BPAS Healthcare

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 proactive, systematic approach to learning. When people raised concerns about safety and ideas to improve, the primary response was always to learn and improve. There was strong awareness of the areas with the greatest safety risks. Solutions to risks were developed collaboratively. Managers investigated incidents thoroughly and the provider was open and transparent when things went wrong. Women were protected by a strong approach to safeguarding. Staff understood and managed risks. The facilities and equipment met the needs of women, 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. Staff managed medicines well and involved people in planning any changes.

We rated this key question good. This meant people were safe and protected from avoidable harm.

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders embedded, maintained, and sought to continuously improve a culture of openness and collaboration. Safety was everyone’s top priority. Systems and resources were available to support continuous learning in response to identified safety risks. Systematic approaches to learning were embedded, incorporated and supported an active, participatory learning processes. Staff were actively encouraged to raise concerns about safety and ideas to improve, and the value of learning was continually demonstrated and reinforced by leaders. There was evidence of improvements in delivery of care and treatment as a result of learning.

Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice. Due to the volume of women that were assessed each day there was a daily incident meeting, chaired by the quality and safety matron and attended by the compliance lead and the managers from all the telemedical services across the organisation. The meeting looked at incidents to ensure they had been correctly graded, and actions had been put in place to reduce the likelihood of similar incidents occurring again. Incidents that required action were assigned to a named person to ensure the actions were carried out within agreed timescales. If an incident required urgent action a separate meeting would be convened so immediate action could be taken. When urgent action was required the meeting would include the organisation’s subject experts and safeguarding leads.

We attended a meeting to look at incidents. The incidents discussed included retained products of conception, and a problem with an appointment. The system recorded the appointment as being cancelled and so the women had not been called to be assessed at the time she expected. The appointment was rebooked as soon as staff were made aware of the issue. We observed during the meeting staff had opportunities to ask questions and contribute to the discussions. We saw all actions were recorded so they could be tracked and reviewed at subsequent meetings.

Staff investigated incidents of infection and failed termination of pregnancy to look for learning. They used a root cause analysis approach to identify the fundamental causes of the problem with the goal of preventing recurrence.

Staff told us they were encouraged and supported to raise concerns. They felt

confident that they would always be treated with compassion and understanding, and would not be blamed, or treated negatively for reporting incidents and or raising concerns. They understood raising concerns helped to proactively identify and manage risks before safety events happen.

Staff told us they received feedback from incidents they reported and had regular learning opportunities to discuss locally reported incidents, as well as incidents that had occurred in other parts of the organisation. Learning points from the previous month’s incidents were shared on staff bulletin boards. The service produced a weekly newsletter that contained important information about incidents and policy updates. Staff were allocated 30 minutes each week to read the newsletter.

A senior leader told us they had seen a trend in incidents regarding the recording of women’s consent. During the summer of 2024 there had been a 0.7% error rate in the correct recording of consent. A member of staff took this issue to the quality improvement board as an idea for a service improvement project. To reduce the error rate, the quality improvement board designed a ‘make it match’ campaign to remind staff of the importance of recording the correct consent for the right procedure. The campaign included information and posters being displayed on staff notice boards and discussions being added to the agenda of the quarterly hub learning days and at regular staff meetings. The aim of the campaign was to ensure a 0% error rate. At the time of our inspection, 8 months into the make it match campaign, the error rate for recording consent had reduced to 0.1%.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people needed to speak to different members of the team.

Safety and continuity of care was a priority throughout people’s care journey. This happened through a collaborative, joined-up approach to safety that involved staff working with partner organisations to ensure women remained safe. There were clear referral pathways with agencies including early pregnancy assessment units, mental health services, domestic abuse support services, and sexual assault referral centres. Staff also worked collaboratively with agencies that supported people from different cultures.

People who were not found suitable for abortion treatment by the provider were either referred to the organisation’s specialist placement team or a specialist NHS team. NHS referrals included women with a gestation longer than 23 weeks and 6 days.

Women could choose to receive a discharge letter once they were confirmed suitable for a medical termination of pregnancy and a prescription for their medicines had been issued. Women could also agree to have a copy of the letter sent to their GP. The discharge letter could be used to advise health providers what medication had been taken, in the event of a medical emergency.

The organisation had a centralised aftercare team that could be contacted 24 hours a day 7 days a week. All women were advised to contact that team if they had any concerns during or after their termination of pregnancy.

The service worked well with people to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always shared concerns quickly and appropriately.

During the assessment process NMPs spoke to women about safeguarding. They explained that if they had safeguarding concerns, after discussion with the women, they would make a referral to the relevant safeguarding team. They also advised that if a safeguarding concern had been identified and they were unable to recontact the woman, they would escalate their concerns. For example, if a referral had been made to a safeguarding team and the NMP wanted to update the women about the referral or seek further information, but the women did not respond, the team would escalate their concern in case the women was actively avoiding the safeguarding team.

Referrals made to safeguarding teams included for homelessness, late disclosure of pregnancy, and coercive partners. Referrals to the Multi-Agency Risk Assessment Conference were made if staff identified high risk domestic abuse cases. There was a process for monitoring safeguarding concerns raised by the clinic and telemedical teams.

There was a strong understanding of safeguarding and how to take appropriate action. Staff told us they felt comfortable discussing safeguarding concerns with women because they were well trained and were supported by senior staff at all times. Staff told us about the type of reasons they would make safeguarding referrals for and gave examples of the times they had done this.

When things had not gone as planned, staff had a debrief so action plans could be developed, and learning could be shared to improve processes. Staff said they could step away from calls and take some time out to reflect and process after a difficult call.

