NHS Cleanliness Standards for GP Practices in 2025

Key Differences from 2021 standards

GP practices must adhere to evolving NHS cleanliness standards to ensure safe, hygienic environments for patients and staff. The NHS National Standards of Healthcare Cleanliness 2025 update and replace the 2021 standards (NHS England » National standards of healthcare cleanliness 2025). Below we analyze key differences between the 2025 and 2021 standards – focusing on changes relevant to English GP (General Practice) surgeries – and provide a comprehensive work pack to help practices comply with the 2025 requirements. This work pack includes standard operating procedures, an audit schedule, and guidance on staff training, serving as a practical resource for UK GP practices.

Key Changes in 2025 Standards (Compared to 2021) and Impact on GP Practices

• Expanded Scope (Ambulance Services Included) – The 2025 standards now encompass all healthcare settings, explicitly including ambulance trusts and patient transport vehicles. (By contrast, the 2021 standards focused on hospitals and primary care facilities.) While ambulance-specific requirements may not directly affect GP clinics, this expansion underscores that every NHS-funded setting, including GP surgeries, is expected to meet national cleanliness criteria. GP practices should be aware that any patient transport or ambulance services they interface with are held to the same rigorous cleaning standards.

• Emphasis on Transparency and Public Assurance – The updated standards put greater emphasis on visible cleanliness outcomes. Healthcare sites must display a “Commitment to Cleanliness” charter with a star-rated hygiene score for each area, akin to a “Scores on the Doors” rating. This requirement, introduced in 2021, is reinforced in 2025 to assure patients and the public that safe cleanliness levels are being met. GP practices are expected to post the cleanliness charter in prominent areas (e.g. waiting room or entrance), showing the cleaning schedule, responsible staff, and a star rating reflecting audit results. This increases scrutiny, as patients can readily see if a practice is up to standard. Practices must update these displays after each formal cleaning audit to maintain transparency.

• Functional Risk Categories – Six-Level Risk Rating – The 2021 standards introduced a risk-based approach with four functional risk categories (Very High, High, Significant, Low risk). The 2025 version increases flexibility by utilizing six Functional Risk (FR) categories (FR1–FR6). (Two additional risk levels were added to the original four, allowing finer gradation of areas by infection risk.) Healthcare organizations can continue with four categories if already in use, but the expanded six-tier system enables more tailored cleaning frequencies – increasing or decreasing an area’s risk level as needed. For GP practices, this means each area (e.g. minor surgery room, general exam rooms, waiting area, offices) should be assessed and assigned an appropriate FR category based on patient exposure and infection risk. Higher-risk areas (e.g. treatment rooms where invasive procedures or blood exposure occur) may fall into FR2 (High risk), requiring more frequent and thorough cleaning, whereas administrative offices might be FR6 (Very low risk) with less frequent cleaning. Practices must document a justification for each area’s risk category and review it at least annually or if the room’s usage changes, ensuring the cleaning regimen remains appropriate.

• Updated Cleaning Elements and Frequencies – The 2025 standards include an updated list of 60 cleaning elements (items/surfaces to be cleaned), up from 50 elements in the 2021 guidance. Eight new elements are specific to ambulance environments, and the remainder refine existing categories. While most new items relate to ambulance vehicles (not applicable to GPs), practices should review the full elements list and confirm which apply to their setting. Each element comes with a performance standard (what “clean” looks like) and an assigned cleaning frequency based on the area’s FR category. The 2025 standards explicitly link “safe cleaning frequencies” to each element and functional risk area. For example, an examination couch in an FR2 treatment room might require a full clean daily (and between patients), whereas a shelf in an FR6 admin office might be cleaned monthly. GP clinics need to align their cleaning schedules with these frequency guidelines, ensuring that high-touch, patient-contact surfaces in clinical areas are cleaned much more often than low-risk areas.

