Middleton Lodge 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

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same. This meant safety was a priority, and people were protected from abuse and avoidable harm.

This service scored 72 (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. Staff felt there was an open culture, and that safety was a top priority.

People were supported to raise concerns and staff treated them with compassion and understanding. We found that complaints were reviewed to identify trends and that when it was appropriate to do so, learning was shared with staff. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. The service hada backlog of complaints when they took over leadership at the service and had commissioned an external organisation to help manage complaints. Learning from incidents and complaints resulted in changes that improved care for others. For example, the management team acknowledged that they required additional capacity to effectively respond to complaints. To mitigate the problem the service agreed to telephone people to inform them of capacity issues so that people were kept informed.

Leaders encouraged staff to raise concerns when things went wrong. There was a system in place for staff to report incidents, near misses and safety events. The service referred to these incidents as significant events. Significant events that had occurred within the practice were investigated, discussed with staff at team meetings and learning disseminated to improve the service provided. Information was shared to those who were not present at the meeting. The service reviewed all significant events to identify trends and themes and ensured that relevant changes were made to reduce reoccurrence of the events. There was a significant event policy in place which was available to all members of staff. We saw evidence of a training process and that significant events were regularly reviewed and learning shared with the relevant staff. We reviewed two significant events and found that a thorough investigation had been completed, and changes had been implemented to avoid issues occurring again that the effectiveness of the changes made was reviewed.

Leaders encouraged staff to develop and learn new skills. For example, the service was very proud to have secured a place, from only two available positions, for ‘GP Practice Nurse ‘training, supporting a member of staff to learn the skills and procedures required within general practice.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. People felt supported and that clinicians acted in their best interest to keep them safe. The service shared concerns quickly and appropriately.

The service had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They shared concerns quickly and appropriately.

The practice’s safeguarding policy included all aspects of the statutory framework, to include female genital mutilation (FGM), radicalisation and due regard to the need to prevent people from being drawn into terrorism, modern slavery and human trafficking. Clinicians we spoke with were aware of safeguarding and specifically talked about how they respond to potential concerns about FGM.

Staff were appropriately trained in safeguarding procedures. There were a dedicated safeguarding GP lead and an administrator to support the safeguarding service. The service maintained a list of vulnerable people and acted on concerns working collaboratively with other organisations. Multidisciplinary team meetings were regularly held and used to raise awareness of potentially vulnerable groups of people. Practice GPs and nurses attended the safeguarding meetings and minutes were produced and saved on the shared computer drive for absent clinicians to read. All staff members we spoke with were aware of who the safeguarding leading was and how to raise a safeguarding concern.

People were offered chaperones for intimate examinations or procedures, for example, breast examinations. Staff had received training on chaperoning and had a clear understanding of their role.

The service worked with people to understand and manage risks using a holistic approach. The service provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The practice had engaged with people to obtain their views on access to a health care professional via an in-house survey. The survey was responded to by 994 of the 12,996 (7.65%) registered people who used the service. One of the questions included within the survey was to gather people’s satisfaction with contacting the service via the telephone. Results of the survey were analysed and 50% of the respondents reported that telephone calls took too long to be answered, whilst 40% did not report any issues with telephone access. The remaining respondents did not provide a conclusive response.

In comparison the National GP Patient Survey asked people how easy it was to contact the service on the telephone. The national survey results evidenced that 56.2% of the people felt it was easy to contact their GP via telephone. These percentages were below the national average satisfaction percentage of 69.6% satisfaction of contacting the service via the telephone.

There were systems and processes in place to identify and manage emerging risks of people and regular liaison with other health care professionals to highlight the risk, e.g. with the community nursing team, palliative care team and referral to hospital consultants.

The service took all necessary actions to provide accessibility for all people. Step free access was provided for people with mobility needs, pushchairs and wheelchairs. Disabled parking and accessible toilets were provided. The practice staff made reason adjustments for people with mobility needs allocating accessible rooms in advance of their appointment. The service identified and coded people with mobility needs, learning disabilities, sensory impairment and vulnerable groups, for example, homeless people, to ensure that staff were aware of their needs in advance of their attendance. Consulting rooms were all on the ground floor. Hallways and corridors were clean and tidy and free from clutter. Staff offices were secure, and access was restricted from the public.

The service had been working with the Integrated Care Board (ICB) and the Primary Care Network (PCN) to secure funding and authorisation for an extension to the surgery. The extension would provide additional consulting room and opportunity for additional staff and services to be delivered.

The practice had clear security arrangements to keep people and staff safe and access to non-public areas were adequately restricted and monitored.

We saw that the service had effective systems to monitor and comply with mandatory risk assessments, including fire safety and legionella testing to ensure that people and staff remained safe.

Records showed fire alarms were routinely tested, and the service had trained all staff members to be aware of the fire marshals role to direct people and staff in the event of a fire. Staff completed fire training and attended regular fire drills which included the evacuation of people.

Electrical equipment had been calibrated and tested. Safety alerts relating to equipment were shared with the relevant staff and acted on.

