Nettleham Medical Practice Also known as Dr Waller 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

The service had a good learning culture and people could raise concerns. We received feedback from some patients who said they had difficulties in using the virtual receptionist/electronic booking system. The most recent patient survey in May 2026 showed a score of 2.4 out of 5 of patients experienced difficulties when using the virtual receptionist system. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

We looked for evidence that people were protected from abuse and avoidable harm.At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed to good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider demonstrated a positive approach to safety, with an emphasis on openness and honesty. Staff listened to concerns and took steps to investigate safety events, and learning was shared to help improve practice over time. We saw a significant event newsletter where learning was shared from issues identified within the practice and the wider primary care networks.

Staff told us they felt able to raise concerns, and clinical matters were discussed in team meetings to support learning.

There were established processes for reporting incidents, near misses and safety events. The provider also had systems in place to manage complaints when they arose. When things went wrong, staff apologised and offered support. Learning from incidents and complaints contributed to changes intended to improve care for others. There was a dedicated patient support manager who helped patients deal with concerns and oversaw the administration and reception staff in promoting a culture of openness and transparency.

The provider had systems in place to support the delivery of safe care. They worked with patients and other healthcare providers to maintain safe systems and monitor safety within the practice. We saw an artificial intelligence (AI) receptionist function had been installed to manage phone queues and streamline patient access to services.

Managers told us they had implemented a VIP list which automatically directed vulnerable patients, including those with significant sensory impairment and on a palliative care pathway to bypass the AI function to a member of the clinical team.

We did, however, have feedback from some patients who said they had difficulties in using the virtual receptionist/electronic booking system. The most recent patient survey in May 2026 showed a score of 2.4 out of 5 of patients experienced difficulties when using the virtual receptionist system.

Arrangements were in place to support continuity of care. Patients received follow-up where appropriate, including review of test results and advice where needed. The practice supported patients when they were referred to other services and aimed to maintain oversight of their care.

There were processes for registering new patients and reviewing relevant clinical information. Referrals, correspondence and test results were managed in a timely way, and the practice worked with other providers when patients moved between services.

The provider had arrangements in place to safeguard children and vulnerable adults from abuse. Safeguarding policies were available to staff and reflected relevant legislation and local guidance. Quick response codes (QR) were displayed in patient and staff areas which had links to the providers policies and leaflets which included safeguarding.

There was a nominated safeguarding lead within the service, There was a nominated safeguarding lead within the service, they had been trained to level 3 safeguarding, along with 2 further senior members of staff. Managers told us there were imminent plans to increase the number of staff trained to level 3. All other staff had received safeguarding training appropriate to their role and were able to describe how to identify and report concerns. We saw there was a noticeboard dedicated to identifying and managing safeguarding concerns and flowcharts of actions required. Safeguarding concerns were discussed as appropriate, and referrals were made to external agencies in line with local procedures. The service worked with other healthcare professionals and agencies to support people at risk and maintained appropriate records of safeguarding concerns.

The provider worked with people to understand and manage risks, taking a holistic approach to their care. Care and treatment were delivered in a way that aimed to meet people’s needs while supporting them to remain safe and maintain their independence. We saw several noticeboards advising patients on a variety of conditions, giving advice, suggestions and signposting to support them in better managing their health.

Emergency equipment was available and appropriately maintained. Staff had received training in and were able to recognise signs of a deteriorating patient and understood the actions to take in response. Patients were provided with information about risks associated with their condition and were advised on what to do if their symptoms worsened or their condition deteriorated.

Nettleham medical practice delivers care from 2 sites, Nettleham village which is the main site a smaller branch surgery at Cherry Willingham. Both sites were clean and well maintained. Work had been undertaken at Nettleham to provide additional clinic rooms, update existing clinic rooms and to decorate both public and staff areas. We were told the 2 treatment rooms at Nettleham were to be modernised soon to provide an improved experience for both patients and staff.

We were told space was at a premium at the Cherry Willingham site, we saw a cleaning cupboard which was untidy and equipment was stored on top of each other. We brought this to the attention of managers who immediately addressed this.

