i-HEART 365 Service - Out of Hours Service

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• 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

At our last assessment, this key question was rated good. However, concerns regarding the delivery of safe services contributed to a requires improvement rating for well-led services and a breach of regulation. This was because the provider lacked adequate systems and processes to identify and assess risks to the health, safety, and welfare of people using the service. Since the last assessment, the service has made significant improvements and is no longer in breach of regulation.

At this assessment, the rating in the safe key question remains rated as good. Staff understood and now managed safety risks at the branch site. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience and safe recruitment processes were in place. Managers made sure staff received training and regular appraisals to maintain high-quality care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service now detected and controlled potential risks in the care environment including the branch site. They made sure equipment, facilities and technology supported the delivery of safe care.

The main site had effective systems and processes in place to maintain a safe environment. Comprehensive health and safety risk assessments and audits had been completed, and action had been taken to address identified risks. Leaders had developed processes and now had oversight of the health and safety arrangements, including risk assessment and audits undertaken at the branch site to ensure risks were identified, assessed and mitigated appropriately. The provider had strengthened oversight of equipment management through the introduction of an equipment monitoring tracker. This provided assurance that all equipment was suitable for use, tested, maintained and serviced in accordance with manufacturers’ recommendations. Records demonstrated that this was subject to monthly monitoring.

Vehicles used to undertake visits had received the appropriate maintenance checks and testing to ensure they were safe and fit for purpose. The service had a business continuity plan.

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

There were a range of clinical and non-clinical roles with most clinical positions held by long‑standing locum GPs of many years. We found that staff training was up to date and being monitored, learning and development needs were now appropriately identified and managed, and staff were working within their agreed scope of competence. All staff had now received an annual appraisal, and the provider had introduced a structured annual check-in process for locum GPs. This complemented the national GP appraisal scheme and provided additional assurance that the learning, development, and performance of locum GPs within the service were being effectively monitored and supported.

Clinical supervision, learning and development primarily took place during quarterly clinical governance meetings, where incidents, complaints, safeguarding matters and complex cases were discussed. Locum clinical staff had previously been required to attend one session per year; however, this had increased to 2 sessions annually to strengthen clinical supervision. Staff undertaking clinical roles, such as physician associates, had an allocated mentor and were supported by a locum GP who maintained oversight of, and reviewed, their daily consultations.

Safe recruitment practices were followed, and the provider had implemented a system to review and maintain clinical oversight of staff immunisation status.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.