Gravesend 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

The service had a learning culture and people could raise concerns. Managers investigated all reported incidents to reduce the likelihood of them happening again. If things went wrong, staff acted to ensure people remained safe. Staff provided people with support and information on their care and treatment. 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.

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 service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, they discussed and learnt from clinical and non-clinical issues. Staff felt there was an open culture, with a “no blame culture” and that safety was a top priority.

Staff and leaders demonstrated their understanding about how to raise significant events and the process for complaints. They were able to provide examples of recent incidents, as well as the learning that took place to improve care.

The provider 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. Learning from incidents and complaints resulted in changes that improved care for others.

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. Referrals and test results were managed in a timely way. Staff demonstrated a clear understanding of the process for handling urgent referrals and were able to explain their responsibilities in following up to ensure that patients had received and attended their appointments. Staff explained that although workload was high, there were processes to identify any capacity issues, and they felt this was addressed.

We saw systems were in place to ensure urgent referrals were completed within an appropriate time frame, and staff understood their responsibility to follow up on these referrals.

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. The provider had a designated safeguarding lead and deputy. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. All staff knew how to identify and report concerns. Safeguarding concerns were discussed in clinical meetings. Staff demonstrated they understood their responsibilities. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The practice actively monitored its most vulnerable patients and demonstrated a proactive and diligent approach to ensuring their well-being.

There were systems and processes in place to flag records for vulnerable children and adults. The provider had recently reviewed the application of alerts to ensure they were accurate and alerted staff to appropriate records for parents, carers and siblings.

There were notices in the practice that advised patients chaperones were available if required. We looked at the personnel records of staff who acted as chaperones. We saw they 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 people barred from working in roles where they may have contact with children or adults who may be vulnerable).

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. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

Staff informed us there were systems in place to schedule appointments for patients with long-term conditions as well as for immunisations and screening tests. They also said that if children or vulnerable individuals were not brought to their appointments or failed to attend, this would be flagged to practice management for follow up.

The practice had an up-to-date staff immunisation policy and we saw evidence that staff had received vaccinations in line with this. Staff had completed annual fire safety training and staff appointed as fire wardens also received appropriate training. The practice was equipped to respond to medical emergencies (including suspected sepsis) and staff were suitably trained in emergency procedures. The practice maintained appropriate equipment and emergency medicines. There were systems in place to monitor stock levels and expiry dates. There was medical oxygen and a defibrillator on site and systems to ensure these were regularly checked and fit for use. All medicines and equipment we checked were in date and stored securely.

Records showed that fire drills and fire alarms were regularly tested. Records also showed that calibration testing of equipment had been carried out within the last 12 months. Records showed that portable appliance testing was booked to take place in March 2025.

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

Health and safety risk assessments and audits had been undertaken and risks identified had been addressed.

There were systems and processes in place to identify fire safety risks. They had recently revised their fire risk assessment to ensure people with mobility difficulties could safely exit the building.

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 were a range of clinical and non-clinical roles within the practice. 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 performance and conduct was monitored, and poor performance was addressed. This was achieved through supervision, appraisal and support.

Safe recruitment practices were followed.

During our site visit we observed clinical rooms. We saw the practice had maintained appropriate standards of cleanliness and hygiene. The practice employed an external cleaner, and we saw that cleaning schedules and Control of Substances Hazardous to Health (COSHH) risk assessments were maintained and checked by the provider.

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. Regular audits were completed, and actions taken to mitigate risks. Clinical staff used single use items and had access to body fluid spillage kits to mitigate the risk of infection.

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 regularly monitored the emergency medicines held by the practice. Monitoring records were comprehensive and listed all emergency medicines. The practice stored medical gases, such as oxygen, safely and had systems in place to ensure it was regularly checked and fit for use.

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 and were competency assessed on medicines optimisation.

Staff followed protocols to ensure they prescribed medicines safely, and ensured people received recommended medicines reviews and monitoring. The provider had effective systems to manage and respond to safety alerts and medicine recalls.

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. For example, the number of antimicrobials issued by the provider was lower than local averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

We reviewed fridge temperature monitoring records for medicines requiring refrigeration to assess compliance with national guidance. There were systems and processes in place to monitor fridge temperatures to maintain the integrity of stored medicines.

The provider recently reviewed their processes for authorising Patient Specific Directions (PSDs – are an instruction to supply or administer a medicine written and signed by the prescriber) to ensure all were completed.

Blank prescription forms were stored securely, and a tracking system was in place.