Dr Jefferies 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. We assessed all the quality statements from this key question. At our last inspection, we rated this key question as good. At this assessment, the rating has remained the same, although we found areas of improvement, leaders acted promptly to provide evidence to address these during the site visit.

This service scored 69 (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 proactive and positive culture of learning, 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. In particular, the practice immediately addressed and mitigated all areas of improvement we identified during our site visit. Staff told us they knew how to identify and report concerns, safety incidents, and near misses. They were able to raise concerns when things went wrong, and shared examples of improvements made following incidents and complaints. Staff felt there was an open culture and confirmed they had weekly meetings where they discussed incidents and learning. We reviewed a sample of minutes of various practice meetings and were satisfied that they were appropriate and included learning.

Representatives from the Patient Participation Group (PPG) felt the practice took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

The practice 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. There were systems in place for processing information relating to new patients. The practice worked with other providers to deliver shared care and when patients moved between services, particularly for patients with learning disabilities or complex needs. The leaders explained they had oversight of the workflow tasks to ensure they were all responded to promptly. There were processes in place to act on correspondence received by the practice with a designated member of the team having oversight. We reviewed six patient group directions (PGDs). PGDs determine who can supply and/or administer specific medicines to patients without a doctor. Two of the PGDs we reviewed were not appropriately authorised and signed by the local healthcare body, but this was rectified promptly.

The leaders submitted safeguarding children and vulnerable adults policies. Both policies were last reviewed in February 2025, which were appropriate and included all key information, to ensure there was a safe system to identify, review, and safeguard patients. People who provided feedback for this assessment had no specific views or concerns in this area.

The practice had a system to highlight vulnerable adults and children on their medical records.There were regular meetings between the practice and other health and social care professionals, such as health visitors and district nurses, to support and protect adults and children at risk of significant harm. We reviewed safeguarding multidisciplinary team meeting minutes.Staff explained they had a system to follow up with children who were not brought to appointments and AE attendances to identify any patterns as per the practice’s policy.

The practice had a safeguarding register which was maintained by one of the partners who was also the safeguarding lead. Safeguarding policies and procedures were available and accessible to all staff. Staff knew who the safeguarding lead was and how to report any concerns. The safeguarding lead also attended external safeguarding meetings and updated the team during weekly meetings.We reviewed four staff files and found safeguarding training was provided appropriately and staff had completed the correct level of safeguarding training for their role. The practice told us that they monitored staff training closely and that staff received reminders to remain up to date.

The practice worked with people to understand and manage risks by thinking holistically. The practice had guidance for staff to identify people with immediate life-threatening conditions and people whose health was deteriorating. This included immediate advice to give people and how to escalate risk to an appropriate clinician. Leaders told us the reception staff were trained to triage patients to the appropriate clinicians. All staff had completed basic life support, and anaphylaxis training relevant to their role. Staff could recognise a deteriorating patient and patients were advised on risks related to their condition and actions to take if their condition deteriorated.

During the assessment, we reviewed the practice’s premises safety processes. Leaders at the service were able to detail the policies and procedures that were in place to ensure that the environment was safe. The practice had undertaken a full range of risk assessments to ensure the premises was maintained and that the environment was safe, including health and safety. All equipment had been checked and calibrated as required. The practice had completed Legionella and fire risk assessments. There was a business continuity plan in place which was monitored and reviewed.

Systems and process were in place but not always being followed. The practice had arrangements in place to ensure the premises were maintained. We saw evidence of regular checks of fire alarms and fire evacuation procedures. We observed fire exits were clear and fire safety equipment was easily available and maintained by an external company. However, during the site visit it was observed that some of the fire extinguishers were overdue maintenance at both sites. The leaders informed the external company while we were on site to arrange for this to be seen to and provided follow up evidence. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. However, we observed unprotected and loose electrical wiring from the ceiling and found cardboard boxes left near the waste bins which presented a fire risk, immediately following the site visit leaders provided evidence that these had been addressed.

Staff were aware of what to do in an emergency and where emergency medicines and equipment were stored. Allocated staff also knew how to safely manage spillages of bodily fluids. The practice had the required emergency medicines and equipment in place to ensure that emergencies could be safely managed, with the exception of an anti-inflammatory medicine. However, immediately after the inspection the practice provided a risk assessment for not stocking this. One of the emergency medicine was also kept in the directors office, rather than with the rest of the emergency medicines. Emergency equipment was available and maintained, however it was found that the oxygen and defibrillator checks were also being done monthly, rather than the recommended daily or weekly checks as per guidance. Therefore, we weren’t assured risks were always mitigated by the service, but leaders demonstrated openness to learning and the service took prompt action during the inspection to address this.

There were a range of clinical and non-clinical roles within the practice, however one of the premises in the afternoon, did not have a member of staff at reception whilst clinics were active and patients on site. We saw signs directing patients where to go but this may not be clear to those with impairments or learning difficulty. The practice informed us this was due to staff sickness on the day of the visit, and they acted immediately to address this when it was highlighted to leaders. We found that training was up to date, the learning needs and development of staff were managed appropriately, and staff were working within their areas of competence. We reviewed staff files and were satisfied there was safe recruitment practices in place, including pre-employment checks, professional qualifications, and mandatory training. Staff told us they received the support needed to deliver safe care and could request additional training or support, for example, the practice provided training and support to upskill an administrator to be a senior staff member.

The practice managed the learning and development needs of staff appropriately, and staff worked within their agreed areas of competence. We checked 5 staff files, there were no concerns that the staff had completed role-specific training.Staff responsible for specific clinical interventions, for example, reviews of people with learning disabilities, long-term conditions, cervical screening, and childhood immunisation, told us they received specific training.

The practice ensured processes were in place to manage infection prevention and control, although we found these were not always followed. The equipment was safe and maintained according to manufacturers’ instructions. A legionella risk assessment was in place. Cleaning schedules were in place and followed and the practice also had an external company for this. However, we found that some sharps bins were not always labelled, signed or dated. Some of the walls in clinical rooms had large cracks and dents which posed an infection control risk as this can lead to a build up of bacteria. After the site visit, leaders provided supporting evidence to show this was dealt with and no longer a safety concern.

Policies and procedures were available to staff, which provided guidance and information on infection prevention control (IPC) practices. The practice had a designated IPC lead. Staff had completed the infection prevention and control training relevant to their role. The premises were visually clean, hygienic, and uncluttered. Patients told us the practice was always clean and well-maintained.

The practice 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.

Staff 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. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing administration and recording of medicines. Staff managed prescription stationery appropriately and securely. Staff usually followed protocols to ensure they prescribed medicines safely, and ensured people received recommended medicines reviews and monitoring.

Medicines including vaccines were stored securely, although the practice had only one temperature recording device for the vaccine fridge, rather than the recommended two as per guidance. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely. The practice had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. 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. For example, the number of antimicrobials, gabapentinoids and hypnotics issued by the practice were within range with national averages. There were regular clinical audits of prescribing that focused on improving care and treatment.