The Nile 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 has changed to Requires Improvement.

The service was in breach of legal regulation in relation to safe care and treatment. In particular, safeguarding, safe environments, recruitment of staff, infection prevention and control and medicines management.

This service scored 53 (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 very supported to raise concerns and felt staff treated them with compassion and understanding. A representative from the Patient Participation Group (PPG) told us the provider listened to their views and acted on them. For example, the introduction of a new telephone system to improve telephone access to the practice; the promotion of the PPG to increase its membership through banners, adverts on the TVs in waiting rooms and posters within the practice.

Staff told us managers proactively encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff told us there was an open culture and they felt very confident to raise any concerns and they would be acted on.

There were processes in place 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. However, documentation to support the analysis of significant events and complaints lacked detail and trends in significant events had not been completed.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. For example, the Primary Care Network and the palliative care team. They made sure there was continuity of care, including when people moved between different services.

There was a backlog in the summarising of new patient paper records. The provider was aware of this and had introduced systems to start to process this information. 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 did not always work with healthcare partners to understand what being safe meant to them and the best way to achieve that.

The service had very recently introduced internal safeguarding meetings to review the care of people with safeguarding concerns and minutes were kept demonstrating this. However, patients’ records had not been updated to reflect decisions about care made at these meetings. The practice maintained a list of vulnerable people however, systems to corroborate this with the wider multi-disciplinary team were not in place. Alerts were added to the records of people with a safeguarding concern however, alerts had not been added to the records of people living in the same household.

Safeguarding policies were in place and known to staff. However, the policies made no reference to human trafficking or radicalisation. Following our assessment the service sent us their updated policy.

Staff were appropriately trained in safeguarding procedures. There were systems in place to follow up people who failed to attend appointments in primary and secondary care or were frequent attenders to AE.

The service mostly 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.

Most of the required emergency equipment was available and maintained. However, emergency equipment for children and young people was not always readily available. For example, paediatric pulse oximetry, oral airways for children, and paediatric pads for the defibrillator. Following our assessment, the provider sent us evidence these had been ordered. Suction was not available at either of the 3 practices. The provider showed us evidence that this had been ordered.

Some staff were aware of how to recognise the rapidly deteriorating patient however, protocols were not in place for non-clinical staff to refer to. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The service did not always detect and control potential risks in the care environment.

Appropriate testing of electrical equipment and electrical hard wiring were in place. However, the provider was unable to evidence that the gas boilers had been serviced. Following our assessment the provider sent us evidence that servicing of the gas boilers had been arranged for 26 February 2026.

Staff had completed fire safety training and there were named fire marshals at all 3 practices. However, checks to ensure a fire risk assessment had been completed at the Hednesford practice had not been made. Fire risk assessments had been completed for the other 2 practices however, action plans to mitigate identified risks had not been put in place. Following our assessment the provider sent us actions plans for the 2 fire risk assessments that had been completed which highlighted many areas that needed addressing.

Legionella risk assessments had not been completed at 2 of the 3 practices. Water testing was in place however, running of taps and monitoring of water temperatures was not. Control of Substances Hazardous to Health (COSHH) risk assessments were available for the products used by the cleaning staff however, service wide COSHH risk assessments were not. Blind hoops for blinds were not always secured to walls in line with national alerts. Following our assessment the provider sent us photographs to demonstrate they had been fitted. Systems to clean and maintain the wheelchairs kept at the practices for people’s use were not in place.

General health and safety risk assessments had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed. However, the plan did not include telephone contacts for essential services such as electricity, gas and water.

The service made sure there were enough qualified, skilled and experienced staff. However, they did not always make sure staff received effective support, supervision and development.

There were a range of clinical and non-clinical roles within the practice. Most staff had not received a recent appraisal. Our review of 4 staff records showed that whilst non-clinical staff were mostly up to date with required training, some clinical staff were not. Systems to address this had recently been put in place.

