Stanmore Medical Group

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 Although this process was embedded, our GP specialist advisor discussed enhancing the current ways of working to a strengthened approach, which the provider acknowledged and provided evidence of best practice implementation. 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 Stanmore Medical Group in May 2024, the views of the practice team were sought as part of the evidence category of staff feedback. There were 69 responses reviewed and the feedback was mostly 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. Almost all responses highlighted that the practice was very focussed upon patient care and providing the best service to meet their needs. Some non-clinical staff expressed some dissatisfaction with managers, saying they did not always feel supported, and that staff welfare required greater focus. However, other 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 345 complaints in the previous year. When we reviewed this as a percentage of the total number of patients registered, this equated to 0.69% and demonstrated the practice has a low number of complaints for the approximate 50,000 patients registered. We found that the practice monitored and reviewed safety using information from a variety of sources including significant events and complaints. 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 event 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.

Staff we interviewed told us the practice had implemented an Enhanced Support Service. Patients identified as frail, vulnerable and carers for others were given direct access to the practice and were overseen by a dedicated care coordinator, frailty team and social prescriber. We saw there were up to 5 frailty visits a day completed. Staff would review and plan the weekly visits every Tuesday and prioritise by tasks and monitoring. There was a team of 2 clinicians per visit and a special home visit equipment box was used and replenished after each visit. A formal frailty review was completed annually and each patient was assigned a dedicated care coordinator who they could contact for advice. Each enhanced service patient also had a social check completed and staff would ensure they had enough heating, food and support in place. If extra support was required, staff would then discuss with the social prescriber to arrange.

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. We also spoke to local Healthwatch who told us that the feedback from the practice had been mixed, with access being a challenge due to the use of the new online request form not being well received by patients. The provider had taken this feedback and made changes as required.

The practice worked with secondary care respiratory consultants who would see patients at the practice in order to minimise the waiting times for respiratory reviews. Bloods would be taken on a Monday, and 2 clinicians would see the patients on a Wednesday for an advanced clinical assessment. This one stop whole clinical assessment approach would rule out non related respiratory conditions, for example, cardiac before an appointment was given. The programme had been so successful, the local primary care network had adopted the framework. The provider was working with the local integrated care board on this project and told us they would like to eventually roll out to all of Hertfordshire.

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.

There were monthly multidisciplinary meetings with partner organisations to discuss patients who were requiring safeguarding. This meeting also included vulnerable and frailty patients who could require extra support.

All patients who were listed as at risk would have a flag placed on their patient records. Family members also had flags placed on their patient records in order for the practice to offer support to the whole family. All children who did not attend appointments would be followed up with a telephone call and letter. If a child had attended A&E or out of hours appointments, the provider would follow them up the following day. There was a designated safeguarding lead and administrator. Staff could raise concerns with ease and felt supported to do so. All staff training for safeguarding and chaperoning was in date. all staff had the required disclosure and barring checks required to perform their role.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We completed staff interviews as part of our assessment. We saw that there was an overall positive response to staffing levels and that staff did not feel overworked. The staff teams told us they felt like a family and worked well together as a team. Staff also told us examples of how they were supported to upskill themselves. For example, we saw staff who had began their careers as a reception team member and were now in a clinical role. The provider also welcome an opportunity to train others and at the time of our assessment, there was a student nurse on placement who told us they were enjoying their placement and had learned a lot. Leaders told us they learned as much from the student nurse as they learned from the practice. Staff morale was positive and described as a family ethos and enjoyable working envirnoment.

Leaders told us they had staff who had been employed for over 20 years. We saw there had been changes to staffing from upskilling staff and moving them into different roles. The leadership team told us that they felt this was important not only for staff retention and morale but also for forward succession planning. Staff wellbeing was a strong focus for development. Staff told us there was a structured system for annual leave to ensure patient appointments were not affected. An example of this was only 1 or 2 department members on annual leave at one time. Staff feedback was they would discuss annual leave as a department and agree leave requests between them before submitting for approval. Staff told us communicating annual leave in this way made them feel more of a team and they enjoyed this informal approach to ensure patient care was maintained to the highest standard. During our staff interviews, staff told us they felt really supported in developing themselves and leaders were extremely encouraging of skill enhancement. They would be placed on any course that would improve practice and staff felt valued and this had improved staffing retention.

The practice had a staffing model of 10 administrators, 7 care coordinators, 24 care navigators, 4 data processors, 10 emergency care practitioners, 3 finance administration staff, 11 managerial staff, 6 department managers, 5 medicine management staff, 22 nurses and 5 healthcare assistants,16 GP partners, 1 wellbeing and health coach, 1 mental health nurse, 1 prescribing supervisor and 9 prescribing clerks, 1 rota supervisor, 12 salaried GP's, 8 medical secretaries and 6 GP trainees. The practice offered offered 1000 appointments daily and would review on a daily basis based upon demand and capacity for appointments. Patient feedback was positive to appointments offered. Patients told us they did not have to wait long for appointments and there was always available appointments due to sufficient staffing levels. Staff received supervision and appraisals annually. Staff who prescribed medicines received formal clinical supervision monthly and could have informal supervision daily. Physician associates were debriefed with their supervisor after each appointment. Advanced care practitioners with extended roles such as diabetes and respiratory also received clinical supervision from their practice mentor and also from secondary care specialty mentors. Staff told us they found this process extremely beneficial as it allowed them to remain up to date with all current evidence based practice. The provider has policies for clinical supervision that were reviewed at least annually.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Feedback from the remote clinical searches was welcomed by the practice.

We observed the emergency medicines and fridges monitoring as part of our on site assessment and we saw well established monitoring processes in place. All emergency medicines were stored appropriately in boxes and within date, oxygen was stored safely and correct signage was in place. Each branch site had the same emergency drug trolley set up as staff worked across sites. There were regular checks in place for emergency medicine and equipment. We observed the fridges and they were stocked well, cleaned regularly, including the fridge seals. We also saw daily recording of temperatures. Regular audits were completed and all staff were up to date with training including infection prevention and control. The clinic room environments were clean, sharps bins were in date and not overfilled. Curtains in the clinical room were changed in line with current guidance and clinical room beds and chairs were all clean with no tears. We observed staff interacting with patients and they were treated with kindness and respect.

There were 461 patients out of 3324 who had a high HBA1C blood test result above 75 m/mol and there was appropriate monitoring in place for all these patients. We saw good monitoring by the pharmacy team for 14 patients prescribed Methotrexate ( a disease modifying anti-rheumatic drug). Patients prescribed a direct anti-coagulant medicine (DOAC), we saw 75 out of 1064 patients had not received monitoring in the past 6 months. We spot checked 5 patient records and saw 1 patient had just been commenced on this medicine and the remaining 4 patients had been contacted for blood tests. The provider was aware of these patients prior to our inspection and had recalled the patients for review. Overall there were no concerns noted for these patients.

Patients who were affected by safety alerts were monitored. The provider kept contact from secondary care annual risk assessments and contraception advice on a separate spreadsheet stored centrally. Our GP SpA identified during our remote clinical searches these patients should have their annual reviews and contraception advice stored within the patient records and discussed an improved process. The provider acknowledged this and had addressed these patients by the time we went on our on site inspection. An action plan of each patient was provided and overall there were no concerns noted. We saw 29 patients with a potential missed diagnosis of diabetes had been contacted for review with the practice.