Saville Medical Group

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 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 strong proactive and positive culture of safety, based on openness and honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice

People felt supported to raise concerns and reported that staff treated them with compassion and understanding. Managers promoted a culture of openness and encouraged staff to speak up when things went wrong. Clinical issues were discussed as a team during staff meetings, creating opportunities for shared learning.

The provider maintained a structured process for recording and investigating incidents and complaints. When things went wrong, staff apologised and supported those affected. The service took proportionate approach to responding to safety events, and all those involved in a safety event were involved in the response as appropriate to support learning and improvement.

Key learning was shared through team meetings and the internal bulletin. For example, an incident occurred where there was a delay in a patient receiving test results due to incorrect address details and administrative filing processes. Concerns raised were used alongside other safety information to proactively identify risks and contributing factors, which were systematically analysed and mitigated. The practice responded by providing additional training for the coding team on checking demographic discrepancies and introducing annual audits of coding quality.

The practice also monitored and reviewed both formal and verbal complaints to identify themes and learning. During 2024–2025, 34 formal complaints and 27 verbal complaints were received, compared to 46 formal and 58 verbal complaints in 2022–2023, showing a downward trend over time. Analysis showed that communication was the most common theme, followed by treatment. Actions taken included introducing care navigation staff profile cards to give reception teams clear, up-to-date information about clinicians’ skills and appointment requirements. Leaders told us this reduced booking errors, improved consistency of care navigation, and led to a reduction in complaints from both patients and internal teams. This demonstrated that systemic learning led to improvements in the delivery of care and treatment as a result of action taken.

People and staff were actively encouraged to raise concerns about safety and ideas to improve, and leaders supported staff to implement these changes. For example, a team member identified the need for a Patient Specific Direction (PSD) for Vitamin B12 injections to ensure accurate documentation and safe administration. This proactive change improved prescribing safety and reduced delays for patients.

Positive feedback was also acknowledged, with 19 compliments received in 2024–2025 across different staff groups and published in bulletins to reinforce good practice.

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.

Systems were in place for processing information relating to new patients, managing test results, and coordinating referrals. The service collaborated with other providers to deliver shared care and manage transitions.

Referrals to specialists and urgent services, including 2-week-wait (2WW) referrals, were managed through a clear process. Once a 2WW referral template was completed, the secretarial team monitored it using a tracking spreadsheet to ensure no referrals were missed.

The practice had systems in place to identify and respond to safeguarding concerns. Regular safeguarding meetings provided structured oversight, individual concerns were addressed appropriately, and information was shared with relevant partners when required.

Staff had completed safeguarding training appropriate to their role and were clear on who the safeguarding lead was, reporting they could access support when needed.

The practice had a chaperone policy in place to provide reassurance and mitigate risk for both patients and staff. Disclosure and Barring Service (DBS) checks were undertaken when required.

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. Staff were trained to 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. All staff had completed Basic Life Support (BLS) training.

A care navigation system was used to help reception staff signpost patients to the correct clinician based on urgency and clinical need.

The service generally detected and controlled potential risks in the care environment. We were provided with a legionella risk assessment for Newbiggin Hall Surgery dated 2017; however, this related to the previous building occupied by the practice, and no legionella risk assessment had been carried out for the current Newbiggin Hall Surgery site. The risk assessment for Saville Place (City Centre Surgery) had also not been updated since 2017. After the site visit, the provider sent us evidence demonstrating that legionella risk assessments for both sites were completed in January 2026 and told us a written scheme of control was now in place.

The service delivered from Saville Place is in an older building. While the premises were clean and functional, many areas showed signs of wear, including lifting wall coverings and scuffed doors. The provider had an ongoing programme of maintenance and improvement at the site. Evidence was provided that internal redecoration had commenced, and significant work had already been completed, including replacement of the roof and windows.

The service ensured equipment, facilities and technology supported the delivery of safe care. Contracts were in place to maintain the premises. Most health and safety risk assessments and audits had been undertaken, and identified risks were addressed. A business continuity plan was in place, monitored and reviewed.

The environment was secured with coded access, secure storage, visitor sign-in protocols, and confidential waste disposal arrangements.

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. We found training was up to date, learning needs and development of staff were managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed.

Clinical competency was monitored through structured training, supervision, prescribing update courses, peer reviews, annual appraisals and mentoring for nurse practitioners, Advanced Clinical Practitioners and the pharmacy team. Ongoing learning was recorded for revalidation, and we saw documented case reviews for trainees, salaried GPs and non‑medical prescribers. Cases were also discussed on an ad hoc basis as part of routine clinical supervision.
Following the assessment, leaders told us they had planned developments to further strengthen oversight of non‑medical prescribing. This included integrating prescribing audits and case reviews into the annual appraisal process, ensuring evidence is reviewed and discussed each year.

The service did not always assess or manage the risk of infection effectively. There was not an effective process in place to assure that all staff (clinical and non-clinical) were protected from infection through appropriate routine pre-exposure immunisation. This was not in line with guidance issued by the UK Health Security Agency, as outlined in the Green Book: Immunisation Against Infectious Diseases.

Following the assessment, leaders told us they had taken prompt action and updated staff records. They told us that complete immunisation status was now available for all staff.

In addition, we were provided with a legionella risk assessment for Newbiggin Hall Surgery dated 2017; however, this related to the previous building occupied by the practice. No legionella risk assessment had been carried out for the current Newbiggin Hall Surgery site. The most recent assessment for Saville Place (City Centre Surgery) had also not been updated since 2017. Leaders have since provided legionella risk assessments for both sites, dated January 2026, and told us a written scheme of control was now in place.

The practice had a designated infection, prevention and control lead and all staff had received relevant training. Cleaning schedules were in place and followed. Other risk assessments and audits were completed, and actions taken to mitigate risks.

The service ensured that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes occurred.

Staff involved people when reviewing 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.

We carried out clinical searches as part of the assessment and found that the practice had effective systems to identify and manage potential risks related to medicines. A small number of issues were identified, involving only a few patients who required additional monitoring, such as blood tests. The practice had already taken steps to address these, and appropriate plans were in place.

One area identified was a small group of patients who had been prescribed a higher number of inhalers than expected. Out of 3,292 patients prescribed inhalers, 78 (2.37%) had received 12 or more short-acting beta agonist (SABA) inhalers in a year. The practice was aware of this and had a plan in place to review and support these patients. Medication reviews sampled during the assessment were thorough and comprehensive, and good management of long-term conditions was observed.

Staff managed medicines safely and regularly checked the stock levels, expiry dates, and storage temperatures for all medicines, including emergency medicines and vaccines. Medical gases were stored safely, and staff held appropriate authorisations under Patient Group Directions (PGDs).

We noted that metoclopramide (used to treat nausea and vomiting) was not available in the emergency medicines trolley at Newbiggin Hall Surgery. The medicine was replenished before the end of our onsite visit.

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 monitoring needs received the recommended observations. They took steps to prescribe medicines appropriately to optimise care outcomes. However, we identified a small number of patients (5) who had been prescribed both omeprazole and clopidogrel, where co-prescription should be avoided. Leaders told us immediate action was taken to contact affected patients, and new processes were implemented to prevent recurrence, including regular searches and alerts for prescribers.

Our review of prescribing data showed that the practice’s use of antibiotics was in line with local and national averages. Prescribing antibiotics appropriately helps reduce the risk of antimicrobial resistance, which can make infections harder to treat.