Netherley Health 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 all quality statements under this key question. This is the first rated assessment of this service since the provider took over the contract. We rated this key question as requires improvement.

This service scored 62 (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. Processes were in place for staff to report incidents, near misses and safety events. Safety events were investigated, and lessons were learnt to identify any shortfalls, prevent a recurrence, and embed good practice. Staff felt overall that there was an open culture, and that safety was a priority. However, they were not confident that concerns about staffing were being addressed.

Incidents and complaints were investigated, and regular meetings were held where the learning from these were shared and discussed. The provider held a log of significant incidents and a log of complaints which they used to identify themes and trends.

Staff told us they were supported to identify their training needs and protected learning time was provided for them to undertake training, learning and professional development. Training was provided within the service and through attendance at locality wide training and educational events.

The provider worked with people who used the service and healthcare partners to establish and maintain safe systems of care. There were systems and processes to share information with staff and other agencies to enable them to deliver safe care and treatment and the service worked with other providers to deliver shared care.

Members of the staff team were aware of local services and support networks that they could refer patients to in order to support them with their needs and to prevent ill health. Reception staff had been trained in care navigation to direct patients to the most appropriate service or services to meet their presenting needs.

Regular multi-disciplinary meetings were held where the needs of patients with more complex conditions or those approaching the end of life could be discussed.

Clinicians followed care and treatment pathways for treating and referring patients to other services. Referrals to secondary or specialist care were made promptly, and patients referred under the two-week wait rule for suspected cancer were followed up appropriately. Correspondence from secondary care such as discharge letters/summaries were being processed quickly and effectively. The provider had identified a risk of backlog in this area and had recently outsourced the management of correspondence to mitigate this.

The service worked to safeguard people from the risk of abuse. This included working with partner agencies. There were systems and processes to respond when it was suspected that people may be subject to abuse or neglect.

Staff had been provided with safeguarding training at a level that was appropriate to their roles and responsibilities. Staff had a clear understanding of safeguarding and were able to tell us who the responsible lead for safeguarding was. They knew the action to take if they had concerns about a patient’s safety and they told us they would feel confident to report concerns. Alerts were added to the patient record system when a patient was subject to a safeguarding concern so that all relevant members of the staff team could readily identify this. The provider had a designated member of staff who was responsible for regularly checking the safeguarding register and liaising with relevant agencies.

Feedback from people who used the service did not include any concerns with regards to safeguarding.

Staff recruitment procedures were in place to ensure staff were appropriate to work in the service.

The service worked with people to understand and manage risks.

The care and treatment provided was safe, supportive and encouraged people to remain healthy. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Staff were trained in areas to support people who lived with long term health conditions, for example, diabetes. Patients were called in for regular checks on their health when they were living with a long-term condition.

There was an effective system in place for dealing with patient safety alerts.

The service was located in a purpose-built building that provided the required facilities such as safe access for people with physical disabilities.

The provider detected and controlled potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out on the premises, facilities and equipment provided. Contracts were in place to ensure the premises were clean and well maintained.

Health and safety related assessments and procedures to manage health and safety were in place. This included fire safety. Staff had been provided with training in health and safety related topics such as fire safety, infection control and manual handling. Staff told us in discussions and feedback forms that they had no concerns with the arrangements in place for ensuring health and safety.

There was a business continuity plan in place to provide guidance for dealing with a major disruption to the service, for example an IT failure.

Staffing levels were not sufficient to meet the needs of the people who used the service. Staff in a range of roles told us there were not enough staff to meet the demands of the service and people who used the service frequently reported a long wait time to obtain an appointment. Feedback from people who used the service that was shared directly with CQC showed levels of dissatisfaction with access to clinicians. The provider was in the process of reviewing the staffing establishment. This was required as a priority to ensure sufficient numbers of clinical and non-clinical staff with the right skills, qualifications and experience are working at the service. This review should include an assessment of the needs for cover for all roles including GPs (relative to patient list size) and the requirements for the sufficient provision of appointments. We looked at the actual number of appointments being provided on a sample of days over a 4-week period. This did not support the appointment data as shared by the provider. The provider must consider this as part of their review of capacity and demand and appointment provision. Staff told us that staffing concerns had been compounded by a reduction in the clinical team when an advanced nurse practitioner (ANP) had left and had yet to be replaced. The provider told us they were currently looking at capacity and demand and looking at information to capture contacts and the use of digital/on-line service provision. The nursing model was also under review in consultation with the nursing team. This was to include an assessment of the current model of working across multiple sites and the speciality training of nurses. Another area of work in progress was to establish a clearer picture of the prevalence of patients with long term and multiple health conditions and assessing acuity of patients to support decisions around the staffing establishment.

Staff told us they would like to have more presence from the management team to support them in their roles particularly as there had been changes across the team and changes in the skill mix of staff. Some staff described low morale and feeling isolated from the provider’s other services and clinical and administrative hub.

Staff told us they had protected learning time for them to undertake training, learning and professional development and that they had received training appropriate and relevant to their role.

There were arrangements in place for covering staff sickness, absence and vacancies and the use of temporary staff was minimal.

We looked at the recruitment records for a sample of staff. These showed recruitment practices were carried out in line with requirements. However, the provider should consider the process for securing documentation when staff are transferred from another provider.

All new staff underwent an induction programme and were required to undertake mandatory training within an appropriate timescale.

The facilities and premises were purpose built and appropriate to provide clinical care and minimise the spread of infection. Personal protective equipment was in good supply and located appropriately around the premises.

The provider assessed and managed the risk of infection. There were clear roles and responsibilities around infection prevention and control with a dedicated lead person and staff had undergone training appropriate to their role.

Cleaning schedules were in place and infection prevention control and cleaning audits were carried out on a regular basis. Cleaning equipment was stored securely and in line with best practice.

The provider made sure that medicines and treatments were safe and met people’s needs. Our review showed that medicines were managed safely and the approach to medicines reflected current and relevant best practice and professional guidance. Staff followed established processes to ensure people prescribed medicines with specific risks received the recommended monitoring. Our review of the patient clinical record system showed that patients who were prescribed high risk medicines were being monitored effectively.

Regular medicines reviews were carried out for people who used the service to ensure their medicines were safe and appropriate to their needs.

Staff had access to emergency medicines and equipment including oxygen and a defibrillator. These were regularly checked for stock availability and to ensure they were in date. Vaccines were stored appropriately, and regular checks were carried out to ensure safe storage and stock.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Appropriate action had been taken in response to the medicines alert we looked at.

The provider was aware of and acting upon prescribing data to improve the prescribing of medicines generally and where data showed prescribing of higher risk medicines were higher than local and national averages. Our review of data showed improving trends in this.