• Efficacy Audits (Process Auditing) – A notable enhancement in 2025 is the focus on auditing not just cleaning outcomes but also the cleaning process itself. The standards now detail “efficacy audits,” which broaden the audit function to evaluate how cleaning is carried out (technique, equipment, correct procedures) in addition to verifying that the environment is visually and hygienically clean . Under the 2021 regime, audits primarily measured technical cleanliness (e.g. visual inspection or ATP swab results). Now, GP practices must also periodically observe and assess cleaners’ methods – for example, confirming that staff follow the correct Standard Operating Procedures, use appropriate PPE and color-coded tools, and adhere to contact times for disinfectants. This change means increased scrutiny on training and technique: it’s not enough for a room to appear clean; the practice must assure that cleaning is performed according to protocol. Efficacy (process) audits should be scheduled at least annually in GP settings, or more often for higher-risk areas, to identify any procedural gaps and retrain staff as needed.

• Pandemic and Infection Surge Preparedness – Reflecting lessons from COVID-19, the 2025 standards incorporate guidance on maintaining cleanliness during pandemics or major infection outbreaks. It directs organizations to have contingency plans for enhanced cleaning in such scenarios (see Section 5.7 “Cleaning operations through a pandemic”). While the 2021 standards were published during the COVID era and emphasized infection prevention generally, the new standards explicitly require practices to be able to “review and increase cleaning frequency, adjust auditing, and minimize non-essential activity” during a pandemic. GP practices should ensure their infection control policy includes surge cleaning protocols – for example, more frequent disinfection of waiting areas and isolation of suspected infectious patients – and that staff are trained to implement these heightened measures when needed. This is an area of increased scrutiny, as regulators may ask how practices would maintain cleanliness if another pandemic or high-consequence infection arises.

• Strengthened Governance and Accountability – The updated standards reinforce that maintaining cleanliness is an organisational responsibility tied to regulatory requirements. They explicitly reference Regulation 13 of the Health and Social Care Act 2022 (which updated earlier regulations on safe care environments). This regulation mandates that healthcare premises must be clean, secure, suitable, and properly used, and that providers “maintain standards of hygiene appropriate to the purposes for which they are being used”. For GP practices, this underscores a legal duty to meet cleanliness standards as part of the CQC Fundamental Standards (which include cleanliness and infection control). The 2025 standards, together with the Health and Social Care Act and the Code of Practice on infection prevention, form an assurance framework that CQC inspectors will use to assess compliance. There is greater expectation that GP surgeries have: a named cleaning lead responsible for oversight (a requirement under CQC’s regulation 15), documented cleaning schedules and policies, adequate resources allocated to cleaning, and a governance process to review cleaning performance at board or partner level. In practical terms, GP practices should formally assign a lead (e.g. the practice manager or an IPC lead nurse) to oversee environmental cleanliness, ensure cleaning contracts include the new standards (as contracts must embed these standards and audit requirements, and report on cleaning performance within their internal clinical governance meetings.

• Continued Focus on Collaborative Cleaning Responsibility – Both the 2021 and 2025 standards highlight that keeping a healthcare environment clean is a shared responsibility. The 2025 update continues to promote a “collaborative approach” – recognizing that different staff groups (domestic cleaners, clinicians, nurses, admin staff) often each clean certain items, and all must work together to achieve an area’s overall cleanliness target. Importantly for GP practices – where dedicated cleaning staff may be part-time or only on-site after hours – day-to-day cleanliness also relies on clinical and admin staff (e.g. wiping down examination couches or keyboards between patients). The star rating for an area reflects the whole area’s cleanliness, not just the cleaner’s performance on their tasks. The Commitment to Cleanliness Charter (required to be displayed) explicitly reinforces that “cleanliness is everybody’s responsibility…from the Chief Executive (or practice leadership) to the cleaner”. This means GP teams should foster a culture where, for example, doctors and nurses understand their role in infection control cleaning, and there is clear communication and handover between staff and contract cleaners about any issues. In summary, the 2025 standards don’t introduce new collaborative roles beyond 2021, but they stress continued vigilance and teamwork – something CQC will expect GP practices to demonstrate (e.g. through training records and staff interviews about cleaning duties).

The above changes collectively raise the bar for cleanliness in primary care. GP practices will need to ensure compliance with stricter auditing and display requirements, adjust cleaning protocols to meet prescribed frequencies, and invest in staff training and oversight. The following sections provide a Work Pack to help GP practices implement these standards effectively, including model SOPs, an audit schedule, and guidance on training.