The Wellington 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 assessed a total of 8 quality statements from this key question. We found improvements had been made since the previous inspection in January 2023. For example, staff were up to date with mandatory training, supervision and appraisals and processes continued to be improved to ensure patients prescribed medicines were up to date with routine monitoring. We also found when things went wrong, staff took concerns seriously and leaders investigated incidents to reduce the likelihood of them happening again.

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.

Patient feedback did not indicate any concerns with learning culture.

Leaders encouraged staff to raise concerns when things went wrong and staff we spoke with were clear about how to raise a significant event or report an incident.

Processes were in place for staff to report incidents and significant events. The provider had a system in place to record and investigate significant events and complaints and clinical meeting minutes demonstrated staff discussed and shared learning from these.

Patient feedback did not indicate any concerns with referrals to secondary care or other services. The 2024 GP Patient Survey results demonstrated 80% respondents said they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This was above the local average of 65% and national average of 68%.

Staff and leaders told us there was a system to ensure referrals to specialist services were documented, contained the required information and there was a system to monitor urgent referrals and any delays.

Feedback from partners was positive and provided that the practice engaged well with partners to maintain safe systems of care and ensure continuity of care for patients moving between different services. This included having a lead GP for local care homes, who conducts regular weekly visits to see their residents.

Processes were in place to manage patient pathways and transitions. This included having oversight of referrals to external health service as well as sharing and receiving information with other service providers. The practice had an effective system in place to manage incoming correspondence and we found clinical correspondence and test results were up to date. The practice had a 2 week wait referral procedure with a dedicated member of staff who had oversight of any delays to appointments and could follow up referrals and escalate as necessary.

Peoples’ feedback regarding safeguarding was limited. However, results from the national GP patient survey 2024 demonstrated that 77% respondents felt the healthcare professional they saw or spoke to was good at considering their mental well-being during their last general practice appointment. This was above the local and national averages.

Staff and leaders understood their safeguarding responsibilities and were aware of what action was required if they thought a person was at risk of potential harm. Staff were clear on who the safeguarding lead was, and safeguarding contacts were available in clinical rooms.

Partners told us the practice engaged well with regular meetings throughout the year as well as within their own primary care network.

Processes were in place to ensure staff could access safeguarding training in line with national intercollegiate guidance and we found all staff were up to date with safeguarding training. Systems were in place to identify vulnerable patients on practice’s records, and we found the practice held regular discussions with external agencies such as health visitors and school nurses. Following the practice’s safeguarding meeting in October 2024, a decision was made to train 2 members of staff to become the practice’s domestic abuse champions, as the provider recognised this was a need for the local population. This was achieved by the day of the assessment and the practice was in the process of setting out guidance for the champions to be able to respond and be able offer support to local patients and families where appropriate.

Patient feedback via the National GP Patient Survey 2024 indicated 88% patients said they were involved as much as they wanted to be in decisions about their care and treatment, this was in line with local and national averages.

Staff were aware of action to take if they encountered a deteriorating or acutely unwell patient, and they also used a prioritisation tool which helped identify high risks. Staff told us there was a process to prioritise and send patient correspondence from external providers to clinicians to action as required.

There were systems to manage referrals, prompts for patients to attend for routine tests and reviews of their conditions and to ensure correspondence was prioritised appropriately. The practice was equipped to respond to medical emergencies and all staff had completed sepsis or sepsis awareness training, in line with their role.

Staff informed us they had undertaken required mandatory training in respect of health and safety, such as annual fire safety training. Staff told us they had no concerns related to health and safety in the practice.

During our site visit we found the environment was safe and well maintained. There was a fire procedure in place.

Risk assessments were completed routinely in relation to health, fire and safety and we found actions had been completed. Clinical equipment was calibrated, and electrical goods received portable appliance testing at regular intervals.

Patient feedback did not indicate any concerns with staffing. National GP patient survey results from 2024 showed 95% respondents felt their needs were met during their last appointment. This was above the local and national averages. In addition, 73% of respondents described their overall experience of this GP practice as good, which was in line with local and national averages.

Some staff told us they felt the practice needed more staff to deal with the demands of the role but felt supported by leaders. Leaders were aware of the significant rise in patient numbers and knew this would continue to be a challenge to meet demand given the location of the practice and the need to accommodate a larger team.

There were processes in place to ensure all staff were offered annual appraisals and supervision was in place for non-medical prescribers. Recruitment processes were in place and appropriate recruitment checks were completed for staff files we reviewed. This included the process to record staff vaccination and immunisations.

Feedback from patients did not indicate any concerns regarding infection control.

Staff we spoke with had a good understanding of infection, prevention and control (IPC) and they knew who the IPC lead at the practice was. Staff who handled clinical specimens were aware of how to carry out their role safely.

We found all areas, including the GP consultation room, the nurse treatment room and the waiting area were visibly clean, which protected people from the risk of infection. We also saw the arrangements for managing waste and clinical specimens kept people safe.

The practice had an effective approach to assessing and managing the risk of infection. There were policies for infection, prevention and control (IPC) and there was a comprehensive audit process in place for infection control. There were no significant actions from the most recent audit. All staff were up to date with IPC training.

People’s experience in relation to the safe management of their medicines was limited. We received feedback from local care homes who told us the repeat prescription process for residents was positive and worked efficiently.

Staff felt confident managing the storage, administration and recording of medicines. Interviews with lead clinicians indicated there were effective processes for the management and monitoring of patients on repeat prescriptions including high risk medicines which required patients to attend for regular blood tests. Leaders were aware of the performance of these monitoring systems.

We observed medicines and vaccines were stored appropriately and securely. This included monitoring to ensure medicines were stored within correct temperatures. Emergency medicines and equipment were available. Blank prescriptions were stored securely and monitored and audited appropriately to ensure continued security.

There were processes which ensured medicines were stored safely and securely with access restricted to authorised staff. This included processes for the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions). Processes were in place to demonstrate appropriate supervision was in place for the non-medical prescribers to ensure they were prescribing safely and within their competencies.

We undertook a series of remote clinical searches on the practice’s clinical record system to review if the practice was assessing and delivering care and treatment in line with current legislation, standards and evidence-based guidance. Overall, we found systems and processes in place minimised the risks associated with high-risk medicines. There were a very small number of patients who did not have all the interventions required by evidence-based research, but these were not as a result of system failures and the practice was working to ensure the interventions needed took place. For example, we found 586 patients had been prescribed aldosterone antagonist + ACEI/ARB (monitoring of blood electrolytes is essential in patients prescribed a potassium-sparing diuretic and an angiotensin converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) for heart failure). The searches indicated 23 (4%) patients had not been monitored correctly. We reviewed 5 patient records in detail and identified 2 had not been monitored in line with NICE guidance. Our clinical searches also identified 8 out of 62 patients prescribed Gabapentenoids (a medicine to treat epilepsy and nerve pain) had not had a medication review in the last 12 months. We reviewed 5 patient records and found 3 of these had not had a medication review or discussion regarding dosage. The practice was aware of these patients, and we were assured this was remedied during the assessment.