Middlestown Medical Centre Also known as Dr Swan and Partners

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. Care and treatment was safely delivered, and the provider worked with others to safeguard people effectively.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a strong and proactive culture of safety; this was based on openness and candour. We saw that incidents and concerns were investigated, and that lessons learnt had been used to continually identify and improve services. For example, we saw that a recent incident regarding the treatment of a patient had led to changes in consultation and prescribing practices. Patients were supported to raise concerns, and we saw that information was available to patients about how to raise concerns and complaints.

Staff we spoke with demonstrated a good understanding of how to identify and record incidents and concerns, including complaints from patients.

Managers encouraged staff to raise concerns when things went wrong and record these as significant events, and this was confirmed by staff when we discussed this with them. Learning events were shared with staff at regular weekly team meetings. It was noted that learning had a strong focus during these meetings, with incidents being discussed as well as other learning from clinical audits, cascaded learning from training that had been undertaken, and changes and updates to local and national guidance and best practice.

The practice worked with healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services.

There were systems in place for processing information relating to new patients joining the practice which included new patient registration health questionnaires and consultations. As part of our assessment, we undertook remote clinical searches of records and found correspondence, test results, and incoming health information to have been handled, assessed and processed in a safe, effective, and timely manner.

The service worked with other providers to deliver integrated and joined up care, including when patients moved between services. For example, when a patient was discharged from hospital their care needs were reviewed by staff.

We saw that referrals were effectively managed, and that high priority referrals including urgent cancer 2-week waits were subject to regular monitoring to assess and ensure that they were progressing. Referrals to other services were supported by a referrals policy which had been updated in December 2024.

When it was recognised that patients needed additional support, the provider, working as a member of their primary care network, was able to refer patients to care coordinators and health and wellbeing coaches, or other organisations for assistance.

The practice worked with patients and care partners to improve patient’s lives and protect their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect.

We saw that the provider had safeguarding procedures in place which included the appointment of a safeguarding lead. When we discussed safeguarding with staff, we found that they had a good overall understanding of the subject and were able to give examples when they would raise concerns. Safeguarding processes were supported by detailed policies, and we saw that safeguarding had a high profile within the practice and was a standing agenda item at weekly clinical meetings. We saw that safeguarding training had not been delivered in line with national guidance for all non-clinical staff. During our on-site assessment visit we were informed by the practice management team that measures had been put in place to rectify this issue.

Safeguarding was discussed at monthly multi-disciplinary team meetings when cases of concern could be discussed with other health and care professionals such as health visitors and midwives. The provider ensured that effective communication and coordination was in place for safeguarding, as the practice footprint straddled the boundaries of 2 safeguarding authorities.

Chaperone support was available to patients. The provider had planned further training in the near future for staff to effectively and competently deliver this role. Whilst the use of chaperones was recorded in patient notes by the clinician, we saw that chaperones did not record their use in line with best practice. When we raised this with the provider, they told us that they would implement this immediately as an added safeguard for both patients and staff.

The practice worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, and supportive.

Staff we spoke with explained how they could recognise the signs of a patient with deteriorating health and knew of action to take to keep them safe and effectively respond to the situation. We saw that emergency equipment and medicines were available within the main practice building and at the branch sites, and that these were subject to routine checks. Personnel records showed that staff had received necessary training in basic life support, and emergency procedures.

Senior clinicians told us that it was the ethos of the practice to manage risks by thinking about the patient holistically and to ensure care met their needs. Patients were not limited to raising single concerns during their consultations, and the duration of consultations were flexible which enabled the practice to provide comprehensive care.

The provider had put 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, the implementation of regular testing and maintenance regimes such as electrical testing, and the regular calibration of clinical equipment.

We saw that fire risks were effectively managed across all 3 sites, including the regular testing of fire alarms, and undertaking scheduled fire evacuation drills.

We saw that all 3 premises were well maintained and fit for purpose. When health and safety checks and assessments had identified actions, we saw that they had taken appropriate action to rectify the concerns identified. There was a business continuity plan in place which was monitored and reviewed.

The practice made sure there were always enough qualified, skilled, and experienced staff, who received thorough support, supervision, and development opportunities. They worked together to provide safe care that met individual needs.

We saw that induction and support procedures were in place for new staff. Induction included an introduction to the practice, mandatory and role specific training, and ongoing mentoring, supervision and review.

The practice used past patient demand data to inform their access and appointment processes, this helped to ensure that there were enough qualified, skilled, and experienced staff on duty across the 3 operating sites. Staff we spoke with told us that they felt that there were enough staff on duty, and that at peak demand periods staffing was effectively managed. Data from the provider showed that demand was effectively managed. Capacity increases since the introduction of the new appointments system in 2021 had seen appointment numbers steadily increasing. For example, in 2021 the provider delivered 37,829 appointments (face-to-face and telephone), which had risen to 46,228 in 2024. The effective staff planning allowed the delivery of the practice’s open access appointments system, which was highly responsive to local needs.

