Park 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

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.

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes. Minor areas for improvement were discussed with the practice during our onsite assessment and prompt action was taken to mitigate risk.

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.

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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. 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. The provider had processes for staff to report incidents, near misses and safety events. The practice team used the ‘5 whys’ as a root cause analysis approach and as part of their learning process. We dip sampled four significant events and other than one which we discussed may require further root cause analysis these were satisfactory. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. We sampled four complaints and identified the need for more consistent inclusion of the Parliamentary Health Service Ombudsman next‑step information within some complaint responses. Learning from incidents and complaints resulted in changes that improved care for others.The practice subsquent to the assessment has updated its complaint response templates to consistently include information on Parliamentary Health Service Ombudsman escalation, in accordance with national complaints guidance.

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 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. The practice had made attempts to verify the safeguarding register with the local safeguarding team to ensure safeguarding information was accurate and up to date but had been unsuccessful to date.Since the inspection, Park Medical Centre advised they have established effective communication with the local authority safeguarding team, enabling validation and cross-checking of safeguarding registers to ensure information was accurate and current. Since March 2026, the practice had also been invited to weekly Vulnerability Hub multidisciplinary meeting with police, social services, housing providers and voluntary sector organisations. This participation strengthens multi-agency safeguarding oversight.

The practice has implemented a structured clinical disengagement monitoring process to identify patients overdue for recommended monitoring or review. Electronic searches identify at-risk groups, including those prescribed medicines requiring monitoring and patients with long-term conditions who have not attended reviews. The application of behavioural science techniques is currently being explored to encourage engagement with monitoring and treatment.

Children and vulnerable adults (up to the age of 25 years with Special Educational Needs) were offered a referral toImproving Access to Psychological Therapies (IAPT). For children and young people, this included Children and Adolescent Mental Health Services (CAMHS) if they needed support with wellbeing or mental health difficulties. Electronic system codes were used to illustrate for example that any child on a child protection plan should be entered into the notes of all individuals living at the same address. As well as codes for those who did not attend for appointments or were not brought to appointments. Training included for example awareness of Person(s) in a Position of Trust (PiPoT) to respond to allegations against anyone who works, either paid or unpaid, with adults who have care and support needs. The practice maintained a chaperone policy and all staff completed chaperone awareness training which covered the role of the chaperone. Electronic coding was used to highlight in patient records whether chaperones were used refused or no chaperone available.

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. Robust checking and emergency medicines monitoring systems and processes were in place. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

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

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

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.

There were a range of clinical and non-clinical roles within the practice. Staff had access to online as well as both internal and external face to face training opportunities. Staff with extended or additional roles had completed additional training. The practices’ mandatory training was for the vast majority of staff up to date. Staff training reminder emails and meetings were held to encourage staff to complete their training. An induction policy was in place and role specific induction documents were held on the services electronic system. Learning disability and autism Tier 1 of 2 training had been completed for all staff. Tier 2 training was being sourced for all remaining staff. We found learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. These were reviewed during staff appraisals and at clinical supervision sessions.

Staff feedback comprising both clinical and non-clinical team members, and the staff we spoke with, reported positively on their ability, with the changes made to the triage systems, to meet service demands. They reported that periods of annual leave and staff sickness did impact on workloads. However, these challenges were effectively managed with team members providing additional support by working extra paid hours to maintain service continuity.

Park Medical Centre is an accredited GP training practice with two approved trainers providing structured supervision and assessment for GP trainees. Additionally, two GPs hold university roles as a GP trainee examiner and a medical student teacher. The practice operates a structured annual leave policy that limits the number of clinicians absent at the same time to maintain safe staffing levels and support clinical continuity through their buddy system.

Gaps were identified in the staff recruitment records. This had already been identified by the practice. We found that person specific risk assessments were in place for each staff member with gaps in their recruitment records and information requests had been made. All staff had been subject to appropriate level disclosure and barring service checks. The Disclosure and Barring Service helps employers make safer recruitment decisions.

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. The last audit was completed 21 November 2025 and included hand hygiene. The practice had an Infection Prevention Control (IPC) action plan following their internal audit with dates set for review and completion. A few minor areas for improvement were highlighted during our onsite visit and the practice put mitigation measures in place. Cleaning staff employed by the practice completed relevant training including Control of Substances Hazardous to Health Regulations 2002, (COSHH) which is UK law requiring employers to control substances that can harm employees' health (e.g., chemicals, fumes, dust, biological agents).

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.

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.

Staff managed prescription stationery appropriately and securely. Prescriptions were only printable from the central printer at reception to maximise prescription security. We fed back on our observations on site where we found that all staff could access keys to the lockable cupboards. This was promptly actioned by the practice.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Waste medicines were recorded and disposed of appropriately including medicines returned by patients. 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. Staff took steps to ensure they prescribed

medicines appropriately to optimise care outcomes, including antibiotics. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

The practice maintained a Medication Monitoring Protocol. This outlined for example the process for monitoring patients prescribed high risk medicines, Direct Oral Anticoagulants, (DOACs are blood-thinning medicines used to prevent and treat blood clots), long term conditions systems and ensuring patients records held Effective Shared Care Agreements (ESCA) when appropriate. The administration team ran regular electronic system searches, checked on secondary care systems for pathology results and downloaded blood results as appropriate. There was a protocol in place used to record in the patient’s electronic record the reason for downloading these blood results. If blood results were not available, they advised the patient to attend the practice for monitoring. The practice policies referred to measures to encourage compliance and attendance for their monitoring and actions such as reduced numbers of days for the prescribed medicine as one of the measures they could use. The role of the pharmacy technician included monitoring these electronic searches to ensure adequate recalls were taking place and to ensure the dosage monitoring of DOACs for patients within the Primary Care Network.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. For example, our clinical searches identified no patients were overdue monitoring for high-risk medicines.

Our clinical searches identified 98 patients on oral non-steroidal anti-inflammatory drugs (NSAIDs) aged over 65 years or prescribed an antiplatelet medicine over 75 years without a gastroprotection medicine. We sampled 5 of the 98. Two of the 5 patients had been reviewed, and a decision made was a gastroprotection medicine was not indicated. During the inspection process the practice investigated and actioned this feedback promptly.

All 5 medication reviews we sampled were comprehensive, good quality reviews conducted by GPs and pharmacists.