Castle Healthcare 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 has changed to Outstanding.

This service scored 88 (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 complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice. Effective systems were in place to share learning. The practice had daily briefing meetings where they shared any immediate learning, new guidance and daily risks. Staff felt supported to raise concerns and felt staff treated them with compassion and understanding. All staff we spoke with told us management were approachable and always listened to ideas and suggestions. Managers encouraged staff to raise concerns when things went wrong, and all staff were invited to serious events meetings. Following a recent incident involving the practice being unaware of a patient having a pessary fitted before accessing their services, they conducted an internal audit and recognised there were system wide issues. Therefore, they shared this best practice piece of work with other local practices through their integrated care board (ICB) to identify other patients in the local area who were potentially lost to follow up. Staff felt there was an open culture, and that patient safety was a top priority.

Representatives from the Patient Participation Group (PPG) felt the service took concerns seriously and proactively made improvements to the service. The practice took their views onboard and consistently involved them in new initiative and campaigns. The PPG had recently audited signage at the practice and management took their views on board to make improvements to signage in place.

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. All staff were invited to significant events review meetings, and all significant events were discussed at regular protected learning time (PLT) meetings to allow all staff to contribute to learning. There were processes in place to share minutes from meetings with those who were unable to attend meetings.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. An audit was carried out to check that 2 week wait referrals were being managed appropriately. The practice served patients who were resident in a care home and to allow continuity in care they ensured the same GP regularly attended ward rounds. When the GP was on leave, a buddy system was in place so the care home and patients knew the GP who would attend the ward round.

Clinical triage was carried out by appropriately trained staff to assess the urgency of care needed. The practice had a robust on call and triage system in place where 2 doctors and 1 nurse made up the triage and on call team.

Routine and follow up appointments were available within a reasonable time frame. Systems in place allowed GPs and nurses to make their own follow up appointments with patients where required.

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 and removing details of patients that had moved to another practice. The service worked with other providers to deliver shared care and when patients moved between services. Effective systems were in place to ensure clinicians were aware of changes and actions required when patients moved between services. Referrals and test results were managed in a timely way.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The practice maintained a list of vulnerable people and acted on concerns, working in partnership with other organisations. The service had regular meetings with partners to share information and recorded this appropriately on patient records, demonstrating, where required appropriate actions were taken to safeguard people. The service shared concerns quickly and appropriately. We saw displays with safeguarding information and contacts on display where staff took calls from patients. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. Staff told us they had completed safeguarding training online. All staff were aware of the clear processes in place to identify and act on safeguarding concerns. Alerts on patient notes relating to vulnerable children and adults were in place. They knew who the safeguarding leads were and where they could get support on safeguarding issues.

The service always worked well with people to fully understand and manage risks by thinking holistically. They provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. All patients that gave us feedback told us how easy it was to access the practice for advice and appointments. A range of appointments were available including evenings and weekends. The practice had recently implemented a Monday-Friday “sit and wait” phlebotomy clinic where patients could drop in between 8am-12pm without an appointment to have their blood taken. The patient also had a choice to book an appointment for this service if they chose.

The practice had engaged with people to obtain their views on access to a health care professional via texts and surveys after each appointment. As a result of feedback they made changes to practice. For example, it was fed back the medicines review text message was not clear around what actions patients needed to take. This resulted in the practice updating the message being sent to patients.

They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The practice offered appointments during evening and weekends. They made notes on patient records if they had additional needs, such as requiring double appointments due to communication needs, which allowed reception staff to offer care in line with patient needs.

Individual risks were assessed, and people were appropriately involved in this. Our clinical searches found patients had regular comprehensive medication reviews and individuals with long term conditions had regular reviews.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. All staff we spoke with knew how to access support in an emergency and were confident these systems worked effectively. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. The service had recently made a blood pressure monitor available to patients, where patients who had not had their blood pressure taken for over 5 years were invited in to take their blood pressure. The service gave them guidance on how to use the machine, where to put their recording and if the reading was over a certain threshold who to contact. The practice told us this process had recently identified a patient had hypertension and they were treated immediately at the practice.

Leaflets were available around common long-term conditions in the waiting area. We saw these were available in different languages to suit the local population.

The practice premises were owned by some of the GP partners based at the location, which consisted of 2 practices. Castle Healthcare shared the premises with another practice and with an adjoining pharmacy. The practice environment allowed them to facilitate additional treatments including ultrasounds, midwifery clinics and diabetic nurse clinics. The building had a lead lined room, should the practice choose to provide x-rays in the future.

A ramp was available for people to access the practice, and lifts were available to all floors. The practice had plans in place for access to rooms on the ground floor if the lift was unavailable and staff told us patients had the option of requesting a consultation room on the ground floor at the time of making the appointment if they wanted.

We saw that the service had effective systems to monitor and comply with mandatory risk assessments, including fire safety and legionella testing to ensure that people and staff remained safe. The practice conducted weekly fire tests, staff completed fire training and attended regular fire drills which included the evacuation of people. Regular environmental audits were completed, and any actions were taken immediately, and learning was shared through robust internal system.

Electrical equipment had been calibrated and tested. Safety alerts relating to equipment were shared with the relevant staff and acted on.

We observed the practice was accessible for all people and included space for wheelchairs and prams. Hallways and corridors were clean and tidy and free from clutter. Staff offices were secure, and access was restricted from the public.