The service detected and controlled potential risks in the care environment and ensured equipment, facilities and technology supported the delivery of safe care. Staff identified hazards, we saw cleaning contracts were in place to maintain the premises, and audits had been completed with identified risks addressed. Systems existed for reporting incidents, near misses and safety events, and processes were in place to manage complaints when they arose. A business continuity plan was maintained and reviewed to support ongoing safe operation.

We found several unlocked cupboards of patient notes at the Cherry Willingham branch surgery. We saw a considerable amount of paper patient records behind the reception area which posed significant risks of data protection breaches. We brought this to the attention of managers who visited the site, commissioned a locksmith to put remedial actions in place and provided us with plans to rectify the issues.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support and supervision. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Staff told us their development and support were a priority to management, and many staff members had developed in additional roles including lead roles. Staff were encouraged to access additional training they felt would support their development. Staff told us they had protected learning time to complete mandatory training and the practice regularly closed for protected learning afternoons, which were used for team building, shared learning and discussion on significant events.

Managers had introduced Jess's Rule training, an NHS England primary care initiative instructing GP teams to "reflect, review, and rethink" when a patient presents three times with the same or worsening unexplained symptoms.

All staff had annual appraisals that focussed on development and staff wellbeing.

The provider had a recruitment policy in place. Management told us they actively participated in the recruitment of additional roles funded by the primary care network. There were a range of clinical and non-clinical roles within the practice. The service had access to additional staff employed through their primary care network (PCN).

We found the provider did not carry out its own audits of work undertaken by a non-medical prescriber employed through the additional role reimbursement scheme (ARR) who completed out structured medical reviews of patients.

We found gaps within one staff file, we did not see references, employment history, physical and mental health questionnaire or an up-to-date disclosure barring scheme (DBS) certificate. Managers had however completed a risk assessment and given assurances on the day of the assessment that full employment checks would be completed for this individual

Both surgeries were visibly clean. Managers assessed and managed the risk of infection.

There was a detailed infection, prevention and control policy in place, which consisted of relevant partner contact details. Infection, Prevention and Control (IPC) audits had been completed. There was a designated IPC nurse lead who had oversight, and staff were aware of who the IPC lead was. Staff had received relevant training.

The provider detected and controlled potential risks in the care environment and ensured equipment, facilities and technology supported the delivery of safe care. Staff identified hazards, we saw cleaning contracts were in place to maintain the premises, and audits had been completed with identified risks addressed. Systems existed for reporting incidents, near misses and safety events, and processes were in place to manage complaints when they arose. A business continuity plan was maintained and reviewed to support ongoing safe operation.

We assessed systems and processes used for the safe management of medicines, including policies and procedures at Nettleham Medical Practice and Cherry Willingham branch site.

The provider ensured medicines were stored safely and securely with access restricted to authorised staff. Prescription stationery was stored securely, and in line with national NHS guidance, staff ensured it was recorded when received and tracked through the practice. Staff told us that they checked for uncollected dispensed prescriptions each month. If any were identified, the patient would be contacted to ensure the medication was still required.

Appropriate emergency medicines and medical oxygen were stored safely and appropriate risk assessments completed. Staff told us they regularly checked the stock levels and expiry dates for all medicines.

A delivery service was in place to deliver prescriptions to housebound patients. However, there was no audit trail to confirm receipt of the dispensed medicines by the patients.

There were standard operating procedures in place for each process in the dispensary. Prescriptions were signed before medicines were dispensed and handed out to patents. There was a process for requesting repeat medicines and evidence of structured medication reviews.

Appropriate systems were in place for the safe management of controlled drugs. The practice monitors the prescribing of antibiotics to reduce the risk of antimicrobial resistance.

The practice was actively monitoring patients on various high-risk medicines. The system would flag when a patient was due a medicines review or when additional monitoring was required.

There was a process in place to record the temperature of fridges being used to store medicines. This was completed in line with national guidance.

Vaccines were stored in line with national guidance.

Dispensary staff had received appropriate training and regular checks of their competency. Dispensing incidents and near misses were recorded and reviewed regularly. There was a process for acting on safety alerts.

Patient Group Directions (a written instruction for the administration of medicines to groups of patients not previously prescribed for) were in place and up to date.