Systems were in place for checking and monitoring emergency equipment and medicines. The practice kept recommended emergency medicines and equipment, including oxygen, and defibrillator. All staff had been trained in basic life support. Staff could recognise a deteriorating person and knew the action to take. People were advised on risks related to their condition and the actions to take if their condition deteriorated.

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. For example, we saw evidence that the prescribing nurse had regular clinical supervision with the lead GP where their prescribing activity was reviewed and monitored to ensure that people were kept safe.

During our assessment we identified that previous partners employed new staff including clinical staff without the mandatory recruitment checks in breach of regulations. To mitigate this risk to service users, the current management team had reviewed all staff files, risk assessed the omissions and implemented a robust recruitment process, however we saw missing references for a member of staff who started work in May 2026.

The service were actively advertising for two additional doctors using creative visual and pictorial adverts to allow them to stand out from other services advertising for the same roles. Also, the service were advertising for two additional receptionists to support the effective running of the service.

There were a range of clinical and non-clinical roles within the service. 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.

Staff received appropriate training and told us they were supported to develop and progress within the team. The service had access to additional staff employed through their primary care network (PCN). Processes had been established to ensure staff working for, but not directly employed by the service, were recruited safely, had received appropriate and up to date training, and were working within their agreed areas of competence. For example, First Contact Physiotherapist, Clinical Pharmacist. social prescriber and a care home Advance Nurse Practitioner to support people in local care homes.

The service assessed and managed the risk of infection. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. The practice ensured staff received immunisations appropriate for their role, in line with national guidance.

Infection, Prevention and Control (IPC) audits had been completed. There was a designated IPC nurse lead who had oversight, and staff were aware of who the IPC lead was. Staff had received relevant training. Risk assessments and audits were completed, and action plans were in place to mitigate potential risks. For example, the IPC audit evidenced that clinical rooms were checked daily for cleanliness and equipment was cleaned after each use.

Disposable curtains were available is all clinical rooms which were recorded with a diary date for when they needed to be changed. Medical couches were all in good state of repair and were visibly clean with disposable couch rolls for use between each person.

The service used disposal single use equipment at all times and records showed that equipment was appropriately disposed of after use. For example, cervical cytology speculums. Clinical waste procedures were in place.

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.

Clinicians 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 from their medicines. Staff followed protocols to ensure that all medicines were correctly prescribed and ensured people received recommended medicine reviews and regular monitoring. Protocols effectively supported the safe prescribing of medicines and staff involved people in reviews of their medicines.

The service identified that that they had an issue with capacity to safely and efficiently manage the repeat prescribing process which they were unable to resolve in a timely way in house. The service completed a risk assessment and recognised that they needed assistance and outsourced expertise from an external prescription management company. This review achieved clearer prescribing leadership, the development of pharmacist-led structured medication reviews, more systematic monitoring of higher-risk medicines, and a review of repeat prescribing and medication reauthorisation processes. In addition, specific areas of clinical risk, including warfarin monitoring and the monitoring of medicines such as lithium, DOACs and other high-risk treatments were addressed with monitoring and recall systems being implemented. Clinical searches and audit activity are being used to identify patients who may require review and to provide assurance that monitoring arrangements are effective.

Leaders told us that the revised prescribing programme was intended to improve consistency, reduce avoidable variation, strengthen oversight and ensure that responsibility for medicines safety is shared across the clinical and pharmacy team.

Medicines were prescribed appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, data on antibiotic prescribing for the treatment of uncomplicated urinary tract infections showed the practice performance was better than national averages relating to safe prescribing, and they had consistently done so since 2019.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. For example, prescribing of pregabalin or gabapentin which are medicines used for the management of pain in long term conditions. Prescribing rates of these medicines were higher than national averages for the period from October 2020 to end of June 2024. Regular medication reviews were completed to monitor compliance and check ongoing suitability of the prescribing. Prescribing of hypnotic medicines used for treating severe insomnia and interferes with normal daily life were better than the national average evidencing fewer prescriptions for these medicines.

We did not identify any significant concerns as part of our review of medicines. We reviewed the medical records of people who had a confirmed diagnosis of asthma and had received treatment for an exacerbation of their asthma symptoms in the last twelve months. The review found that people had all received appropriate treatment. However, we also found that three people who had had an exacerbation and been treated with oral steroids had not been given a steroid card

We also reviewed a sample of records for people who were prescribed medicines for hypothyroidism, (underactive thyroid). We found there was an effective system in place for inviting people for reviews of the condition. We reviewed five medical records for people who had a diagnosis of hypothyroidism. All five people were receiving repeat medication despite not responding to or attending for their medication review. However, we saw evidence that the service had sent out regular invitations for these people to attend for a review of their condition.

Recall processes were robust and demonstrated that people’s safety was a priority. The practice utilised varied methods of communication tools to contact people, including, text messaging, phone calls, letters and telephone calls. The service used interpreters when required.

Systems were in place to manage and respond to Medicines and Healthcare Products Regulatory Agency (MHRA) alerts and medicine recalls. Systems for managing the prescribing of medicines and treatment of other medicines were safe and met people’s needs.

Systems were in place for checking the stock levels and expiry dates of all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were stored securely and safely and they had completed required safety risk assessments.

Waste medicines were disposed of appropriately including medicines returned by people.