Wrenbury Medical 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

There was a proactive, systematic approach to managing safety and staff, patients and partnership workers were actively encouraged to raise concerns. Everyone we spoke with, without exception, who was employed by the practice or in partnership with them, reported that they felt part of a team who discussed and corroborated together to find solutions to problems that may arise. The practice demonstrated through consistent monthly protected learning time (PLT), that the primary response was always to learn and continuously improve. Leaders embedded, maintained and sought to continuously have a culture of openness and collaboration, and safety was everyone’s top priority. Staff demonstrated a commitment to improve safety and there were clear roles, responsibilities and structures to meet safety goals. Risks were robustly assessed and managed through internal and external learning events and strong significant event analyses which were consistently reviewed, to avoid negative outcomes.

There were more than enough skilled staff to deliver safe care and leaders were able to demonstrate that they responded and updated staff rotas to match demand and capacity issues. All necessary training had been completed by all members of staff within the workforce to the appropriate levels for their roles. The practice demonstrated how services were planned and organised with people and communities, including those from minoritised groups and those where outcomes were known to be poorer such as people with a learning disability. This was done by requesting patients to attend Practice Learning Time (PLT) meetings to speak to staff and share their experiences in a way to improve their safety across care journeys. People were given information about choices that supported them to balance risks of harm with positive outcomes about their lives.

This service scored 81 (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 demonstrated a proactive, consistent, and positive safety culture based on openness and honesty. Clear processes were in place for reporting incidents, near misses, and safety events, and these were followed by all staff without exception. Leadership consistently listened to safety concerns, thoroughly investigated issues, and ensured transparent reporting over time.

The practice included a dispensary and provided clear evidence of learning from all dispensary errors. Staff consistently reported feeling comfortable raising concerns, quoting a blame-free environment where safety and learning were prioritised to prevent recurrence.

Patient complaints were infrequent, and feedback was actively encouraged, systematically documented, and thoroughly investigated. All patient feedback was reviewed to identify trends and themes that could drive improvements. Evidence showed that incidents, complaints and any negative feedback were routinely discussed in Protected Learning Time (PLT) meetings, with the full team involved in reviewing outcomes to maximise learning and support change. Verbal complaints were also documented and responded to. We saw evidence of consistently documented clinical learning events over 3 years. In addition, a peer-to-peer referral scheme, systematically evaluated to ensure improvement and shared learning.

The provider worked extensively with a range of healthcare services to establish and maintain safe, effective systems of care for patients and partners alike. We received consistent and positive feedback from these partners, including the community team, district nursing team, Macmillan Nurse, GP locum, the Primary Care Network, the Integrated Care Board, and other allied health professionals such as the social prescribers and physiotherapist. Comments from partnership colleagues included remarks such as, a wonderful surgery, the best they had come across, particular commendations for the administration staff, and nothing was too much trouble with staff going over and beyond what was expected. Despite not being employed by the practice associated workers reported feeling involved and part of the team.

The practice had robust systems and processes in place to ensure information was effectively shared across teams and agencies, enabling the delivery of safe, coordinated care. Collaborative work with other providers supported continuity of care, especially when patients transitioned between services.

Feedback from patients was also consistently positive. They reported feeling actively involved in their treatment decisions and expressed satisfaction with the promptness of follow-up care. Regular multi-disciplinary team (MDT) meetings were held to review the care of patients with complex conditions or those nearing end-of-life, ensuring holistic, well-coordinated care. Clinicians followed established care pathways for diagnosis, treatment, and referral to specialist services. Referrals to secondary care, including urgent two-week wait referrals for suspected cancer, were managed promptly and appropriately followed up. Communications from secondary care, such as discharge summaries, were processed efficiently to ensure continuity of care.

The service was proactive in safeguarding people from the risk of abuse, working closely with partner agencies to ensure a coordinated approach. Clear systems and processes were in place to respond promptly when concerns arose about abuse or neglect. All staff had received safeguarding training appropriate to their roles and responsibilities, and they were able to demonstrate a good understanding of the safeguarding principles within the practice.

Staff were aware of who the designated safeguarding leads were for both adults and children and felt confident in escalating any concerns. They demonstrated how they would act if they suspected a patient’s safety was at risk. Safeguarding alerts were added to the clinical record system when relevant, ensuring that all team members were aware of ongoing concerns and could act accordingly.

The service collaborated with individuals to understand and manage risks effectively. Care and treatment was delivered safely and supportively, with a strong emphasis on promoting good health. An effective system was in place to respond to patient safety alerts and patients were given advice on the risks related to their conditions with clear guidance on what actions to take if their health deteriorated. Staff, including locum staff and GP trainees, were provided with an extensive range of tools and guidance to aid them to support people living with long-term health conditions such as diabetes, hypertension, and lung disease. People with long-term conditions were regularly invited for health checks to monitor and manage their wellbeing.

The provider actively encouraged participation in health screening and exceeded the national cervical screening target of 80%.

