Tollgate Medical Centre

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 seven quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good.

During the assessment, we reviewed policies, spoke with staff, and undertook observations while on site. The practice had systems, processes, and practices to safeguard people. Staff had the information needed to deliver safe patient care and treatment. There were arrangements for reviewing and investigating safety and safeguarding incidents and events when things go wrong.

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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the PPG felt the provider took concerns seriously and proactively made improvements to the service.

Feedback from staff and leaders demonstrated that the practice had a culture of identifying incidents and complaints, learning, and improvement. Staff told us they could raise concerns and report when things went wrong.

The practice had a significant event and complaints policy and a reporting form that was accessible to all staff. Incidents were discussed during team meetings, and the learning outcomes were shared with staff. The provider carried out patient surveys, analysed the feedback and acted based on the results. For example, they introduced a new telephone system based on patient feedback; following implementation the practice conducted monthly telephone audits to monitor their progress.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

All staff knew who the safeguarding lead was. Clinical staff regularly had discussions during clinical meetings; staff were aware of female genital mutilation and trafficking requirements, and the practice used system searches to follow up with patients who did not attend appointments.

There were regular discussions between the practice and other health and social care professionals, such as health visitors, school nurses, community midwives and social workers, to support and protect adults and children at risk of significant harm. Partners told us they had no concerns about the practice's safeguarding processes.

Safeguarding policies and procedures were available and accessible to all staff. There were regular discussions between the practice and other health and social care professionals to support and protect adults and children at risk of significant harm. We reviewed four staff files and found safeguarding training was provided appropriately for all clinical staff. However, the practice’s staff training matrix showed there were a few gaps in basic life support (BLS) and safeguarding training for clinical staff. Namely, six members of the clinical team were overdue in BLS training, one receptionist was overdue safeguarding adults, level 1; two back-office staff members’ training was also overdue in this subject. The provider told us that they monitored staff training closely and that staff had received reminders to complete it. We reviewed the practice’s team meeting minutes and saw that the training matrix, which showed the training gaps, was noted to be sent to staff in August 2024 as a reminder to complete their training.

During the factual accuracy process, which allows providers to correct inaccuracies or address evidence gaps, the provider clarified that most overdue training resulted from staff leave. They subsequently submitted evidence confirming that all safeguarding and BLS training is now up-to-date.

During this assessment, we spoke with four patients. They told us they felt involved in their care and treatment.

Staff told us that patients were involved in their care and treatment.

The practice had multiple systems to support effective risk management. We saw that identified risks and lessons learned were discussed during clinical meetings, and the practice manager shared the meeting minutes with staff. Patients identified as at risk were involved in discussions and informed of options to minimise risks.

Staff knew who the lead staff members were, such as the infection control and safeguarding leads. Leaders informed us they regularly reviewed policies, and all staff had access to them. We reviewed the minutes of the practice's practice meetings and saw that leaders shared information and safety concerns.

We observed the facilities and equipment as well-maintained and suitable for their intended use.

The practice had a range of risk assessments in place, including legionella, waste management and health and safety risk assessments. Medical equipment was calibrated, and portable appliance testing was undertaken to ensure it was fit for purpose and in good working order.

Patients told us they felt clinical staff were effective in their role and did not identify any concerns with staffing levels.

Leaders explained their recruitment processes to ensure appropriate numbers of suitably trained staff were employed to support the delivery of consistently safe, good-quality care that met the needs of the patient population. Staff told us they received the support needed to deliver safe care and could request additional training or support.

There were various policies related to the management of the practice to help maintain a safe and effective workforce. This included recruitment, appraisal, supervision, incident reporting, performance management and training and a Disclosure and Barring Service (DBS) policy.

We checked four staff files; there were no concerns that the staff had completed role-specific training. All staff files we checked had an up-to-date DBS check at the appropriate level and in accordance with the practice’s DBS policy. The provider shared their staff training matrix, which showed gaps in staff training across a range of subjects. The provider shared the steps taken by a senior leader to improve their staff training completion rate, such as sending reminder emails and discussing training requirements during staff supervision. However, we did not see staff training on clinical and reception staff meeting minutes as a standing item.

As part of the factual accuracy process, which allows providers to highlight any inaccuracies or incomplete evidence in the report, the provider confirmed that training is a standing agenda item in full practice meetings to ensure all staff are targeted but is not an agenda item for all practice meetings. They clarified that three staff members with outdated training were on long-term leave, though this was not evident for all of the three staff members during the inspection or reflected in the training matrix. Following the inspection, the provider submitted evidence confirming that staff training is up-to-date for all but one staff member and has updated their training matrix to reflect those on leave.

Patients told us the practice was always clean and well maintained.

Staff were able to confidently discuss their infection prevention and control (IPC) responsibilities. They knew who the IPC lead was and how to report concerns. Leaders were able to discuss the processes to support effective IPC management.

The premises were visually clean, hygienic, and uncluttered. We reviewed the practice's cleaning records, which showed regular cleaning.

Policies and procedures were available to staff, which provided guidance and information on IPC practices. Staff had completed the infection prevention and control training relevant to their role and had all undergone sepsis training. The provider had an IPC lead and waste management process. The practice’s IPC audit in May 2024 had an overall compliance rate of 98.4%. The practice had acted on the issues identified in the audit.

People told us that they were able to get an appointment when they needed and were appropriately involved in decisions about their medicine. Results from the practises latest GP patient survey showed: The practice was in line with the local and national average for the percentage of people that felt they were involved as much as they wanted to be in decisions about their care and treatment during their last General practice appointment.

Clinical staff described the practice's processes to ensure appropriate clinical oversight and told us how they monitored patients' health, including their use of high-risk medicines. We found that staff had good knowledge of current and relevant best practice and professional guidance.

During the on-site inspection, we saw evidence that staff monitored and recorded fridge temperatures daily. The staff knew what to do if the fridge temperature went out of range. Emergency medicines were securely stored, accessible, and monitored for use-by dates. Prescription stationery was removed from clinical rooms and stored in a locked cabinet, and their use was monitored.

The practice had a process for monitoring patients’ health using appropriate monitoring and clinical review before prescribing. There was a system for recording and acting on safety alerts. Our GP specialist advisor carried out a remote review of the clinical record system and found the practice had taken appropriate action in response to safety alerts received. There was an effective system to evidence the competence of non-clinical medical prescribers, including clinical supervision and prescribing audits. We reviewed two of the practice’s clinical audits conducted within the last two years and found that both were carried out appropriately and contributed to improvement in prescribing for patients. The practice had appropriate policies and procedures to govern prescribing effectively.

During the remote clinical searches, we identified two diabetic patients who had received their medication reviews within the required time frame; however, their reviews were not coded (uncoded medication reviews may prevent practices from effectively analysing information, such as prescribing patterns).

The remote clinical searches carried out by our GP specialist advisor indicated that patients' care and treatment were managed in line with current guidance and that information, including examination, management plans, safety netting, and follow-ups, were adequately documented. Patients prescribed medicines were monitored and reviewed in the required timescales, ensuring that all information needed was available for safe prescribing.

The practice’s latest prescribing performance data showed that it achieved above the local averages in three of the six indicators and in line with the local averages in the remaining three indicators.