Medicmart Ambulance Service

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

This means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment of this service at this location.

This key question has been rated as good, this meant that people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

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

The service had clear policies and process for reporting incidents. Incidents were reported using an electronic incident reporting system that staff could access from their personal devices and could complete a paper form. All staff and managers were aware of their responsibilities for reporting and investigating incidents. Incidents were reviewed by the operations manager and discussed at governance meetings with learning themes shared with staff by email and newsletters. There were 10 incidents reported between January 2025 – January 2026. The service also reported incidents to other healthcare partners, with 6 out of the 10 incidents reported leading to joint investigations with the NHS ambulance trust they supported. We spoke to a representative from the NHS ambulance trust who told us that the provider always responded to any patient safety incidents within the 14-day response time.

Staff and managers were aware of duty of candour and the need to be open and transparent, giving explanations to patients and their families when things went wrong.

As a registered provider of regulated activities, the service should notify the Care Quality Commission about certain changes, events or incidents that affect their service or the people using it. The service were not doing this and were therefore in breach of one of their registration regulations for the notification of other incidents.
Following the assessment the provider was told of this noncompliance and has since commenced submitting statutory notifications to CQC in accordance with their registration obligations.

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.

We observed staff gaining information from patients and their families when responding to 999 calls as part of the contract with the NHS ambulance trust. Staff considered the patient’s needs so that a plan of treatment and care could be put into place. All the information was documented and shared with other healthcare providers as appropriate and necessary. There was consistent care as patients moved between services helping to maintain patient safety. Staff had access to other pathways of care and treatment if a patient did not require to go to accident and emergency (A&E) or if they were experiencing symptoms requiring more specialised care.

Healthcare partners told us the service worked with them to establish and maintain safe systems of care with regular weekly engagement meetings allowing for any issues to be raised and discussed.

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.

The service had a safeguarding policy for adults and children. All policies were in paper form on site, staff we spoke to said that they did not know where they were but would ask the manager for help and guidance if they needed to read or review any policies. Managers were planning to upload policies onto digital systems so that staff could gain access to them from their personal digital devices.

The service had a safeguarding lead trained to level 4 safeguarding for adults and children. The safeguarding lead had a portfolio of continuous personal development showing enhanced skills and knowledge to improve response to safeguarding concerns and support to staff.

There was 100% staff compliance in safeguarding level 3 training for both adults and children amongst emergency and urgent care staff. This reflected good practice in line with the Royal College of Nursing intercollegiate document on safeguarding competencies for health care staff.

The staff we spoke with knew how to identify adults and children at risk of abuse or harm. Staff gave examples that demonstrated what actions to take to protect patients. Staff knew their responsibilities for notification of safeguarding incidents and the referral process. The NHS ambulance trust informed Medicmart of the number of safeguarding referrals submitted at weekly engagement meetings. Healthcare partners told us they monitored the services safeguarding referrals and no concerns had been raised. Safeguarding was discussed at the services governance meetings.

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

We observed staff actively listening to patients, considering individual needs and person-centred care. We observed capacity assessments and consent to care and treatment being gained. Information was given in a way that the patient understood. Patients and carers were able to make informed decision and feel part of the decision-making process around the care and treatment they received. Digital patient care records clearly documented these assessments and informed decision making.

The service had a deteriorating patient policy which contained guidance in the event of a life-threatening emergency. There was also a deteriorating patient algorithm on the vehicles together with a red flag observations flow chart and a prehospital sepsis screening tool for staff to use. Staff also used Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines for the management of medical and emergency situations. This was available to staff on their digital devices. Staff used patient observations and tools such as National Early Warning Score 2 (NEWS2) and Paediatric Early Warning Signs (PEWS) to assess patients. NEWS2 and PEWS are standardised tools used across the NHS to assist and respond to acute illness in adults and children. Staff had clear processes to follow during an emergency transfer to hospital. They demonstrated good understanding of the information to share with the receiving hospital to allow medical teams to prepare for the patient’s arrival.

