Cleveland Clinic London Hospital

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

The service managed patient safety incidents well as part of an integrated safety and governance structure. Staff recognised and reported incidents and shared outcomes across clinical specialties. While the GP team provided a clearly defined service, risk management and the learning culture were shared as part of an integrated approach across clinical services. GP leaders investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Staff had the required levels of training to safeguard vulnerable adults and knew what actions to take to keep people safe from avoidable harm and abuse. Systems and pathways maintained safe systems of care in which patient safety was prioritised and risk reduction assured. There was continuity of care when people moved between different specialties and other providers. The design, maintenance and use of facilities, premises, and equipment kept people safe. The service had enough staff with the right skills, training and experience who received effective support, supervision, and development. Staff worked together effectively to provide safe care that met people’s individual needs. The service controlled infection risk well. They kept equipment and the premises visibly clean. Staff used systems and processes to safely prescribe, administer, record and store medicines according to national evidence-based practice.

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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. During team and multidisciplinary meetings, staff discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority.

The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

There was a well-developed learning culture embedded in all aspects of the service. The culture and leadership of the provider was clinically led and promoted joint working between departments. The patient safety lead for primary care worked closely with their counterpart in outpatient centres to investigate incidents and communicate findings with staff through governance meetings and training.

The patient safety and experience team worked across clinical specialties and departments, across all 3 London locations, to coordinate learning from incidents or near misses. Staff discussed errors and omissions in a culture that valued honesty and openness to drive improvement. This meant staff had an understanding of learning from services unrelated to their own, which they used to avoid risk and near misses in their own department.

In the 6 months prior to our visit, GPs reported 7 patient safety incidents and 15 non-clinical incidents across all 3 London locations. None of the incidents resulted in patient harm and staff investigated each to identify learning and to ensure staff had followed expected standards and procedures. For example, 2 incidents related to patients fainting and staff found the team had followed standard operating procedures to keep patients safe. Non-clinical incidents related to IT issues and some administrative errors, all of which the team reviewed and shared broadly using the provider’s digital system. All GPs worked across all 3 sites and the provider monitored incidents as a service not per location.

Staff used an electronic system, shared with all departments, to report incidents and track investigations. The system was integrated with governance systems and gave the provider continuous oversight of safety.

The GP service was based in outpatients and operated seamlessly with other clinical specialities and services, such as diagnostic imaging. GPs worked with consultants from each medical specialty when referring patients for more advanced treatment.

Nurses supported GPs with minor operations and used a safety checklist, based on World Health Organisation (WHO) standards.

The provider had implemented the patient safety incident response framework (PSIRF) tool. The tool is part of an NHS England patient safety process, which the patient safety team and clinical educators had adapted to the GP and outpatient setting. Some GPs also worked in NHS services and shared learning from the implementation of PSIRF across their different practice settings to benefit the wider team.

The team used the electronic patient records system to audit and monitor safe systems and pathways. They used ‘closed encounter’ checks and documentation reviews to meet the needs of repeat patients, such as those with comorbidities or multiple needs. In 2024 the service added a ‘safety netting addendum’ to patients’ records, which included checks of mental health and social needs. Staff designed this to identify underlying health and support needs.

The GP service at this location did not provide paediatric services. However, GPs offered these services from another of the provider’s hospitals and were trained in children and young people safeguarding. If an adult presented at the clinic with a child patient, GPs arranged for them to be seen on the same day elsewhere.

GPs used a buddy system to monitor test results and communications received while they were away. This meant a doctor always acted on patient needs when the requesting GP was unavailable.

GPs had a good understanding of safeguarding incidents, including those in other departments or hospitals in the provider’s network. This formed part of the learning culture and meant the team remained aware of themes and significant events if these were uncommon in the primary care service. The team had recently identified learning from a safeguarding alert made by a GP who was concerned about potential financial coercion.

Safeguarding training included specific cultural information to support the care of international patients. GPs and nurses were trained to recognise and act on evidence of female genital mutilation (FGM) and to identify the risk of radicalisation. All staff completed safeguarding training to level 3, including for children and young people.