The practice partnered with the local primary school and nursing home in a community project aimed at improving the uptake of childhood immunisations. This initiative brought together the youngest and oldest members of the community to share experiences and learn about the importance of vaccinations. As a result of this project, childhood immunisation rates met or surpassed the national 90% target across all age groups, with a 98% uptake among one-year-olds who had completed their primary immunisation course.

Over a six-month period, the practice partnered with the local care home to actively manage risk through dedicated clinical time and enhanced care planning. A single GP provided regular educational sessions, including proactive ward rounds, structured palliative care planning, and consistent multidisciplinary team (MDT) meetings. A standardised, personalised care plan was introduced, supported by ongoing staff education and close collaboration across teams. These interventions led to more proactive, person-centred care, clearer decision-making, and better treatment escalation planning. Outcomes included fewer unplanned interventions, improved coordination and quality of care, particularly for individuals with complex needs such as advanced dementia, and more consistent end-of-life care aligned with people's wishes. Staff within the practice and in the care home reported greater confidence and clarity in their roles, especially when making decisions out of hours. Enhanced communication, streamlined processes, and robust documentation further improved the patient experience. We received consistent positive feedback from the care home manager about the support they received from the practice. As a result of the Collaborative Practice and Nursing Home Project the Nursing Home have now been short listed in the Palliative Nursing Home Award Category.

The service operated from a purpose-built building that provided essential facilities, including safe access for individuals with physical disabilities. The premises were clean and equipped with appropriate resources to support effective infection prevention and control.

The provider actively identified and managed potential environmental risks. Leaders ensured that equipment, facilities, and technology were maintained to support the delivery of safe care. Regular audits of the premises were conducted, with appropriate equipment and facilities consistently provided.

Contracts were in place to guarantee the premises remained clean and well-maintained. Comprehensive health and safety assessments and procedures were established and adhered to. Staff received thorough training in all relevant health and safety areas, including fire safety, infection control, and environmental risks.

A comprehensive business continuity plan was in place to support any major service disruptions, such as IT failures. Although the lift was currently out of service, the practice ensured that anyone requiring lower-floor access would be accommodated accordingly. Plans were underway to enhance the upper floor of the premises by increasing the number of clinical rooms, thereby enabling the provision of additional services. There were no concerns from staff about the health and safety arrangements.

The provider ensured there were more than enough qualified, skilled, and experienced staff, all of whom received effective support, regular supervision, and opportunities for ongoing professional development. Without exception, all staff employed by the practice—and those working in partnership—provided positive feedback about the training and support they received from leadership.

Many of the practice staff also worked in the dispensary and had received training provided by a UK pharmacy training provider. They were able to demonstrate how they worked within their competencies and had robust standard operating procedures to follow.

Staff participated in monthly Protected Learning Time (PLT) sessions focused on learning and professional development. These sessions were well-organised and consistently documented over time.

Staff across all roles confirmed there were sufficient numbers to deliver safe, high-quality care and that teamwork was effective. Robust systems were in place to manage sickness, absences, or staff turnover, meaning the practice rarely needed to rely on temporary or locum staff.

We reviewed a sample of recruitment records which demonstrated that robust recruitment processes were followed, and all required documentation was consistently maintained. Feedback from people was very positive, particularly regarding satisfaction with staff and ease of access to clinicians. Patients told us directly how much they valued receiving care from a stable clinical team, allowing them to see the same clinicians regularly and benefit from consistent care.

The facilities and premises were clean and systems were in place to prevent the spread of infection. Personal protective equipment (PPE) was well stocked and placed appropriately throughout the building. The provider pro-actively identified and managed infection risks, with clear roles assigned, including a dedicated lead for infection prevention and control. Staff had received training relevant to their roles.

Cleaning schedules were in place, and regular infection control and cleaning audits were conducted to maintain standards. Cleaning equipment was stored safely and according to best practice. Waste, sharps, and clinical specimens were managed carefully to keep everyone safe. Staff vaccinations were kept up to date in line with the latest UK Health Security Agency (UKHSA) guidance. There was a clear system for reporting infection concerns to the relevant agencies, such as for notifiable diseases.

The practice also ran a dispensary service. Staff used appropriate PPE when handling medications, and medicines were stored properly in clean, dry, temperature-controlled areas. Pharmaceutical waste, including sharps and expired medicines, were disposed of following regulations.

The provider made sure that medicines and treatments were safe and met people’s needs. We reviewed clinical records for patients who had been prescribed medicines which required routine monitoring. Our review showed that medicines were managed very safely and the approach to medicines reflected current and relevant best practice and professional guidance. The practice prescribed less antibiotics comparatively than other practices, thus demonstrating good antibiotic stewardship.

There was evidence that people taking medicines with specific risks that required monitoring were appropriately monitored before their medicines were prescribed. A small number of people were overdue checks relating to their medicines and the provider evidenced that all of those were rectified during the assessment process. Regular medicines reviews were carried out for people who used the service to ensure their medicines were safe and appropriate to their needs.

Staff had access to emergency medicines and equipment including oxygen and a defibrillator. These were regularly checked for stock availability and to ensure they were in date. Vaccines were stored appropriately, and regular checks were carried out to ensure safe storage and stock. The provider had effective systems to manage and respond to safety alerts and medicine recalls.