Midlands Medical Partnership

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

The service had a good learning culture and people could raise concerns. 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.

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.

It had been reported as a concern to the Care Quality Commission (CQC) that there were no proper investigations or discussions regarding significant events at local or central levels. It was suggested that learning was not shared or implemented and that discussions had been fabricated in meeting minutes. We found that learning was shared, staff demonstrated awareness of the discussions held in meetings, had access to meeting minutes and learning nugget documentation as a form of cascading this information to all staff in bite size formats.

Staff we interviewed during the CQC assessment demonstrated clear awareness of the significant event process and confirmed that key learning points were regularly shared across the service in the form of "nugget knowledge." Of the 24 staff who responded to our CQC feedback questionnaires, the majority, including clinical and non-clinical team members, showed strong understanding of the process and learning, including its role in continuous improvement. Only a small number of non-clinical staff required further development in this area.
We found appropriate significant event analysis and organisational learning took place. For example, a total of 56 significant events (SEAs) were recorded on the annual SEA summary matrix. Each event was risk-rated using a red, amber, green, system and included the date it was discussed at a meeting. The services SEA process overview included:

• Local to Central Escalation: SEAs initially reviewed at local clinical meetings, where learning points and actions were identified, summarised and forwarded to their Governance Team.

• Central Log Maintenance: The Governance Team maintained a centralised SEA log, categorising all reported events. This log was routinely reviewed to identify recurring themes or repeated incidents.

• Thematic Analysis: Events were grouped under key categories such as prescribing, clinical safety, administrative processes, results handling, and information governance. Recurring issues were flagged for further investigation.

• Governance Oversight: SEAs and emerging themes were reviewed during Governance Meetings. If any patterns were identified, action plans were developed with clear ownership and defined timescales.

• Organisation-Wide Learning: Lessons learned were shared across all practices through multiple channels, including quarterly practice development and training (PDT) sessions, weekly governance emails, practice newsletters and governance learning “Nuggets” and various meetings.

• Audit and Quality Improvement. Where thematic trends were identified, the service commissions targeted audits to assess and drive improvement. For example, a prescribing audit on chronic obstructive pulmonary disease (COPD) rescue medicine packs was conducted following a significant event. The findings led to updates in prescribing protocols, which were presented at a practice PDT session and shared via the services ‘Pharmacy Newsletter.’ A follow-up audit was scheduled to ensure the changes become effectively embedded.

The service 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.
There was substantial evidence of engagement with the Integrated Care Boards, as reflected in various service meeting minutes, to support wider learning opportunities.

The service 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 service worked with other providers to deliver shared care and when patients moved between services.
It had been reported as a concern to the Care Quality Commission that tasks were not actioned in a timely manner. Our clinical searches and review of the service found that the ebb and flow of tasks throughout the day were monitored and these had clinical oversight. For example, the tasks numbered 1360 on the morning of 11 September 2025 this had increased to 1451 by midday. For context, the task figures relate to a population of nearly 60k patients across 10 sites. The service analysed the tasks and these were categorised, for example 265 were related to electronic prescription requests made that day. The service maintained a blood test, investigations, letters, actions, and recalls policy which included processes for central activity and local site activity. A spreadsheet of the tasks was forwarded via email to each site with specific time frames for actions to be taken locally, aligned tored, yellow, and green flag risk priorities. Urgent referrals were managed in a timely manner, and the service demonstrated the ability to identify and mitigate risks in the event of any backlog.
Referrals were made to a central team for coordinated assistance to social prescribers. Social prescribers provided support to patients, carers, and families for example those facing financial difficulties, housing issues, and other social challenges. The service benefited from weekly input by the Change Grow Live (CGL) team, providing dedicated support for patients with substance misuse concerns.

To ensure continuity of care and safeguarding for young people nearing the age of 16, medical records were reviewed at least quarterly. This process was to ensure their records were kept up to date, potential risks could be identified and support provided. Site safeguarding leads received regular lists for review, with particular attention given to individuals with safeguarding concerns, such as looked-after children and those at risk of exploitation, to ensure their records were appropriately flagged.

Vulnerable young people were identified for transition to the services adult safeguarding register. The service supported this transition by offering appointment times that accommodated school, college, and work commitments, helping young people maintain consistent engagement with their practice.

