The Green 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 in November 2025, we rated this key question as requires improvement. The service was in breach of legal regulation in relation to providing safe care and treatment. At this assessment in July 2026, the practice had made significant improvements and was no longer in breach of regulation 12 related to safe care and treatment. We focused the assessment of this key question on 7 quality statements. The overall rating for this key question has changed to 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.

During the last assessment in November 2025, the provider could not assure us that learning from complaints and incidents was embedded in daily practice for service delivery improvements. At this assessment in July 2026, we found that the provider had improved the processes for recording and learning from complaints and incidents. The practice maintained comprehensive were logs of incidents and complaints which were reviewed during the site visit. We saw clinical meeting minutes and there was clear documentation of discussion of events and learning points shared with staff. The practice completed annual reviews of complaints and significant events to further embed learning and good practice.

During the last assessment in November 2025, the provider could not assure us that referrals were managed in a timely manner and depended on patients to contact the practice for updates on referrals. At this assessment in July 2026, the provider demonstrated an improvement in the management of referrals. Monthly audits were completed and the clinical system used more efficiently to alert staff on required tasks related to patient referrals including those that were deemed urgent.

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. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. At the last assessment in November 2025, we found that not all household members of patients were coded on the register. At this assessment in July 2026, we found that both adult register and children protection plans were correctly coded. This showed that the provider had acted on the feedback provided at the last assessment and improved the process of coding patients at risk of harm and abuse.

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. At the last assessment in November 2025, we found from our review of clinical records that people were not informed of the signs to look out for if their health deteriorated and what actions to take in such situations. At this assessment in July 2026, we found that people were informed of the signs and what to do in such situations which indicated that the concerns found at the last assessment had been addressed. Staff could recognise a deteriorating patient and knew what action to take.

The service proactively identified and managed risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. At the last assessment in November 2025, we found issues related to the management of Legionella. At this assessment in July 2026, we noted the practice had taken steps to mitigate the risks. We saw a compliance certificate was issued by an external contractor showing the practice as compliant with Legionella safety. The service regularly monitored water temperatures and maintained comprehensive records to ensure ongoing water safety. A fire drill was last completed in February 2026 and recorded by the practice. Health and safety risk assessment completed in November 2025 and there were no outstanding actions.

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

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 concerns found at the last assessment in November 2025, which were related to furniture non-compliance with infection prevention and control protocols, had been addressed and risks mitigated. The practice purchased furniture with impermeable material that was easy to clean and the stained furniture found last time had been removed. Antimicrobial stewardship was completed by the clinicians as appropriate.

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.

At the last assessment in November 2025, staff did not manage prescription stationery appropriately and securely. At this assessment in July 2026, this concern had been addressed and the risk mitigated. We saw how the provider had improved security of prescription stationery and 2 staff were responsible for the distribution of the prescription sheets to the clinicians and kept a logbook of the distribution. At the last assessment in November 2025, staff did not always follow protocols to ensure they prescribed all medicines safely and ensured people received all recommended medicines reviews and monitoring. At this assessment in July 2026, our review of patient records, showed that the practice followed up on safety alerts raised by the Medicines and Healthcare products Regulatory Agency (MHRA), patients were advised on risks related to their condition and actions to take if their condition deteriorated. For example, people with diabetes on a particular medicine were given advice on how to identify or respond to a life-threatening infection that rapidly destroys deep and superficial skin tissues (Fournier’s gangrene) and complication from the condition, such as diabetic ketoacidosis (a condition where the body produces harmful acids when breaking down fat for energy instead of sugar).

We found at the last assessment in November 2025 that the service backdated patient records for several weeks and months to indicate medication reviews had been completed and advice on Fournier’s gangrene and ketoacidosis had been given to patients. At this assessment in July 2026, the practice had documented consultations with patients appropriately. The practice monitored long term conditions appropriately and followed up on patients where needed. For example, our review of clinical records identified 2 patients that required follow up that had not been done by the practice prior to CQC assessment. Following the clinical searches, the practice contacted the patients and completed the required actions and documentation completed. Evidence was shared with the CQC during the site visit. However, medication reviews were not always recorded to show the context in which they occurred or what was discussed with the patient including the medicines reviewed. The prescribing data reviewed as part of our assessment showed the service was optimising care outcomes. For example, the number of antimicrobials issued by the provider was lower than local and national averages.