GPs adapted safeguarding training and professional development to the needs of patients. For example, the team noted an increase in drug-seeking behaviour and established protocols to reduce immediate harm and refer patients to an appropriate support service.

Some GPs also worked in NHS services and worked with the provider to integrate the NHS national safeguards as part of an approach to best practice. The team had access to NHS updates, which helped them stay up to date on the latest practice.

GPs made 2 safeguarding referrals in the previous 12 months to address immediate concerns about patient welfare. Both cases involved complex needs, and the team worked with the safeguarding lead and the local authority safeguarding team to keep the patients safe. Of the cases, 1 was initiated at this site and 1 at the provider’s Moorgate location. However, as patients were seen across sites, and all staff worked across sites, staff managed the incidents at provider level.

The safeguarding committee carried out spot checks on safeguarding standards and documentation as part of an assurance process.

The safeguarding lead maintained links with the local authority safeguarding team and helped GPs to liaise with safeguarding teams outside of the local area when they had concerns about the safety of patients who travelled for appointments. Where staff had concerns about international patients, they liaised with key contacts in the relevant embassy or with the provider’s international safeguarding team.

Staff worked with people to understand and manage risks by thinking holistically so that care met their needs in a way that was safe and supportive and enabled them to do the things that matter to them. For example, patients seeking corporate wellness checks often experienced the health impact of stress. GPs worked with them to identify lifestyle adjustments that could help lower blood pressure and establish better health behaviours.

The service had established risk management systems in place. Multidisciplinary by design, the clinically led systems were based on information sharing across the provider so that staff could learn from risks, near misses, and incidents in other departments. The duty GP met with outpatients’ nurses and healthcare assistants before the start of service to discuss the treatments booked for the day as well as any capacity or staffing issues, and pressures on the service. Colleagues from the provider’s 3 London locations joined the meeting, which helped to solve problems collaboratively and promoted clear understanding of risk.

GPs worked in the outpatient setting and had access to advanced life support equipment and a resuscitation team. All GPs were trained in immediate life support (ILS) and had access to advanced life support (ALS) training as part of professional development. These were higher levels of training than necessary given the services provided and ensured the team could provide life-saving support to patients. Nurses supporting GPs were trained in ILS.

Minor operations in the GP service included suture removal and lacerations. GPs made sure patients understood the potential risk of each procedure beforehand and provided aftercare information. Patients used the provider’s digital platform to contact GPs with questions about recovery. The platform enabled patients to share photos of surgical sites to help GPs identify any post-treatment issues.

GP treatment spaces were compliant with national standards, including the Department of Health and Social Care health building notices in relation to infection control in the built environment and flooring in healthcare environments. The provider managed maintenance and a medical engineering team provided support in the event of equipment failure.

Staff maintained equipment to keep people safe and respond to incidents in the department. This included a resuscitation trolley equipped with airway management equipment, oxygen, and a defibrillator. Biohazard spill kits were available to reduce the risk of contamination. This equipment was shared with the outpatient department and GPs knew how to access them.

The health, safety, and fire manager led audits and compliance activities to ensure the service met the requirements of the Control of Substances Hazardous to Health (COSHH) Regulations. The department held an inventory of substances subject to COSHH and the health and safety team trained champions to carry out monthly audits. The health and safety team monitored results through a dashboard and were in the process of adopting a risk-based approach that would set the frequency of safety checks on each substance based on its individual level of risk. These processes took place at provider level and GPs knew how to escalate any concerns or problems locally.

Fire safety and security were managed at a building level and at departmental level by staff working there daily. All staff completed fire safety training, including practical evacuation training to support people using manual evacuation aids. All GPs were trained to the same standard regardless of their contract type or how often they worked for the service. This provided patients with assurance of consistent standards of safety.

The provider employed 9 GPs, 4 on a permanent basis and 5 from the NHS providers list through an arrangement with NHS England. Patients benefited from this arrangement as it meant the clinical team had experience in private practice and were up to date with the latest NHS guidance for primary care.