Clinicians worked collaboratively with paediatricians, adult care specialists, social workers, and other relevant professionals, including mental health teams and community nurses, to facilitate a smooth handover to adult services. This often involved multidisciplinary meetings to assess and plan for the young person’s ongoing needs. Young people were encouraged to be involved in decisions about their care throughout the process. Continuity of care was supported by offering appointments with a clinician of their choice, fostering trust and long-term engagement with health services. The service encouraged this model of support by the provision of GPs who worked predominately at only 1 or 2 of their sites.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.
Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. The service had reconciled its safeguarding registers to that of the local safeguarding team. The practice had nominated safeguarding leads and administration support.

Records had specific read codes that were current with alerts, icons, information regarding parental responsibility and family contacts.
Multi-disciplinary team meetings were held which included discussions on vulnerable patients, such as those assessed as frail, palliative, end of life care, learning disability and autism and those referred to as ‘platinum patients’ aged over 75 years. The service provided GP services to patients residing in care homes and worked collaboratively with care home staff including patients with non-verbal communication and complex needs. We received extremely positive feedback from 2 care home managers we approached for feedback on the service provided to their vulnerable patients. They singled out for praise named individuals on the support the patients, families and staff received.

Each practice site maintained a safeguarding board displaying key contact information, such as Birmingham City Council, the NHS Birmingham and Solihull Integrated Care Board (ICB) (BSol) advice line, and Multi-Agency Safeguarding Hub, (MASH), alongside readily accessible safeguarding policies to support staff in responding effectively to concerns.

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

Emergency equipment was available and maintained. Where emergency medicines were not held there were risk assessments in place which were regularly clinically reviewed.

Staff could recognise a deteriorating patient and knew of the actions to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.
Clinical leaders reviewed frequent attendees to accident and emergency departments. Emergency department letters received by the service were reviewed to identify patients who may require additional support. Leaders shared examples of collaborative working and information sharing with community teams to provide additional support and access to services for patients when needed.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service provided assurance documents outlining key safety and compliance measures, including the designation of Fire Marshals, scheduling of fire drills, and documentation for the practice sites whereby the landlord held responsibilities for gas and electricity systems. There was evidence of portable appliance testing, equipment calibrations, lift servicing and the scheduling of fire and security risk assessments. These measures were reviewed during our site visits.

Account had been made of the environment/premises risk assessment and security. This included security of shutters, windows, appropriate signage, and premises key holder lists of nominated staff with key access.

We provided feedback at each site on our findings. For example, at Eaton Wood and Old Priory, disabled toilets were suitably equipped with handrails, however, they were missing an emergency pull cord. This was escalated to on-site staff, and partners confirmed to the CQC that remedial works would begin within 14 days, as evidenced by correspondence from property services. The service also checked as to whether any other sites had the same issue.

Fire and emergency evacuation procedures were documented. A minor recommendation was made to list staff participants in fire drills to ensure the provider could readily verify staffs’ annual attendance.

The provider demonstrated awareness of the practice sites requiring routine maintenance and those earmarked for future upgrades and development. The services premise improvement scheme required those sites with landlords to participate and agree to any proposed upgrade changes. Notably, within an eight-month period, driven by a landlord-imposed deadline, the service had successfully funded and constructed new premises tailored to meet the needs of the local population. The new site for Dudley Park Medical Centre was nearing completion.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

The service made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

There was a range of clinical and non-clinical roles within the service. Staff had access to online as well as both internal and external face to face training opportunities. Staff with extended or additional roles had completed additional training.

The practices’ mandatory training was for the vast majority of staff up to date. An induction policy was in place and role specific induction documents were held on the services electronic system. Learning disability and autism Tier 1 of 2 training had been completed for all staff, and some clinical staff had completed Tier 2. However, Tier 2 training was being sourced for all remaining staff.
Learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. These were reviewed during staff appraisals and at clinical supervision sessions.

Safe recruitment practices were followed. Human resource records were centrally managed and well-organised, including a comprehensive matrix detailing staff roles, their associated practice sites, induction and probationary periods, and all relevant recruitment documentation.

A separate matrix was maintained to track staff leavers, with exit questionnaires offered to departing employees. We reviewed 2 of the exit questionnaires. Feedback from these questionnaires was anonymised following a review by HR staff to inform improvements in recruitment and retention strategies. Where necessary, the service engaged an external HR consultant to support performance-related processes and manage redundancies in line with best practice.

