The Grange 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 patients were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as good. At this assessment the rating has changed to requires improvement.

The practice was in breach of legal regulation in relation to safe care and treatment.

This service scored 53 (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 safety. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the team discussed and learnt from clinical issues. The practice had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave patients support. Learning from incidents and complaints was shared with relevant staff to help prevent recurrence. For example, an easy-to-read version of the current immunisation schedule was displayed in clinical areas to act as a visual prompt, helping clinicians stay aligned with the most up-to-date guidance.

There were not established and effective systems in place for processing information relating to new patients in a timely and effective manner. The practice confirmed that 153 patient paper records, the oldest dating back to July 2025, were waiting to be reviewed and added to the patients’ notes on the clinical system. The practice was aware of this backlog and advised this had occurred due to staff shortages. They explained that the majority of new patient information was received electronically from the patients’ previous GP practice and they mitigated any risk by prioritising patients with complex needs or completing a medicine review with a patient before issuing a prescription.

We also saw 3,328 items of clinical correspondence awaiting review and action, with the oldest dated August 2025. The practice told us they were aware of this and had taken action to address it. For example, they upskilled one staff member in March 2025 and another in July 2025 to support the processing of clinical correspondence. They explained that any correspondence requiring immediate action was identified and dealt with promptly. Following our inspection, the practice sent us an update outlining the immediate actions taken to reduce the backlog and the projected timescale for clearing it. They told us that as of 30 December 2025, the backlog had reduced, with 99 documents remaining to be processed.

The practice worked with patients and healthcare partners to understand what being safe meant to them and the best way to achieve that. The practice shared concerns quickly and appropriately.

There were effective systems and processes in place to keep patients safe. We found alerts on vulnerable children and adults’ records to assist clinicians.

Staff had access to adult and children safeguarding leads in the practice and could escalate concerns externally if required. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable patients and acted on concerns, working in partnership with other organisations.

There were notices in the practice showing that chaperones were available if required. We saw that staff who acted as a chaperone were trained for the role and had received a disclosure and barring service check (DBS). (DBS checks identify whether a person has a criminal record or is on an official list of patients barred from working in roles where they may have contact with children or adults who may be vulnerable).

Staff told us if children or vulnerable individuals were not brought to their appointments or failed to attend, this would be identified for follow up action. Staff told us this approach helped ensure that early warning signs were not missed and that necessary interventions could be put in place.

The practice worked with patients to understand and manage risks by thinking holistically. They provided care to meet patient’s needs that was safe, supportive and enabled patients to do the things that mattered to them.

Emergency equipment was available and maintained. Staff could recognise a deteriorating person and knew what action to take. Patients were advised on risks related to their condition and what to do should their condition deteriorated

Patients reported they were involved in their care. In the 2025 national GP patient survey, 86% of respondents reported being involved in decisions about their care, with the national average being 91%.

We found that the practice’s oversight of routine fire‑safety monitoring was not fully robust. The practice had a fire risk assessment in place, completed in November 2021, with the next scheduled for 5 years later in line with its arrangements. It also carried out fire safety equipment checks, fire alarm testing, emergency lighting tests and fire drills. However it did not document routine monitoring of day to day fire safety risks, for example checks of escape routes and fire doors. After the inspection, the practice told us that escape routes and fire doors were checked during the weekly fire alarm test; however, we did not see documented evidence of this. The practice also told us that these checks will be documented in a new format going forward.

We found the practice had not formally assessed the risk to health and safety. They told us informal visual checks were conducted and we saw these were documented on an infection prevention and control risk assessment. However, they were unable to evidence that all risks relating to the health and safety of staff and patients had been fully identified, considered and mitigated.

The practice was not following their Legionella management procedures in line with the practice’s risk assessment. Although an external contractor had undertaken temperature checks, which showed no concerns, these were not completed monthly. The practice had also not flushed little used outlets on a weekly basis, as recommended in the practice’s legionella risk assessment.We saw evidence that a water sample was sent for testing in March 2025, which confirmed that no Legionella was detected.

However, we saw that staff had undertaken annual fire safety training, and the practice carried out regular fire drills to help ensure compliance with safety protocols.

Equipment was maintained to support the safe delivery of care. Portable appliance testing and equipment calibration were routinely conducted by an external company.

The practice made sure there were enough qualified, skilled and experienced staff. The practice had supervision arrangements in place for staff in advanced clinical roles.

We found mandatory training was up to date, learning needs and development of staff was managed appropriately. Safe recruitment practices were followed.

However, we found that some staff had not completed required training to fulfil the role of a fire warden. Following inspection, the provider confirmed staff had placed on a waiting list to complete this training.

There were established systems in place to ensure infection prevention and control (IPC) risks were identified and mitigated. The practice had an action plan with achievable timeframes to address the concerns raised, and evidence showed that identified risks had been acted upon.

We found the practice was clean and tidy.

We saw that cleaning schedules and Control of Substances Hazardous to Health (COSHH) risk assessments were maintained. Cleaning schedules were in place and followed.

Staff had access to gloves, aprons and masks to mitigate the risk of infection to patients. Policies were in place that outlined how staff should triage and manage patients with potentially contagious diseases.

Clinical staff used single use items and had access to body fluid spillage kits to mitigate the risk of infection to patients.

The practice did not always make sure that medicines and treatments were safe and met patient’s needs.

There were not established and effective systems in place for monitoring of some patients receiving medicines typically used to treat high blood pressure. Our remote clinical searches conducted on 16 October 2025 identified 264 patients who potentially had not received necessary monitoring for these prescribed medicines. We reviewed a sample of 5 patient records and found all 5 had not been monitored in line with national guidance.

We identified 110 patients aged over 65 who had been prescribed medicines commonly used to relieve pain and reduce inflammation, or patients over 75 who had been prescribed medicines to prevent blood clots. These medicines can increase the risk of gastrointestinal complications. We reviewed a sample of 5 patient records and found that for 3 patients, there was no documented assessment of gastrointestinal risk to determine whether gastroprotective medicines were required in line with national guidance.

Following the assessment, the practice carried out an audit of the patients and implemented actions where appropriate.

Medicine reviews were not consistently conducted in line with best practice guidance. We found 2 out of 5 patient records reviewed, did not include necessary information to support continued prescribing.

However, we identified appropriate monitoring for patients prescribed immunosuppressant medicines.

The practice had effective systems to manage and respond to safety alerts and medicine recalls.

Medicines were stored securely, and staff regularly checked the stock levels and expiry dates for all medicines. There were appropriate systems in place to ensure the safe storage of medical gases, such as oxygen. Risk assessments had been completed for medicines not held on site.

Waste medicines were recorded and disposed of appropriately.

There were systems and processes in place to monitor fridge temperatures to maintain the integrity of stored medicines.

The practice had a system to securely manage prescription stationary.