Information about safeguarding services was readily available for staff. There was a process to ensure staff in the clinic and telephone hub could make almost immediate contact with a safeguarding lead or a senior lead through a computer-based chat function. NMPs could request and receive support from safeguarding leads if issues arose during the assessment process. The chat function was available to NMPs throughout the duration of their shifts.

Staff received training in safeguarding adults and safeguarding children in line with national intercollegiate guidance. The safeguarding leads supported other staff with safeguarding advice and training. A safeguarding lead told us they delivered monthly safeguarding training that included telemedical based events scenario learning.

An automatic safeguarding referral was made for all women under the age of 16. Treatment for women under the age of 13 was coordinated by the specialist safeguarding team. All women under the age of 18 had part of their assessment conducted over a video call. This was to help NMPs assess women’s safety and explore any safeguarding concerns, such as coercion into abortion treatment. Additional questions were included in the assessment process for young women to assess their sexual safety.

The service always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Women were given information about risks and complications involved in having a medical termination of pregnancy, and assessed to ensure medical abortion treatment was legal, suitable and safe for them. Women were asked to consent to treatment and acknowledge they understood the risks.

Women were assessed to determine if they were high risk for complications. To help reduce risks related to medical termination of pregnancy, women were assessed to establish the gestation of pregnancy. Understanding the gestation of pregnancy was also a legal requirement for having a medical termination of pregnancy as this could only be carried out by women in their own home if their pregnancy was less than 10 weeks gestation. If there was any doubt about the length of gestation, women were asked to attend a clinic for an ultrasound scan to determine the gestation. NMPs explained to women it was illegal for them to supply medication to terminate a pregnancy above 10 weeks gestation. They also advised if a medical termination took place after 10 weeks gestation this could result in increased risk to their health.

To ensure safe and effective treatment women were referred for an ultrasound scan if there was uncertainty about their gestation of pregnancy or there was a history of ectopic pregnancy. All women under the age of 16 were referred for an ultrasound scan because it is more difficult to accurately date length of gestation from information about menstrual cycles in young women. If a woman had had a termination of pregnancy within the previous 3 months they were also routinely referred for an ultrasound scan.

Staff had access to an online suitability tool. The tool showed which medical conditions and medicines were contra-indicated for a medical termination. The organisation also had a ‘suitability team’. This was a team of doctors that could review a woman’s medical history if there was any uncertainty regarding their suitability for treatment. Women were also assessed for risk of venous thromboembolism (VTE), which included taking a family history of VTE.

Important information was displayed in red font to ensure staff could see this information quickly. This included information about allergies, safeguarding forms, concerns around female genital mutilation, and the age of the women seeking treatment.

The service used a structured tool, the SBAR, to communicate important messages to staff and improve patient safety (an SBAR structures information into 4 categories, situation, background, assessment, and recommendation). SBARs provide a clear framework for sharing information to help reduce misunderstanding and errors. SBARs were communicated to staff by email. Staff told us they were required to sign to say they had read and understood important messages.

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

Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care. Staff told us they checked equipment, including computers, at the start of each day.

The telemedical hub was bright and airy and visibility clean. It was suitability furnished.

Portable appliance testing (PAT) took place annually and was last performed the week before our assessment. PAT tests are safety checks for portable electronic appliances to ensure compliance with health and safety regulations. All of the portable electronic appliances we looked at had stickers that showed the date the appliances were next due to be tested.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

A team of doctors were employed by the organisation and could be contacted at all times through an online messaging platform.

To ensure managers had sight of emerging risk, they kept in contact with staff who worked remotely through an online group instant messaging platform.

Staff used an online system to complete mandatory training. The system reminded them of any new or refresher training they needed to complete. Managers monitored compliance with training and ensured staff were allocated time to complete any outstanding training requirements. All staff had an annual appraisal, and NMPs staff were expected to participate in group, individual, and safeguarding supervision. Compliance with mandatory training including safeguarding training, appraisals, and supervision was consistently above the organisational compliance target.

All new staff received an induction. Clinical staff were supernumerary for their first 8 weeks so they could shadow other NMPs to understand and feel confident in their new role.

To maintain safe staffing levels and avoid cancelling appointments, staff supported staff shortages in other parts of the country by increasing the number of assessments they performed. This was a reciprocal arrangement that benefited all 5 of the BPAS telemedical teams across England.

If NMPs wanted to progress into more senior roles, they were provided with managerial development opportunities.

There was a process for managers to follow to check that all staff had an up-to-date Disclosure and Barring Service check and, where applicable, had kept their nursing or midwifery registration up to date.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading.

No patients were seen on the premises. However, there were processes to ensure staff were protected from risk of infection. Housekeeping staff cleaned the premises daily, and audits of cleanliness and the environment were undertaken quarterly. The audits for July 2024 demonstrated 99% compliance with expected standards. The audits for October 2024 and January 2025 demonstrated 100% compliance with expected standards of cleanliness.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Once their assessment was complete and women had been found suitable for abortion treatment, the prescription for the medication was automatically generated. The prescription required signatures from 2 doctors. This part of the process was performed remotely. Medicines for an early medical abortion were sent to people by post from a third-party provider. We saw an example of the pack containing medicine sent by post. The boxes had labels to clearly show what they contained and how when the medicine needed to be used. An information booklet was included in the pack. This contained information about the medication and step by step instructions about how and when to use the medication.

Accurate, up-to-date information about women’s medicines was available, particularly when they move between health settings, in line with current national guidance. For example, if a woman required emergency medical treatment. Women could choose to have an email containing details of their treatment in case of emergency. However, not all women wanted this information sending to them.