Garforth 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

We looked for evidence that people were protected from abuse and avoidable harm. Overall, we found that the service provided safe care and treatment, although there were some areas of medicines management and optimisation which needed improvement. Safeguarding practices were thorough and embedded within the service.

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 proactive and positive culture of safety, based on openness and honesty. We saw that they listened to concerns about safety, and investigated and reported safety events. To support this approach the provider had developed and implemented policies, and recording and investigation processes for complaints and significant events. They used findings to both prevent recurrences, and improve service quality. Documentation regarding the reporting and investigation of complaints and incidents was readily available to staff on the shared information access platform used by the provider. Staff we spoke with told us that they were made aware of learning from incidents and complaints either on a one-to-one basis or via team meetings. They also told us that they felt that the provider had a blame free culture, and therefore felt confident to raise issues and incidents when they were identified. Over the previous 12 months the provider had recorded 10 significant events, and received 23 complaints. We saw that these had been investigated, and that any learning had led to improvements in practice. For example, a vaccine delivery had initially not been recognised as requiring refrigeration due to changes to packaging instructions, and had therefore been left at ambient temperatures for around 1 hour. When investigated the provider had reiterated the correct handling procedures for vaccines to staff to prevent a recurrence. The vaccines efficacy had not been compromised by this break in the cold chain. Learning was also supported by a programme of clinical audits which were undertaken by both staff from the practice and hosted trainees undergoing training at the practice. Subjects of audits included medicines prescribing and long-term conditions.

The service worked to establish and maintain safe systems of care, and worked closely with other care partners to achieve this. The provider worked to ensure that patients had continuity of care. For example, feedback we received showed that patients whenever possible were able to have consultations with named members of staff. There were systems in place for assessing and processing information relating to new patients joining the practice. Patients had access to new patient health checks, and we saw that the summarising of new patient records was up to date. At the time of our assessment 41 records were awaiting summarising, and a further 33 were awaiting further information. The service worked with other providers to deliver integrated services, including when patients moved between services. For example, we saw that care home patients who had been admitted to hospital were reviewed on discharge to ensure their care needs were being met. In addition, the provider worked closely with the local primary care network frailty team to support vulnerable elderly patients. We saw that referrals and test results were managed in a timely way with results being dealt with within 24-48 hours. High priority referrals including cancer two week waits were subject to regular monitoring and audit to track progress.

The provider worked with people and healthcare partners to understand what being safe meant to them, and the best way to achieve that. We saw that staff in the service had access to policies, processes and procedures which helped them to keep patients, and particularly vulnerable patients safe from abuse, neglect and harm. We saw that when required the provider shared concerns quickly and appropriately with stakeholders and partners such as health visitors and members of the local safeguarding authority. The provider had appointed senior health professionals to function as leads and deputies for child and adult safeguarding. When we spoke with staff, they had a good understanding of safeguarding and how to raise concerns. The practice computer system was used to identify and record details of vulnerable patients and their family members, and also allowed the sharing of information with other health and care providers, as well as safeguarding bodies. The provider monitored those on their safeguarding register and carried out other work to examine potential safeguarding concerns. This included monitoring and assessing children who had high attendance rates, or those who had failed to attend appointments. We saw that safeguarding had a high profile within the practice and that safeguarding meetings were held on a regular basis both internally and with external partners. All staff had received safeguarding training appropriate to their roles and training progress was actively monitored. Within their practice locations chaperones were available for patients on request. When we discussed acting as a chaperone with staff, we saw that those who undertook these duties had received training and were knowledgeable about their chaperone role.

The service worked with patients and other stakeholders to understand and manage risks, and sought to provide care which met service user’s needs. Results from the 2025 National GP Patient Survey showed that 89% of patients reported that they were involved as much as they wanted to be in decisions about their care and treatment during their last appointment, compared to the local and national average of 91%, in addition 89% of respondents said that the last healthcare professional they saw or spoke to was good at listening to them compared to the local and national average of 87%. A member of the Patient Participation Group told us that when they attended consultations and reviews, they felt involved in their care and treatment, and were able to raise concerns with clinicians. When we spoke with staff, they showed that they were able to recognise the key signs of a patient with deteriorating health, and knew of action to take to keep the patient safe, and how to effectively respond to the situation. Staff told us of instances where they had called the duty doctor to assess a poorly patient, or when they had called for emergency services. Safety-netting advice was routinely given to patients regarding actions to take should their condition start to deteriorate, and the practice website carried information regarding emergency and out of hours contacts for other healthcare services. The practice sites were stocked with emergency medicines and equipment such as oxygen and a defibrillator, and we saw that these were regularly checked by staff. An examination of staff records showed that staff were up to date with emergency training such as basic life support, and sepsis awareness.