The services minimum staffing was based on a risk assessment and an assessment of the needs of the patients conducted by the lead partners. Recruitment was underway to fill staff vacancies. These included six sessions for a salaried GP to work across multiple sites, positions for a care coordinator and lead, a maintenance assistant covering both northern and southern localities, as well as roles for a senior receptionist and a lead nurse.

Of the 24 staff who responded to the CQC feedback questionnaires, and the staff we spoke with, the majority, comprising both clinical and non-clinical team members, reported that staffing levels were generally sufficient to meet service demands. They reported that periods of annual leave and staff sickness did impact on workloads. These challenges were in general, effectively managed at site level, with team members providing additional support by working extra paid hours to maintain service continuity.

Staff in more specialised roles suggested that a reasonably regular short meetings with others in the same role would be beneficial, to share ideas and for peer support. Although, they reported that communication was good but there was always room for growth and improvement. To avoid duplication of reporting, staff told us an updated organisational chart on lead roles and responsibilities would be beneficial in particular for new staff. This was fed back to the leadership team for their consideration and action.

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 practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. We observed that the arrangements for managing waste kept patients safe. The Control of Substances Hazardous to Health Regulations (COSHH) risk assessments were in place for staff to refer to.

A concern was raised with the Care Quality Commission (CQC) regarding the consistency of updates to infection prevention and control (IPC) action plans.During our onsite visit, an IPC audit was reviewed at the Eaton Wood site, completed in February 2025, achieving a 96% compliance rate. The associated action plan had been implemented, for example, a damaged consulting couch had been replaced following identification of a fabric tear in the audit. At the Old Priory practice site, the IPC audit dated May 2025 showed a 92% compliance rate. While an action plan was in place, some items remained outstanding, such as a leaking tap and a damaged worktop. We found that, the overall action plan tracker used across sites lacked documented completion dates for individual actions. Feedback was provided to the service on the inclusion of target completion dates to strengthen quality assurance processes. The service responded constructively, offering assurances that this improvement would be implemented promptly.

A concern was raised with the Care Quality Commission (CQC) regarding water temperature monitoring and that some Legionella risk assessments were not up to date. We sampled some of the records held and found these to be satisfactory.The practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks. The service was acutely aware of the needs for some refurbishment at some the sites we visited but all were visibly clean and tidy.

The service 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 the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely. Staff followedprotocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. For example, the nursing team completed quarterly audits on the vaccines and medicines cold chain compliance. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The service had effective systems to manage and respond to safety alerts and medicine recalls. Their pharmacy team communicated any medicines changes to the appropriate clinical staff members and put together supportive information such as internal medication safety bulletins to communicate measures, as well as a pharmacy team newsletter.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. For example, our clinical searches identified 7 patients prescribed a specific diuretic. We reviewed 5 of the 7 records, all contained documented evidence that patients had been informed of the associated risks. Communication to patients included initial text message invitation for a review, followed by reminder texts to ensure follow-up.

Our clinical searches identified 1 patient prescribed an oral non-steroidal anti-inflammatory medicine aged over 65 years/or an antiplatelet medicine when aged over 75 years without being prescribed a gastroprotection medicine. We reviewed this record and found a discussion had in fact taken place with this patient.

Our clinical searches reviewed patients prescribed specific medicines used in the treatment of high blood pressure requiring regular monitoring. We found there was a potential for 45 patients not to have been in receipt of the appropriate monitoring. We sampled 5 of the 45 records and found they had been in receipt of monitoring and were satisfactory.

Our clinical searches identified that 727 patients had been in receipt of a medication review in the previous 3-month period. We sampled 5 records and found 1 record which lacked detail but overall, the medications reviews were well documented.

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. Non-medical prescribing audits were carried out on each prescriber.

There was a programme of regular clinical audits on prescribing that focused on improving patient care and treatment. For example, a quality improvement cycle took place on the issuing of steroid cards for those who were eligible, between October 2024, with a repeat audit cycle in August 2025. In line with the national safety alert issued it was apparent that the audits had led to a 61% improvement in the issue of steroid treatment cards for those eligible. Another quality improvement cycle took place regarding a medicine prescribed for rheumatoid arthritis in October 2024 with arepeat audit cycle in August 2025. The results from the second cycle audit demonstrated clear improvements, with 100% compliance achieved for example with recording the specific day of the week this medicine was to be taken.