Jubilee Street 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 looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 84 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

People felt supported to raise concerns, with QR codes displayed on all clinical rooms, the admin office, and staff room doors, linking to an app that provided a significant event reporting process map and an electronic submission form. Submitted events were automatically shared with relevant leads and discussed within seven days of occurrence. This accessible process made it easy for staff to report concerns promptly and actively encouraged a transparent, no-blame learning environment focused on continuous improvement.

Representatives from the Patient Participation Group (PPG) told us they felt the provider took concerns seriously and proactively made improvements to the service, and provided examples of this. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and provided appropriate support. Learning from incidents and complaints resulted in changes that improved care for others, with the patient participation group (PPG) involved in reviewing and signing off resulting actions to ensure, from a patient perspective, that these would deliver the intended improvements.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way.

The service regularly engaged in multi-disciplinary meetings to review and plan care for patients with complex conditions or those nearing the end of life. This included discussions with their Primary Care Network, and the wider community care teams.

The service 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 service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures, safeguarding was a standard agenda item on all practice meetings.

The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations, this included regular multidisciplinary meetings where individual cases were discussed and action plans put in place.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of appropriate action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. The duty doctor was based in the reception area, meaning they were immediately on hand to deal with any emergencies there and to support reception staff with urgent telephone calls.

The service detected and controlled potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

Contracts were in place to ensure the premises were well maintained. Health and safety risk assessments and audits had been undertaken, and identified risks were addressed through an overarching action plan covering all aspects of building safety, including but not limited to health and safety and fire safety. The action plan was electronically managed and provided ongoing automated reminders of outstanding actions and required completion dates.

There was a business continuity plan in place which was monitored and reviewed as well as available to all staff in the teams WhatsApp group.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

There was a comprehensive range of clinical and non-clinical roles within the practice. We saw clear evidence of staff progressing within their roles and being successfully promoted within the service. This included administrative staff who had developed into management and director-level positions. Non-clinical staff were actively encouraged and supported, through structured training and development opportunities, to transition into clinical roles where appropriate.

Staff training was up to date, learning needs and professional development were proactively managed, and staff consistently worked within their agreed scope of competence. In addition, a dedicated training budget was available, enabling staff to apply for courses to pursue personal interests such as swimming, photography, tennis and painting, even where these were not directly related to their role, further supporting staff wellbeing and retention.

Safe recruitment practices were followed, with staff files regularly maintained and kept up to date, and all staff receiving regular appraisals.

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

The practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

Medicines were stored securely and at appropriate temperatures.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Our review of patient records showed that people taking medicines with specific risks were appropriately monitored before their medicines were prescribed. Regular medicine reviews, including for high-risk drugs, were carried out for patients to ensure their medicines were safe and appropriate to their needs.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. For example, the practice’s antibiotic audit demonstrated a sustained reduction in inappropriate prescribing, with broad-spectrum anitobiotics use falling from 8.27% to 7.88% and all targeted antibiotics, including flucloxacillin and phenoxymethylpenicillin, meeting the recommended 5-day course by September 2025. These improvements were achieved through clinician education, decision-support tools, patient information, and monthly monitoring, and were externally recognised during a national visit by the Chief Pharmaceutical Officer for England.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration, and recording of medicines. A supervision protocol was in place, with staff allocated named supervisors, supported by monthly training and tutorial sessions, and access to a shift supervisor who could provide advice or support with complex cases.

Prescription stationery was managed appropriately and securely, and staff followed established protocols to ensure medicines were prescribed safely, with people receiving recommended medicines reviews and monitoring.

Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. All relevant alerts were also reiterated in the staff newsletter.