The service had measures in place which it used to identify and control potential safety risks within the care environment. We saw that the provider had developed guidance and processes which ensured that equipment, and facilities supported the delivery of safe and effective care. This included, undertaking health and safety risk assessments, and the implementation of regular testing and inspection and maintenance regimes such as electrical testing, and calibration of clinical equipment. We saw evidence that fire risks were managed across all 3 sites, including the testing of fire alarms, and the holding of fire evacuation drills. When assessments had identified actions, we saw that they had taken appropriate action to rectify the concerns identified. Health and safety issues were discussed at bi-monthly management meetings, and staff were encouraged to raise any concerns regarding the safety of the sites in which they worked. It was though noted that a cleaners store cupboard in the main Garforth Medical Practice site was in a poor structural condition, and needed to be cleaned and maintained to a better standard.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, mentoring, supervision and development. The provider had developed and adopted policies on recruitment, induction, staff appraisals, and clinical supervision which were available to staff on the practice’s shared information access platform. We saw records, and received staff feedback, which confirmed that that staff had received regular appraisals. We saw that appraisals discussed key areas such as performance, training needs, and career progression, as well as assessing staff satisfaction. In addition to formal appraisals, we were informed that line managers had regular meetings with staff on a one-to-one, and an ad hoc basis. The provider held lunch and learn awareness raising and training sessions for clinical staff to improve their knowledge. Subjects included audits and clinical updates and also included external speakers. Staff rotas were in place which ensured that enough staff were available, and additional support could be used through offering overtime and by using regular locums. We saw that at the time of our assessment the provider had appointed, or was in the process of sourcing and appointing 2 salaried GPs and 2 practice nurses. The additional GP resource would add an additional 7 GP sessions to practice capacity. We reviewed 4 staff personnel files in detail as part of our assessment, and saw that records and documents related to their recruitment and training were in line with guidance. This included Disclosure and Barring Service (DBS) checks, and immunisation and vaccination records. Managers explained to us how the service ensured staff were appropriately qualified and had attained the necessary skills to carry out their roles, and how they supported them to enhance their skills and qualifications. For example, staff had received additional training in long-term conditions such as diabetes. The provider undertook clinical supervision with trainees, students and non-medical prescribers. This included sessional debriefings and assessments of consultations. Records of this for in-house non-medical prescribers though were limited and needed formalising. Although, we were able to confirm that supervision and clinical assessment was being undertaken with non-medical prescribers through interview.

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 provider had measures in place to manage infection prevention and control (IPC). The provider had appointed a senior nurse to act as their IPC lead. Whilst knowledgeable about their role as designated lead, it was noted that they had not received any additional training to support this enhanced role. The provider had developed and implemented an IPC policy, and we saw that IPC audits had been undertaken. Both clinical sites and the office location were found to be generally well maintained and cleaned. There was carpeting in some areas of the Elmwood Surgery which was tired and worn, some minor damage to plasterwork and sinks in clinical rooms were hand operated, so therefore did not comply with current IPC guidelines. However, we were informed that redesign and refurbishment work was planned for Elmwood surgery in the future. Staff had undertaken IPC training both during their induction, and annually thereafter. Specimens and clinical waste handling procedures were in place, as was a clinical waste contract.

Overall, the service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The provider had processes in place for the management and oversight of prescribing including audits. Whilst we saw that medicines had generally been prescribed safely there were some areas our remote clinical searches showed which required improvement. This included, of 84 heart failure patients prescribed Aldosterone Antagonists, 17 had potentially not received the required monitoring. Following our feedback the provider had investigated this further and found that some patients had already been recalled for monitoring and others were no longer taking the medicine. This still though left 9 patients who the provider told us would be recalled. We found that 321 frail or over 75 years old patients had been prescribed a Direct Oral Anticoagulant (DOAC), of these 112 had potentially not received the required monitoring. After discussing this with the practice they told us that they would recall these patients for a full review. In addition, 235 out of 941 patients who were prescribed over 10 medicines (polypharmacy) had not received a polypharmacy review in the last 18 months. The provider was aware that they had limited resources to meet this review demand, were looking at ways of meeting this, and were working with their primary care network to achieve this. The provider operated a dispensary from their Elmwood Surgery. The dispensary worked to standard operating procedures that covered all aspects of the dispensing process. The provider had signed up to the Dispensing Services Quality Scheme, and there was a named lead GP for medicines management. Dispensary staff were trained to complete compliance reviews with eligible patients to ensure repeat prescriptions were still appropriate. There was a process in place to review errors, and we were told these were discussed at team meetings. All prescriptions were reviewed and signed by a GP before they were issued. We checked medicines stored in the treatment rooms and medicines refrigerators, and found they were stored securely. Processes were in place to check medicines were within their expiry date at the point of dispensing, and an ad hoc system at other times that was not clearly documented. Controlled drugs were stored securely, and appropriate records were kept. Where appropriate patients could have medicines supplied in a monitored dosage system to aid compliance. There was a process to manage medicine delivery to housebound patients, however further assurance was needed to ensure an appropriate audit trail and compliance with the provider’s policy regarding the signing for deliveries of high risk medicines. When we discussed this with the provider, they told us that they would take immediate action to rectify these issues linked to the dispensary. The provider had systems to manage and respond to safety alerts and medicine recalls. However, we found that an alert which dated back to 2014 had potentially not been actioned fully. This related to the dosage of Citalopram (used to treat low mood and panic attacks) and required doses to be limited to 20mg if aged over 65 years. We found 4 patients aged over 65 years who had been prescribed over this dose without necessary discussions on dose reduction or having necessary electrocardiogram (ECG) monitoring in place to check for arrhythmia. The provider has since informed us that they intend to discuss dosage reductions with these patients, and if refused will offer the required ECG testing. The provider followed up with us the issues raised with them with a detailed action plan. We saw that to support medicines management that the provider undertook a number of clinical audits, this included asthma inhaler usage and prescribing.