All staff were trained to provide Basic Life Support (BLS) Intermediate Life Support (ILS) or Advanced life Support (ALS) in both adults and children depending on their clinical grade and scope of clinical practice.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During our assessment we inspected two vehicles that were used for emergency and urgent care work. One vehicle was used daily with the other kept as a spare. Both vehicles were seen to be visibly clean both inside and out and free from damage, however the vehicle that was kept as spare was found to be out of date with the Ministry of Transport (MOT ) test for two months. This test ensures that vehicles over three years old meet the legal safety and environmental standards. This was reported directly to the registered manager, they responded immediately and the vehicle was taken off site for MOT that day. Evidence seen since our on-site visit confirms the vehicle now passed its MOT. Following our assessment leaders carried out an investigation as to how this happened. It was found that an administrative error had occurred and leaders took steps to have greater oversight to reduce any future errors occurring.

The mattress on the spare vehicle was ripped, and the hand cleaning gel was empty, these were reported to the manager and arrangements were made for it to be replaced.

Staff undertook daily vehicle inspections at the beginning of their shift; these were recorded electronically on their digital devices. All equipment was visibly clean, serviced and had been portable appliance tested (PAT).

The service has a part-time Make Ready Officer (MRO) who restocked and monitored stock levels on the vehicles. They identified any shortages and escalated any concerns to managers if necessary. Staff also had access to equipment and consumables when the MRO was not available. Faulty equipment was taken from the vehicles, documented and put into a separate storage unit; this avoided any confusion with out of service equipment getting mixed up.

The service had appropriate safety harnessing for the transportation of children and equipment to assist with the moving of patients.

Fire alarm checks were completed and documented alongside a completed estates fire risk assessment. Fire extinguishers were calibrated and in date. All vehicle and store cupboard keys were locked and secure.

The service had a Control of Substances Hazardous to Health (COSHH) folder with appropriate signage giving staff information on how to use and store the substances safely. Staff were observed to dispose of clinical waste safely.

The non-clinical environment appeared generally well maintained and clean. Staff had a social area and a small kitchen area with facilities to prepare hot and cold food and drinks. The grounds of the property and all three industrial units within it were protected by CCTV and a security gate.

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

The service had a safe recruitment process; the service used an external company to assist with advice about any Human Resources (HR) issues. All staff employed by the service, either on a permanent or a temporary basis, were subject to an enhanced Disclosure and Barring Service check (DBS). All paramedics, both permanent and temporary were registered with the Health and Care Professional Council (HCPC). New staff received induction and orientation into the service and a staff handbook.

All staff were qualified within their own clinical competencies to undertake their role, and they were aware of their scope of practice within their clinical skill group. Staff could access their clinical scope of practice from a staff portal available to them from their digital devices and in paper form.

Staff observed were experienced, qualified and had the right skills and knowledge to treat and care for patients. Staff told us that if presented with a patient requiring treatment outside of their clinical competency, they would request additional assistance or seek clinical advice via the contracting NHS ambulance trust.

Staff were offered additional training programmes that were supported and funded by the provider. Four members of staff have been supported to complete their First Response in Emergency Care (FREC) courses to levels FREC 4.

The Operational and training director was also a level 4 mentor and in the process of completing an Internal Quality Assurance (IQA) level 4 course. The service had a training policy in place that was current. All emergency and urgent care staff were 100% compliant with their mandatory training, including training around learning disabilities, autism and dementia.

The service had access to a training system that triggered email to staff 2 months before any mandatory training was due to expire. With additional reminders sent one month before and then a week before the expiry date Staff training compliance was also shared with their contracted NHS ambulance trust. The NHS ambulance trust was assured that the staff provided by the service were trained and able to carry out their roles. Training was a mixture of online and face to face training. Staff receive some end-of-life care training at induction and training around Do not attempt cardiopulmonary resuscitation forms (DNACPR) and Recommended Summary Plan for Emergency Care and Treatment forms (ReSPECT). The NHS ambulance trust protocols could be accessed from the JRCALC plus app available to all staff on their digital devices.

Data received showed that all emergency and urgent care staff had received an appraisal within the last year with audits to monitor when they were due again.

Patients we spoke to said that they felt confident staff treating them were trained and knowledgeable.

Staff were blue light trained and were re-assessed for emergency driving every 5 years. Driving licenses were checked every 6 months. The service only employed 1 permanent Paramedic and 5 on their temporary staff bank register , therefore the 999 support that the service provided was often Emergency Technician led. The NHS ambulance trust told us that staffing levels and skill mix were usually in line with their requirements and staffing was discussed as part of a weekly operations meeting.

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.

