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GP Practices: Key themes following our inspections

Following recent assurance work, we have reported on a number of issues within GP practices across Wales. In some circumstances we have needed to ask the practices to take immediate action to reduce risks to patient safety.

Back to basics

We recently refreshed our General Medical Practice (GP) methodology and enhanced the methodology to include key elements such as mental health support services and the wider primary care landscape including referrals and signposting to other services. We now include a practice nurse peer reviewer on our inspection team to reflect the importance of the role and the extent of work they contribute to the effective running of a GP practice. We have inspected nine GP practices with our refreshed methodology in 2022/23.  

GP practices are under significant pressure and are facing unprecedented demand, impacted by long wait times at Emergency Departments and other areas of pressure on the NHS.  This pressure has been reflected in our findings, which have varied significantly.

However, patient safety is paramount, and we have noted clear risks to patient safety in many of our inspections. 

We have issued Immediate Assurance letters on five occasions.  For context, in 2019/20 inspection year, we completed 32 GP inspections and only required six Immediate Assurance letters.

The Immediate Assurance issues included (some of these have occurred more than once):

  • Incomplete safeguarding records and poor follow up of concerns
  • Checks of emergency equipment and drugs not completed
  • No DBS checks on staff including admin/reception staff
  • Medicines not safely stored
  • Medication fridge temperature checks not completed
  • Poor compliance with mandatory training including safeguarding, CPR and infection prevention and control 
  • Out of date equipment including sterile sutures, sterile gloves, urine sample collection packs, minor surgical operations packs and needles, some of which were dated 2006.

We consider mandatory training to be a vitally important part of maintaining patient safety at any healthcare setting.  Topics that are deemed mandatory, for example infection prevention and control, safeguarding and CPR, are mandatory because of real risks to patients and how a setting manages a potential incident.  In addition, the proper storage of medicines, and checks on emergency equipment, are again a requirement because of clear patient safety risks.  While they all take time to complete, the resource investment is worthwhile as it helps to protect patients and staff. 

Despite the service pressures, our patient experience surveys regularly conclude that staff treat patients with dignity and respect, but around a quarter of patients tell us they struggle to access an urgent appointment. 

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