i-HEART 365 Service - Out of Hours Service

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Leaders and staff shared a clear vision and culture focused on listening, learning and trust. However, we identified breaches of regulation relating to good governance because the provider did not have adequate systems or processes to identify and assess risks to the health, safety and welfare of people using the service. There was no system in place to monitor environmental safety, branch‑site risk assessments, or equipment used by locum GPs. Although an appraisal policy existed, not all staff reported receiving an appraisal within the last 12 months, and there was no process for long standing locum GPs to receive an appraisal. Whilst recruitment checks were appropriate, there was no oversight of staff immunisation status to confirm it was suitable and aligned with national guidance. Staff were able to describe how safety and medicines alerts were managed, but there was no recorded monitoring log of actions taken, and General Data Protection Regulation (GDPR) processes for outgoing calls required review. Leaders were visible, knowledgeable and supportive, and staff said they felt able to raise concerns and understood their roles and responsibilities. Managers engaged with the local community to provide high‑quality care and were open to new ideas, supporting a culture of ongoing 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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders had a clear understanding of the needs of the local population and also hosted the Primary Care Network (PCN) on behalf of Barnsley practices. Staff feedback gathered during the assessment was positive, with staff reporting that they felt supported by leaders and that the organisation fostered a positive culture.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. Staff told us leaders in the service were approachable and responded to any concerns raised. Staff told us they could access senior managers when they required support. We saw the leadership team worked with other practices within the PCN and were engaged in the development of primary care services within the local area.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. The service had established Freedom to Speak up arrangements and staff were aware of how to raise concerns.

The service strongly valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them. Policies and procedures to promote diversity and equality were in place and adjustments had been made to ensure all staff were valued, for example we saw adjustments to support staff who may have a disability were in place.

Improvements were needed to ensure that there were systems and processes in place to enable the provider to identify and assess risks to the health, safety and/or welfare of people who use the service. For example, there was no mechanism for monitoring the environment or safety risk assessments at the branch site where the provider was responsible for carrying out regulated activities, and the service did not have a system to provide assurance that equipment used by locum GPs had been appropriately tested for safe use. Although staff uploaded their immunisation status to the HR system themselves, there was no established process for reviewing this information to ensure it aligned with relevant guidance to support staff and patient safety. The service also received and acted upon safety alerts but did not maintain a monitoring record of these. In addition, staff making outbound calls did not routinely inform the general data protection regulation (GDPR) information message to patients.

Although the appraisal policy stated that all permanent and fixed‑term staff should receive an annual appraisal, some administrative staff reported they had not had an appraisal undertaken by this provider within the past 12 months and locum GPs—despite working regularly with the service for many years—did not receive an appraisal directly from the provider. Instead, they participated in the NHS appraisal scheme, which ensured they met professional requirements but did not provide the service with a formal mechanism to review or reflect on their performance within this service.

Despite these areas for improvement, the provider had implemented several strong governance processes suited to the needs of the service. These included effective monitoring arrangements for the safety of the main premises, infection prevention and control (IPC) oversight at both sites, systems to monitor staff training, and clear processes for managing incidents and complaints. Leaders and managers were supportive and accessible to staff, and all staff who fed back into the assessment understood their individual roles and responsibilities. Staff had access to all relevant policies and procedures through the services intranet system.

Managers held regular meetings with staff including quarterly clinical governance meetings where they reviewed clinical concerns and emerging risks. Locum GPs were required to attend one of these sessions a year. Actions from these meetings were clearly documented and shared with staff to support continuous improvement. Staff demonstrated a strong commitment to maintaining patient confidentiality and information security, although the absence of a GDPR‑compliant system to record outbound calls remained an area that required review.

The service recognised its responsibility to collaborate and work in partnership to ensure care pathways were seamless for people. They shared information and learning with partner organisations, for example, patients’ own GPs and worked jointly to support continuous improvement. As the provider also operated as a Primary Care Network (PCN), they employed additional staff through ARR roles to support the service and practices across Barnsley, for example, mental health workers who delivered specialist assessments and short‑term interventions for more complex cases to support patients receiving support sooner and reducing hospital attendances.

The provider had been recognised with a British Gymnastics Collaborative Partner Award 2026 for their contribution to the ‘Love to Move’ programme, which supported a reduction in falls among residents living in local care homes.

The service demonstrated a commitment to continuous learning, innovation, and improvement across the organisation and local system. They promoted creative approaches to ensuring equality of experience, outcomes, and quality of life, and acted on staff feedback. For example, by introducing monthly staff recognition awards. Plans were also in place to introduce a menopause champion and mental health first aiders to provide staff with additional knowledgeable support.

The provider supported the BEST website, which offers clinical training, links to local care pathways, and prescribing guidance for staff working both within the service and across Barnsley practices. Staff were encouraged to attend monthly training sessions through this. They had also redesigned driver and administrative roles into a combined post to create a more flexible workforce and to better support clinicians. Additionally, they were developing a more detailed induction pack to support both new starters and existing staff with comprehensive information and signposting which was due to be rolled out imminently.