High Green Medical Practice

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 all quality statements from this key question. Our rating for this key question is good. We found safety was a priority, and staff took all concerns seriously. When things went wrong, staff acted to ensure people remained safe. Managers investigated all reported incidents to reduce the likelihood of them happening again and shared the outcomes of the investigations with staff. There were safe recruitment practices with a learning and development programme in place to support staff. Staff supported people to live healthy lives and provided them with support and information on their care and treatment. Infection prevention control was monitored, and actions taken to keep people safe. Medicines were regularly reviewed by specialist clinical pharmacists to ensure people remained safe.

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.

We reviewed some complaints received by the practice in the last 12 months. We saw evidence that lessons learned were embedded within systems and procedures to promote safe practices. They shared these changes with patients though a You said, We Did board which was displayed within the practice and on their website.

Staff we spoke with told us they attended regular meetings where significant events were discussed, and they were also communicated through regular staff newsletters. For example, there were delays in sending death certificates over the Christmas period. In response to this, clinicians developed a flow chart for all deaths to ensure administrative staff knew what information was required by medical examiners and also track records which were in the process. No delays were observed since this was implemented. We saw evidence of this in meeting minutes.

There was a system to record and investigate complaints, and when things when wrong, staff apologised and gave people supports. Policies in place included significant events management and reporting of serious events. Learning from incidents and complaints resulted in changes that improved care for others.

Results from the national GP survey (unverified by CQC) showed 59% of the respondents said they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses, compared to the local and national average of 68%.

Leaders told us they utilised the Community Pharmacy Consultation Service (CPCS) to refer patients for a consultation with a community pharmacy to combat the pressure and burden on general practices. People could be seen at the pharmacy for minor illnesses/ low acuity conditions which included urinary tract infections, shingles, infected impetigo, infected eczema, infected insect bites, otitis media, sore throat, and sinusitis. Staff we spoke with told us referrals from the practice were recorded and monitored by the medical secretary team to ensure that the referral is accepted and converts to an appointment or advice and guidance for the patient.

We did not gain feedback from system partners regarding this topic area during our assessment.

There were processes in place for managing referrals to other services where appropriate, including shared care agreements for people who are managed in collaboration with external healthcare professionals. The practice followed a federation-wide safety alerts policy which ensured consistency in how practices responded to safety information. This was accessible through a shared platform, ensuring all practices within the federation had up to date information. This demonstrated how they coordinated with partners to maintain safe systems.

We did not gain any feedback from patients on safeguarding during our assessment. We reviewed examples of safeguarding concerns recorded by the practice. This showed people's clinician acted in the person’s best interest to keep them safe.

Managers told us all staff had received the appropriate level of safeguarding training for their role. This was corroborated by staff we spoke with and training records reviewed during the assessment. Most staff knew who the leads were within the practice, and also told us safeguarding concerns were discussed regularly at meetings. However, some staff told us they were unsure how to raise a safeguarding concern and one member of staff was unsure who the leads were.

Information supplied by the practice from the local Integrated Commissioning Board (ICB) indicated the practice was signed up to additional safeguarding support offered by their leads to general practices in the area.

Policies in place to keep people safe included safeguarding, chaperone, mental capacity and domestic violence. We saw evidence that the practice regularly held safeguarding meetings with both practice staff and external healthcare professionals such as health visitors. All staff had received chaperone training, ensuring that people's dignity and respect were maintained.

Results from the national GP survey (unverified by CQC) showed 82% of the respondents said the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment, compared to a local average of 86% and national average of 87%. 73% of respondents knew what the next step would be after contacting their GP practice, compared to a local and national average of 83%. The practice obtained patients views by conducting their own survey in March 2024 on getting appointments, contacting the practice, and how satisfied they were when they had contact with a GP. Their results showed patient satisfaction had improved and people's feedback was used to design how care was delivered to people.

Staff we spoke with were aware of where the emergency equipment and medicines were kept. They were aware of procedures to follow in the event of a fire to keep patients safe.

We found that appropriate emergency equipment and medicines were kept at the practice and systems for checking emergency equipment and the expiry dates of medicines were effective. The practice had a medical emergency policy and a comprehensive business continuity plan which covered most aspects of risk including fire, flood, loss of computer and telephone and staff shortages. During our assessment we saw minutes from multidisciplinary meetings held with external health care professionals to review people’s health and social care and ongoing or emerging risks. These included specialist nurses in palliative care and community nurses. The clinical team meet weekly to discuss clinical risk, safeguarding, palliative care patients, recent deaths and causes and if the death was expected.

