neutral

"The practice had a number of policies and procedures to govern activity and held regular governance meetings."

Neutral

"• Staff received training that included: safeguarding fire procedures basic life support and information governance awareness."

Positive

"Monitoring care and treatment The practice carried out quality improvement activity but this did not always ensure that the effectiveness and appropriateness of the care provided improved."

Positive

"• Clinical audit had had some positive impact on quality of care and outcomes for patients but had not demonstrated improvement such that care in the areas reviewed were consistently good."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"The practice told us that they audited a sample of care plans and created a written process for the management of care plans to ensure uniformity in the quality of care plans produced and to ensure they fully met patients’ needs."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"Privacy and dignity The practice respected patients’ privacy and dignity."

Positive

"They also told us they were satisfied with the care provided by the practice and said their dignity and privacy was respected."

Positive

"• Curtains were provided in consulting rooms to maintain patients’ privacy and dignity during examinations investigations and treatments."

Positive

"• Staff took steps including working with other agencies to protect patients from abuse neglect harassment discrimination and breaches of their dignity and respect."

Positive

"• According to information held by the practice nearly half of all staff had not done recent training in safeguarding children from abuse and most had not done recent training in safeguarding adults."

Positive

"Safety systems and processes The practice systems to keep people safe and safeguarded from abuse were not consistently implemented."

Positive

"• Staff knew how to recognise signs of abuse in vulnerable adults and children."

Neutral

"It did not address staff immunity and according to the practice training matrix most staff members had not completed recent infection control training."

Positive

"The practice had a variety of other risk assessments in place to monitor safety of the premises such as control of substances hazardous to health and infection control and legionella Legionella is a term for a particular bacterium which can contaminate water systems in buildings."

Positive

"The nurse specialist was the infection control clinical lead who liaised with the local infection prevention teams to keep up to date with best practice."

Neutral

"There was an infection control protocol in place and staff had received up to date training."

Positive

"• The practice actively promoted equality and diversity."

Neutral

"Staff had received equality and diversity training."

Positive

"• Information about how to make a complaint or raise concerns was available."

Positive

"• The complaint policy and procedures were in line with recognised guidance."