Highlands 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 remains the same.

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. This was then assessed through the significant events process. During monthly staff meetings, the whole team discussed and learnt from significant events. If events were serious, they would be discussed in daily team briefings to ensure learning is put into place quicker. Staff we spoke with 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. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

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 had a lead and deputy lead for safeguarding who met regularly to discuss any concerns. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

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. This was kept in a restricted clinical room where staff could access if needed. Staff could recognise a deteriorating patient and knew of action to take. Regular training took place within staff meetings where scenarios would be discussed on a regular basis to ensure staff continued to be aware of how to handle them. 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. Those working for the service were supplemented by staff working for the Primary Care Network (PCN) which included clinical pharmacists. 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. 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. Safe recruitment practices were followed.

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 service 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 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. Our remote clinical searches identified that patients who had a long-term health condition or on high-risk medicines were being monitored appropriately. Staff followed processes to ensure people prescribed medicines with higher risks received recommended monitoring. Steps were taken to ensure staff prescribed medicines appropriately to optimise care outcomes, including antibiotics.

The prescribing data reviewed as part of our assessment showed that the service prescribed antimicrobials at a slightly higher level than local and national averages, however, the prescribing of medicines used for treating long term conditions such as epilepsy and neuropathic pain was lower than the local and national averages. Controlled medicines were not given to patients on a repeat prescription, allowing the practice to review each time a patient requests them.

Patient Group Directive (PGDs) and Patient Specific Directive (PSDs) were appropriately managed and maintained to support the safe supply and administration of medicines. A PGD provides a legal framework for the supply and administration of specified medicines to defined groups of patients, were appropriately documented and signed. A PSD is a written instruction, signed by a prescriber for medicines to be supplied and/or administered to a named individual after the precriber has assessed that individual on a one-to-one basis.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. These searches were completed with the consent of the provider, to review if the service was assessing and delivering care and treatment in line with current legislation, standards and evidence-based guidance.

Our clinical searches showed that patients with asthma, hypothyroidism, diabetes, and those prescribed medicines used to treat high blood pressure or support kidney function had been appropriately managed and monitored. Required reviews, follow-up investigations, and medication monitoring had been completed, and records had been appropriately documented.

Three patients were prescribed medicines to combat autoimmune conditions (such as Rheumatoid arthritis, psoriasis and Crohn’s disease) and 1 of those patients had a blood test outstanding.

We found that antibiotic prescribing was higher than expected, with the practice recording 12% in March 2026 (expected 8.3%). The practice was aware of this and was working to reduce this figure where it can.

There was a system in place for the monitoring and actioning of Medicines and Healthcare Products Regulatory Agency (MHRA) alerts. However, when asked, the service could not assure that there was an adequate system in place to ensure that staff had read and actioned the alerts. This was an area that the service was happy to develop to provide the assurance needed to ensure the actioning of any relevant safety alerts are not missed.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do if their condition did not improve or they experienced any unexpected symptoms.

Staff received regular training which included how to deal with emergencies and how to identify when patients became unwell.

Staff managed prescription stationery appropriately and securely. Protocols were followed to ensure staff prescribed all medicines safely and recommended reviews and monitoring was done with patients.

Staff regularly checked the stock levels and expiry dates for vaccines and controlled drugs. Emergency medicines were placed in an area accessible to all at the practice. Systems were in place to ensure that these were appropriately monitored. At the time of the visit, all emergency medicines that the practice documented that they held were present and in date.

Staff stored medical gasses such as oxygen, safely and completed the required risk assessments.