Grange Medical Centre

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

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

The service had a good learning culture and people could raise concerns. Complaints and incidents were discussed and used to make improvements. There were designated safeguarding leads and appropriate safeguarding processes in place. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained. However, there was evidence that actions from premises maintenance reports were not always addressed in a timely manner. Staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved patients in their care.

This service scored 69 (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 proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated incidents and complaints. Lessons were learnt to continually identify and embed good practice. Managers encouraged staff to raise concerns when things went wrong, and staff felt supported to do so. There were policies and processes in place to record, investigate and take action from incidents and complaints. These were discussed in practice and clinical meetings and minutes were made available to staff. Learning from incidents and complaints resulted in learning to prevent reoccurrence and to improve care. For example, an incident whereby an urgent referral had not been completed resulted in a discussion in a clinical meeting, where GPs were reminded to send a task to the administrative team when a referral form was ready for sending. The error was picked up via routine audits of urgent referrals carried out by the practice.

There was a safety alerts policy and a process in place for recording, sharing and actioning medicine safety alerts. A review of clinical records on this inspection indicated that safety alerts were generally actioned in line with guidance. For example, patients prescribed a teratogenic drug were made aware of the risks with this medicine in pregnancy and had effective contraception in place where required. However, we found the following:

Pregabalin: 4 patients were identified. We reviewed 2 records in detail and found that both contained a record of discussion around risks. However, we saw no record of the practice having communicated the risks to the patient in writing. After the assessment the practice reviewed the patient and arranged appropriate follow-up.

There were policies in place to support workflow and pathways for appointments, referrals, records summarising and correspondence. There were processes to monitor and manage care when patients were moved between services, such as out of hours, after referral to secondary care, or admission to hospital. Fortnightly reports were run to monitor any urgent referrals. Staff we spoke with understood the referrals processes and how to safely manage medical correspondence. A review of the practice clinical system, which formed part of this assessment, indicated that patient test results were being managed in a timely manner. The practice told us that at the time of the assessment 99.5% of records had been summarised.

There were designated safeguarding children and adult leads at the practice and safeguarding policies containing relevant contact details and escalation processes. Staff told us how they used the clinical system to record and alert others to safeguarding concerns, and how they escalated any concerns. However, during our search of clinical records we found that not all relevant staff had access to the safeguarding nodes on the clinical system. In addition, we reviewed one patient record and found that the appropriate safeguarding flag was not visible on the record. After the assessment the practice told us they had addressed the issues identified for all patients on their safeguarding register. In addition, the practice noted the issue as a significant event to be discussed in their next practice meeting and reminded staff of the importance of documenting any safeguarding concerns using the relevant template. Staff explained their responsibilities around reporting incidences of female genital mutilation. At the time of the assessment staff were up to date with training in these areas. Staff carrying out chaperoning had received training for this process. The practice maintained a register of vulnerable patients. Staff attended monthly safeguarding multi-disciplinary meetings and acted on concerns, working in partnership with other organisations.

Staff we spoke with knew where to locate emergency drugs and equipment and were able to explain how to act safely in an emergency, including alerting clinical staff and emergency services. We saw that checks on emergency drugs and equipment were carried out and recorded regularly at both sites. Staff could recognise a deteriorating patient and received training in anaphylaxis, sepsis awareness and basic life support. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Staff we spoke with told us that they had no concerns related to health and safety in the practice. We saw that both sites were in a good structural condition, and that equipment was maintained regularly, stored safely and was suitable for use. For example, fire extinguishers had been serviced, and clinical equipment had been calibrated to ensure correct operation. There was appropriate signage in place for fire doors and escape routes. There were policies and processes in place for health and safety risk management. For example, regular fire alarm tests and evacuation drills were carried out, and risk assessments were undertaken at both sites. We saw that some actions from recent risk assessments had been completed, and others were in progress. However, urgent actions from a September 2022 electrical installation condition report for the main site had not been addressed. After the inspection we saw that the practice had arranged for this work to be carried out in March 2025. Designated fire marshals had received training for their role.

There was a recruitment policy in place. Staff received regular appraisals and induction packs were provided. There was an induction pack available for locum GPs at both sites and this included key contacts and referrals processes. We reviewed 3 staff personnel files as part of this assessment and found that documentation was generally in line with guidance. This included Disclosure and Barring Service (DBS) checks, immunisation records and appraisal records. Non-medical prescribers and physician associates were appropriately supervised, which included daily debrief sessions with the GP. Staff told us they had enough support to carry out their role and could seek further guidance from senior staff when needed.

The service assessed and managed the risk of infection. Feedback from staff informed us that they had a good understanding of infection prevention and control (IPC). Most staff knew who the IPC lead and deputy were and how to raise IPC concerns. We found premises and equipment at both sites to be tidy and clean. Cleaning records were in place and personal protective equipment was available to staff. There was an IPC policy in place and staff received IPC training. Staff who handled clinical specimens explained how to do this safely. Regular internal and external IPC audits were carried out at both sites, for which actions were taken to mitigate risks. Clinical waste was appropriately managed by an external company. IPC issues were discussed in monthly practice meetings.

Staff regularly checked stock levels and expiry dates for medicines. Refrigerators used to store vaccines were clean and temperatures were monitored. Prescribing data reviewed as part of our assessment showed that the practice performance was in line with or better than national averages for all indicators. There were Patient Group Directions and Patient Specific Directions in place which relevant staff worked to.

As part of our assessment a CQC GP specialist advisor undertook searches of patient records on the practice’s clinical system. Overall, our searches showed that medicines were effectively managed. Findings included:

Methotrexate (a disease-modifying anti-rheumatic drug): We identified 15 patients and found that all had received the required monitoring in the last 6 months. We looked at 5 patient records in detail and found that all had a shared care protocol in place and that prescribers were appropriately checking monitoring prior to prescriptions being issued. However, we found there was no documented link to the condition for which the patient was taking the medication. After the assessment the practice told us that action had been taken to address this.

Aldosterone antagonists: We identified 14 patients with heart failure who were prescribed this medication. Of these, 1 patient had not had the required monitoring. However, this patient had been contacted 3 times by the practice and the duration of the drug had been appropriately reduced.

Direct Oral Anticoagulants: We identified 34 patients and found that all had received appropriate monitoring.

Potential missed diagnosis of diabetes: We identified 24 out of 75 patients. We reviewed 5 patient records and found that there had not been appropriate follow up of patients with a raised HbA1c above 47 between 2 and 12 weeks. In addition, we found issues with the coding of prediabetic patients. After the assessment the practice told us that action had been taken to address these issues.