Whilst locum usage was reported to be low, any new locums that needed to be used were supported via an initial induction to the service and a detailed locum information pack. The provider told us that most locums used by the service had worked at the practice previously and were aware of operating procedures.

Staff had regular appraisals, one-to-ones, and access to mentorship when required. This was confirmed by staff that we spoke with or received questionnaires from during the assessment. Clinical and non-clinical supervision was embedded within the practice, and staff we spoke with told us that they were able to approach others for advice and support when required.

The provider regularly audited prescribing and discussed this with individual prescribers, and this work was supported by other clinical audits to assess the quality of care and overall performance of the practice. We assessed a number of audits including those linked to clinical supervision and found these to be of a high standard. For example, the provider had undertaken a detailed audit into the clinical documentation of a trainee within the practice which showed clear structured and comprehensive documentation, good safety netting, and appropriate reasoning, with no corrective actions required. As a training practice measures were in place to actively support trainee GPs and others. This included clinical debriefing sessions and immediate on call support. Feedback from those who had trained at the practice confirmed the high level of support they had received.

The provider had measures in place to manage infection prevention and control (IPC). This included the appointment of an experienced staff member to function as the practice’s IPC lead, the development of an IPC policy, and the undertaking of regular IPC and hand hygiene audits.

We saw that recent externally delivered audits had shown high levels of compliance with standards at all 3 sites. When audits had identified IPC concerns, we saw that the provider had taken appropriate action. During our onsite visits to the sites, we found them all to be in a clean condition and generally well maintained. We saw that the decorative condition of the main dispensary was in need of improvement.

Personnel records showed that staff had undertaken annual IPC training, and staff we spoke with had a good understanding of infection control procedures and were all aware of who to contact if they had any IPC concerns.

We saw that the provider had assurance that staff had received the necessary immunisations and vaccinations to undertake their roles safely.

Overall, we saw that clinical waste hazards were effectively managed, and the provider had a clinical waste contract in place. The main waste storage area at the Middlestown Medical Centre though would benefit from sweeping out, and extraneous articles which were awaiting disposal needed to be removed.

The provider made sure that medicines and treatments were safe and met patient’s needs, capacities, and preferences. They involved patients in planning, including when changes happened. We saw that staff from the practice and their supporting primary care network (PCN) involved patients in reviews of their medicines and helped them understand how to manage their medicines safely.

As part of our assessment, a CQC GP Specialist Advisor (SpA) undertook remote clinical searches of patient records to assess patient care and medicines management. We found during the searches that patients and their medication needs had been well managed. For example, we found that patients in receipt of high-risk medicines such as Disease-Modifying Anti-Rheumatic Drugs had been treated in line with guidance and were regularly monitored and reviewed. We saw that in some records it was not immediately clear in the patient summary the reason why a particular medication had been prescribed.

We saw that in the previous 3 months the provider had undertaken 1,059 medication reviews. The quality of these reviews varied with some being comprehensive, whilst others lacked detail. As part of the medication review process, we saw that the provider engaged with patients and utilised patient questionnaires to gather their feedback on the medicines they had been prescribed.

The practice had effective systems to manage and respond to safety alerts and medicine recalls, and our remote clinical searches showed these had been effectively actioned. Safety alerts were subject to regular in-house searches, and new alerts and findings from searches were discussed at weekly clinical meetings.

Following our feedback regarding our remote clinical searches the provider had put in place actions to improve these areas. This included measures to improve the coding of diagnoses, increase the level of detail recorded during medication reviews, and to continue to utilise a newly installed software platform to further improve patient monitoring and management outcomes.

We found that quality assurance processes in respect to medicines usage were embedded within the practice. For example, we saw that the provider had a programme of internal prescribing audits which it used to track adherence to best practice guidance, and as part of good antimicrobial stewardship. Prescribing performance was reviewed at both practice and individual level, and feedback was given to prescribers to allow individual improvement. As noted previously, the provider undertook clinical searches to assess key performance areas such as medicines monitoring.

The provider explained that non-medical prescribers had access to medicines advice and support, should this be required, and were also monitored as part of the provider’s ongoing clinical supervision procedures.

The main dispensary and branch collection points were effectively run, and necessary standing operating procedures were in place to support safe and effective dispensing. This included the dispensing of high-risk and controlled drugs. However, we found there was no recording of prescription serial numbers, which could be used to prevent fraud and aid prescription management. When we raised this with the provider, they told us that they would examine this further and take action.