Staff informed us that they had all completed their mandatory training, including fire prevention and health and safety training which was corroborated when we reviewed staff training records.

High Green Medical Practice resides within the Mary Potter Centre and the centre management maintain the cleanliness and maintenance of the building, including mandatory health and safety risk assessments, including legionella, fire risk assessment. During our on site assessment we observed the areas occupied by the practice to be clean and well maintained. The practice was accessible for all patients and included space for wheelchairs and prams. We observed that blinds were prohibiting reception staff from being able to see patients within the waiting room, and therefore, were unable to see if a patient became unwell. We explained our concern to the reception manager who immediately addressed this.

The practice had effective systems to monitor and comply with mandatory risk assessments, including fire safety and legionella testing to ensure that people and staff are safe. They used an external Health and Safety Specialist to audit and monitor safety and compliance with the law. Records kept within the practice showed medical equipment was maintained, calibrated and tested regularly. The practice had a lone working policy to safeguard employees.

We spoke with three people during our onsite assessment. They told us that whilst access to appointments had improved, they did not always get an appointment with a GP and that they were sometimes offered an appointment with an alternative health care professional.

Staff told us there were usually adequate staff numbers. Whilst some staff said there was not enough reception staff, they told us there were flexible working arrangements and they could work additional hours to cover sickness and holidays. The practice also utilised locum GPs and nurses to cover absences.

We reviewed the records of three members of staff recruited by the practice. We found that systems were in place to ensure that all of the required recruitment information was in place. This included satisfactory written explanations of gaps in employment and an assessment of any physical or mental health conditions that were relevant to a person’s ability to work. The practice had processes in place to monitor staff training and renewal dates and all newly appointed staff received a comprehensive induction plan. Medical students, resident doctors and non-medical healthcare professionals participated in weekly clinical meetings. Systems were in place to provide assurance that staff recruited by the Primary Care Network and working within the practice were recruited and supervised appropriately. Staff had completed training in line with the practice’s learning requirements and when updates were due, there was a system in place to inform staff.

People we spoke with told us that they thought the practice was clean and tidy, and they did not have any concerns relating to Infection Prevention and Control (IPC).

Leaders told us the centre management completed IPC audits every two years, whilst the practice nurse also completed an IPC audit at practice level which was regularly reviewed.

We saw the practice was clean and tidy during our onsite assessment. However, we saw a clinical couch was torn, posing potential risks to infection. The practice informed us that a replacement couch had been ordered.

The practice has effective systems to manage Infection Prevention and Control (IPC) requirements and the IPC lead has dedicated time to review these systems and processes. Policies covered prevention of clostridioides difficile (known as Cdiff), MRSA, respiratory illness, gastroenteritis (norovirus) and use of personal protective equipment (PPE).

We did not receive any feedback from patients relating to this topic area during our assessment.

The practice employed two pharmacists through their Primary Care Network (PCN), who told us that they conducted medication reviews, processed prescriptions and reviewed polypharmacy in care homes and in the community. They also collected patient feedback on their services through surveys.

We carried out remote clinical searches as part of our assessment. We found that guidance in Medicines and Healthcare products Regulatory Agency (MHRA) alerts was acted on. For example, MHRA alerts for medicines that could cause birth defects if taken during pregnancy had been followed. Blank prescriptions were stored safely; access was controlled and prescription stationery was audited. All medicines we checked were in date, including emergency medicines and vaccinations. The practice did not store controlled drugs. Staff showed us how they disposed of expired or unwanted medicines that patients had returned. We saw that staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). We observed staff interacting and helping people who attended the practice for appointments, with queries, or to request or collect prescriptions.

We reviewed the prescribing of two or more courses of steroids for patients with asthma who had been prescribed within the last 12 months. Whilst we found no harm to patients, the practice was unaware of those who had been prescribed steroids in out of hours services and told us they would review this area. There were protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicine reviews and monitoring. Medicines safety alerts were processed by pharmacists. There was a programme of regular clinical auditing of prescribing that focused on improving care and treatment.

National prescribing data showed that the practice's prescribing rates of antibiotics and pain killers were positively lower than national averages. The practice was below the local and national average in the prescribing of medicines that promote sleep which demonstrated they were proactive in monitoring the prescribing of these medicines to keep patients safe.