Safe recruitment practices were not followed. For example, Disclosure and Barring Service (DBS) checks; evidence of satisfactory conduct in previous employment; complete employment histories; and satisfactory information about physical or mental health conditions relevant to the person’s ability to carry out their role. Assurance had not been acquired to confirm that staff employed by the Primary Care Network (PCN), and working in the practices, had been appropriately recruited, trained and supervised. Following our assessment, the provider sent us a memorandum of understanding between the practice and the PCN that had showed there was an agreement in place for the recruitment of staff however, there was no reference to training and supervision of staff.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

The practices were visibly clean however, there were areas of damp on the walls at the Hednesford practice. Infection prevention and control (IPC) audits had been completed for the 3 practices. However, all the IPC audits had failed to identify there were overflows in some of the sinks. Action plans to mitigate identified risks such as carpets in clinical and non-clinical areas and some non-wipeable chairs were not in place. We brought this to the attention of the provider, and they arranged for the carpets at the Nile practice to be deep cleaned. They told us they planned to arrange this for the other practices with a schedule of cleaning until the carpets could be replaced with wipeable flooring. Following our assessment, the provider sent us action plans for 2 of the 3 practices to mitigate risks identified in the practice. However, 1 of the action plans made no reference to carpets and non-wipeable chairs, as identified in their IPC audit, and the other action plan contained no details of how risks were being mitigated.

Of the 4 staff files we reviewed we found 3 of the staff did not have a complete record of all the recommended immunisations for potential healthcare acquired infections. Risk assessments to mitigate potential risks had not been completed. There was a record of the required immunisations for 1 member of staff.

The practice had a designated infection, prevention and control lead and most staff had received relevant training. Cleaning schedules were in place and followed.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

When medicine reviews were carried out, they were effective. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment and clinical pharmacists ran regular searches to monitor the prescribing of medicines.

However, our remote searches identified that some people prescribed medicines that required monitoring had not received the required blood test monitoring. Whilst we saw attempts to recall these patients had been made, systems for dealing with non-compliance were not in place. Following our assessment, we saw some evidence to show the service had started to put some systems in place to follow up this group of people.

We were unable to locate the shared care agreement for some people prescribed a medicine used in the treatment of rheumatoid arthritis and, in line with national guidance, the day of the week to take the medicine was not included on their prescription. The provider told us they had discussed the difficulty in locating shared care agreements and were liaising with secondary care providers to locate them.

Overall assessments of people with asthma who were unwell following an acute exacerbation of their asthma were carried out thoroughly. However, when this group of people were prescribed steroids to manage the exacerbations, systems to review the treatment within 48 hours, in line with national guidance, were not in place.

We reviewed a Medicines and Healthcare products Regulatory Agency (MHRA) alert relating to women of child-bearing age who were prescribed a medicine used in the treatment of epilepsy. We found that the required safety precautions had not been followed for 1 of the 3 people prescribed this medicine.

Staff did not always involve people in reviews of their medicines and help them to understand how to manage their medicines safely. For example, people prescribed a medicine that had the risk for abuse and dependence had not always received a review within the last 12 months. This meant that the risks might not have been explained to people and opportunities to reduce the dosage of the medicine could had been missed.

Staff had the appropriate authorisations to administer medicines (including Patient Group Directions (PGD) or Patient Specific Directions). We found that some PGDs had been authorised before they had been signed by a practice nurse. There was a system in place for tracking prescription stationery throughout the practice however, it was not effective.

Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. There was a system to audit the prescribing on non-medical prescribers and provide clinical supervision however, this was not formally documented.

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. Appropriate emergency medicines were available within the practices although pain relief was not available at the Hednesford practice and a risk assessment to mitigate potential risks had not been completed. Following our assessment the provider sent us evidence that this had been ordered. Staff stored medical gases, such as oxygen, safely and following our assessment sent us a copy of their completed safety risk assessment. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. The prescribing of medicines used to improve low mood, thoughts, perception, and behaviour were below the national average. Systems were in place to maintain the cold chain for the safe storage of vaccines.