The practice had a dedicated emergency room, consisting of all emergency equipment and helped maintain patient dignity during emergency treatment. Staff also had access to privacy screens if and emergency occurred in a communal area.

Systems were in place for checking and monitoring emergency equipment and medicines. The practice kept recommended emergency medicines and equipment, including oxygen, and defibrillator. The practice had an excellent resuscitation kit in place. This consisted of drugs bags within master kits that were colour coded for various conditions including cardiac conditions, diabetes and seizures, all consisting of written instructions.

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

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. The service had a robust on call system in place where there were 2 doctors and 1 nurse were on call every day to see patients who required appointments on the day, call back patients requiring advice, advise staff triaging calls, take calls from partners such as safeguarding teams and schools or respond to emergencies on site. The service held a daily morning briefing where they discussed possible staffing pressures due to sickness and put appropriate mitigation in place. All staff attended these meetings, and it was clearly noted who the on-call team was, if anyone was off sick, (and the provisions in place), who the trainee GPs were and who would be leading their debriefs (if required). This gave the team a clear plan for the day and direction for support.

We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Staff told us their development and support were a priority to management, and many staff members had developed into additional roles including lead roles. Staff were encouraged to access additional training they felt would support their development.

All staff had annual appraisals that focussed on development and staff wellbeing.

Management had put additional measures in place within staff rotas to prevent exhaustion. For example, reception staff worked on a daily rota consisting of time taking calls, front desk and administrative time and GPs were allocated time for clinical debriefs and administrative tasks.

Safe recruitment practices were followed. The practice had a robust recruitment policy in place. Management told us they actively participated in the recruitment of additional roles funded by the primary care network. There were a range of clinical and non-clinical roles within the practice. The service had access to additional staff employed through their primary care network (PCN). Processes had been established to ensure staff working for but not directly employed by the service were recruited safely, had received appropriate and up to date training and were working within their agreed areas of competence. For example, pharmacists, a social prescriber and an advanced clinical practitioner.

Staff told us they had protected learning time to complete mandatory training and the practice regularly closed for protected learning afternoons, which were used for team building, shared learning and discussion on significant events.

Staff were encouraged to attend conferences and courses to improve their own learning, and we saw regular in-house training and protected learning afternoons were implemented to enhance workforce understanding of clinical topics, governance requirements and shared learning.

The practice was visibly clean. 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 detailed infection, prevention and control policy in place, which consisted of relevant partner contact details. Infection, Prevention and Control (IPC) audits had been completed. There was a designated IPC nurse lead who had oversight, and staff were aware of who the IPC lead was. Staff had received relevant training. Risk assessments and audits were completed, and action plans were in place to mitigate potential risks.

Staff had access to spill kits if required and were appropriately trained to use these.

Contracted cleaning staff were employed. Cleaning cupboards were visibly clean, appropriately stocked, and single use equipment was used. We saw clinical rooms were clean and suitably supplied with equipment including pedal bins, PPE and hand wash facilities. Cleaning logs were completed and retained for audit purposes and overseen by the IPC lead at the service.

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.

Clinicians 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 from their medicines. Staff followed protocols to ensure that all medicines were correctly prescribed and ensured people received recommended medicine reviews and regular monitoring. Protocols effectively supported the safe prescribing of medicines and staff involved people in reviews of their medicines.

Medicines were prescribed appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, data on antibiotic prescribing for the treatment of uncomplicated urinary tract infections showed the practice performance was within national averages relating to safe prescribing, and they had consistently done so since the practice first opened in October 2014.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. For example, prescribing of pregabalin or gabapentin which are medicines used for the management of pain in long term conditions. Prescribing rates of these medicines were in line with national averages for the period from January 2025 to end of June 2025. Regular medication reviews were completed to monitor compliance and check ongoing suitability of the prescribing.

Prescribing of hypnotic medicines used for treating severe insomnia that interferes with normal daily life were in line with national averages.

We did not identify any significant concerns as part of our review of medicines. We reviewed the medical records of people who had a confirmed diagnosis of asthma and had received treatment for an exacerbation of their asthma symptoms in the last twelve months. The review found that all people had received appropriate treatment and had received a follow up of their asthma condition within required timescales, as stated by National Institute of Clinical Excellence, (NICE). We also found that asthma consultations recorded within the medical records detailed relevant observations of the person’s breathing as per NICE guidelines.

We also reviewed a sample of records for people who were prescribed medicines for hypothyroidism (underactive thyroid). We found there was an effective system in place for inviting people for reviews of the condition. We reviewed five medical records for people who had a diagnosis of hypothyroidism. We found no patients were excessively overdue for blood tests and all had been identified, and appropriate action had been taken by the practice.

Recall processes were robust and demonstrated that people’s safety was a priority. The practice utilised varied methods of communication tools to contact people, including, text messaging, phone calls, letters and telephone calls. The service used interpreters when required.

Systems were in place to manage and respond to Medicines and Healthcare Products Regulatory Agency (MHRA) alerts and medicine recalls. Systems for managing the prescribing of medicines and treatment of other medicines were safe and met people’s needs.

Systems were in place for checking the stock levels and expiry dates of all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were stored securely and safely and they had completed required safety risk assessments. Prescription stationery was stored securely and tracked throughout the practice utilising a robust process which all staff were aware of. Prescriptions in printer drawers were stored securely overnight.

Waste medicines were disposed of appropriately including medicines returned by people.