Permanent GPs completed statutory and mandatory training with the provider. GPs working with the NHS completed their training with their home practice and the provider maintained assurance of completion rates. The service checked this annually with the GP’s statutory body at the same time as an appraisal check. The provider had a mitigation plan in place for delayed data provided by NHS services to ensure GPs could continue practising safely.

The provider had processes in place to act on non-compliance with required training and competency assurance. The head of primary care services worked with the medical executive committee to make decisions regarding suspension or withdrawal of privileges. While this was a good safety mechanism, it had not yet been needed, and GPs consistently maintained compliance with the provider’s training and appraisal requirements.

Permanent GPs participated in an annual professional review, which was similar to the NHS appraisal and job planning system but adapted to this service. At the time of our inspection 100% of GPs were up to date.

Nurses worked across multidisciplinary clinics and specialties and had access to training to develop their competencies. For example, GPs supported nurses to build their skills in minor operations such as to support suture removal.

We observed effective infection prevention and control (IPC) and hazardous waste and sharps management. A dedicated housekeeping team maintained cleanliness and good hygiene in the environment. GPs and nurses used antibacterial procedures on equipment between patients and labelled them when they were safe for use. Good hand hygiene practices were embedded in practice and staff undertook regular training and auditing. In the previous 12 months staff averaged 96% compliance in hand hygiene standards against a target of 95%. This was an overall result across all 3 sites. Each site met or exceeded the provider’s target.

All GPs and staff supporting them completed IPC training, including evidence-based practice, to level 2. At the time of our inspection all GPs were up to date. A microbiologist and IPC nurse were on duty in the hospital during all times the GP service operated.

In the most recent cleaning inspection in line with the NHS England National Standards of Healthcare Cleanliness, the department scored 93% across all sites. This was a joint inspection with the outpatient team and reflected broadly good standards of practice. Staff used a comprehensive schedule to manage daily, weekly, and monthly cleaning as well as periodic deep cleans. Staff monitored performance through a programme of audits, which included checks of the environment and staff practices.

The provider managed Legionella at hospital level and standards met national requirements.

The IPC committee provided continuous oversight, monitoring, and guidance of standards of practice. The IPC team used an automated surveillance system that tracked any organisms of concern identified in any area of the hospital. This was good practice because it meant the service responded immediately to risk before infectious organisms could spread. Standards of practice were reflected at provider level, which meant patient had assurance of high standards of practice when they moved between services. For example, the environment services team had been awarded gold in the national CAP (continuous achievement programme), recognising outstanding performance in cleaning and hygiene.

The service made sure medicines and treatments were safe and met people’s needs by enabling them to be involved in planning.

The pharmacy team were responsible for the ordering and overall management of medicines in the department. They had established an electronic system that incorporated stock control, temperature monitoring, and secure access to authorised staff. The system dispensed medicine only on recognition of the GP’s fingerprint and use of the patient’s individual unique ID number. The automated system monitored and recorded storage temperature and alerted the pharmacy team if a fault resulted in a temperature rise beyond the safe limits recommended by medicine manufacturers

GPs followed appropriate safety measures to prescribe Controlled Drugs (CDs). They used a colour-coded prescription pad, with individually numbered and tracked sheets, to write prescriptions. These were checked by a consultant as part of an additional safety system that met national standards. The team undertook quarterly CD update training. In the previous 12 months the team maintained a 100% completion rate.

Nurses could administer some medicines, such as flu immunisations, using patient group directions (PGDs). PGDs enable trained, non-prescribing staff to administer specific medicines to defined groups of patients without doctor approval. GPs managed medicines for patients outside of these conditions.

GP services reported no medicine errors or incidents in the previous 12 months. Staff maintained learning from the most recent incident, in late 2023, in which an adult was administered a paediatric vaccine at another location in the provider’s network. The patient experienced no harm or immune deficiency as a result, and the team implemented improvements in the electronic dispensing system as a result.

GPs undertook regular continuing professional development in medicines management and medical records. Recently this included monitoring antimicrobial side effects and prescribing for elderly patients with renal failure.