Cleaning materials were available to be used with signage indicating what cleaning chemicals should be used for specific areas. There were chemical dispensing units fixed to walls to ensure that correct amounts of chemicals were used. There were colour coded signage systems in place for mops and buckets to avoid cross contamination within the cleaning areas. The service used disposable mop heads.

The service used an external company to deep clean their vehicles, which were deep cleaned every 6 – 8 weeks. Swab testing was conducted before and after deep cleaning. Preclean swab tests look for the presence of surface dirt and contamination. High preclean swab tests taken, in June 2025, found that windowsills, trolley beds and worksurfaces were not being cleaned properly in between deep cleaning. Managers took action to address the high swab test results. This risk was added to the corporate risk register and vehicle cleaning was closely monitored. Improvements to test results have been seen since the enhanced monitoring of vehicle cleaning.

The service had an infection protection and control (IPC) policy. Staff understood their responsibilities around IPC; they were observed to be bare below the elbows when assessing and treating patients and carried out good hand hygiene procedures. Hand hygiene audits were carried out by the service. Personal protective equipment (PPE) was worn where appropriate. Staff carried out vehicle cleaning at the beginning and end of their shift, as well as in between patient transfers throughout the day. If a person was transported with a known infectious disease, staff would return the vehicle back to their base station for appropriate and thorough cleaning. All emergency and urgent care staff were 100% compliant in their IPC mandatary training.

The vehicles and reusable equipment were visually clean, personal protective equipment (PPE) was available to staff. There was safe disposal of clinical waste and sharps. Sharps bins were dated and labelled correctly. Decontamination wipes and clean linen were available.

All non-clinical areas were observed to be clean and well maintained by staff as part of their daily operational roles. IPC was discussed at governance meetings. The NHS trust ambulance service did not report any IPC issues or concerns. We received evidence from Medicmart of spot checks on IPC that were undertaken by the NHS trust when crews were working their shifts.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff had access to systems and processes to administer medicines safely. Medicine policies and procedures had been reviewed in April 2025.

Medicines were well organised and stored securely with access only to authorised staff. Temperature monitoring for medicines was undertaken to ensure they were stored within the safe storage temperature range required. We were shown how medicine bags were prepared separately for technicians and paramedics and stored securely. The batch number and expiry date of medicines were recorded with a running total of the amount medicines available. A system was in place to ensure each medicine bag could be tracked. However, there were no minimum medicine stock levels in place to ensure adequate stocks of medicines were available and there was no checking process to ensure that ready prepared medicine packs were correct before they were tagged as ready to use. Since our onsite visit we have received evidence that a process is now in place to monitor minimum medicine stock levels.

The service had a medical gas policy which also provided guidance to support staff on patient transport vehicles (PTS) who may administer medical gases. Medical gases were stored safely and securely with clear segregation between full and empty cylinders. However, there were no warning signs visible to warn people about smoking and naked flames near a medical gas store. We were assured that this would be rectified immediately. Since our onsite visit we have received evidence that warning signs are now displayed.

Controlled Drugs (CDs are medicines requiring more control due to their potential for abuse) were not stored on site. Registered paramedics can possess a limited range of CDs as personal issue. There were processes in place for paramedics to safely procure CDs. We were informed that the service had oversight of how personal issue CDs were managed which included undertaking CD audits, however there were no records available of these audits. We were informed that CD audit records would be kept following this visit.

The service undertook contracted business with an NHS Trust ambulance service Patient Group Directions (PGD’s) were provided by this NHS Trust service for the contracted work. PGDs are written instructions for the administration of authorised medicines to a group of patients. This meant that for any NHS Trust contracted business that medicines were administered to patients by staff with the legal authority to do so under the PGDs of the NHS Trust, however, the service did not have any authorised PGDs for work outside of their contracted business with their contracted NHS ambulance Trust. There was no evidence that a doctor or pharmacist was involved in writing, reviewing or authorising PGDs for Medicmart ambulance service which is a requirement of medicines legislation.

We were shown monthly medicine audits ,which was undertaken as part of the NHS ambulance contract, these were reviewed on site. The audits showed that the service was compliant with the safe storage and handling of medicines. This included auditing 10% of patient care records to ensure the correct medicine was given for the right condition.

We were shown how medicine incidents would be recorded although there had been no medicine incidents reported.