i-HEART 365 Service - Extended Hours

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 positive learning culture where people felt able to raise concerns, and managers investigated incidents thoroughly. People were protected and mostly kept safe, although there were some gaps in oversight of environmental and equipment safety checks. Staffing levels were appropriate, and staff had the right skills, qualifications and experience. Recruitment checks were generally suitable, but there was no oversight to ensure staff immunisation status aligned with national guidance. Managers ensured mandatory training was completed, though not all staff had received an annual appraisal in line with the service policy. Staff managed medicines effectively, and there were strong infection prevention and control measures in place. Although safe is rated as good, concerns identified in relation to the delivery of safe services have contributed to the rating of requires improvement for the delivery of well-led services and a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 69 (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. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others. For example, after a staff member was unable to access the clinical system because their access pass had failed, the service developed a new standard operating procedure to ensure administrators could unlock access during evening and weekend shifts.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. For example, the provider had effective systems in place to ensure that patient consultation notes were shared promptly with the patient’s own GP.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The service shared concerns appropriately. Safeguarding policies and procedures were in place and staff, including locum staff, knew how to access them. Staff were appropriately trained in safeguarding procedures.

The service provided care to meet people’s needs that was safe and supportive. Emergency equipment was available at both sites and maintained in line with current guidance. Staff could recognise a deteriorating patient and knew of action to take, for example, the service utilised an observation‑based scoring system integrated into the clinical system to support the identification of sepsis, and administrative staff had received training in care navigation. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Appropriate policies were in place, including lone working arrangements.

The service did not consistently identify or manage environmental risks, and equipment and facilities did not always fully support safe care. The main site had effective maintenance processes, with comprehensive health and safety risk assessments and audits completed and actions taken. However, the provider lacked oversight of any environmental risk assessments at the branch site, relying on the primary occupier of the premises to have carried these out and have taken appropriate action. Equipment at the main site had been safety tested and calibrated, but the provider could not confirm whether equivalent checks had been completed at the branch site. Locum staff used their own medical equipment, and the service had no system to verify that this equipment was suitable, tested, or maintained according to manufacturer’s instructions. Following the assessment, staff were asked to sign declarations confirming their equipment had been appropriately tested. Vehicles used for visits had undergone appropriate maintenance checks and testing.

A business continuity plan was in place and regularly reviewed.

The service ensured there were sufficient numbers of qualified, skilled and experienced staff, who received day‑to‑day support and supervision. Staff worked effectively together to provide safe care that met people’s individual needs.

The service employed a range of clinical and non‑clinical roles, with most clinical positions held by long‑standing locum GPs of many years. Mandatory training was up to date. While locum GPs participated in the national GP appraisal scheme, they did not receive internal appraisals or one‑to‑one supervision to ensure their learning needs and professional development were appropriately monitored and 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.

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, the provider reported this had recently increased to two sessions annually to strengthen clinical supervision. We were told 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 mostly followed. However, staff were responsible for uploading their own immunisation status to the HR system, and the provider did not have oversight to ensure the information was in line with national guidance.

The service had good systems in place to ensure that infection, prevention and control (IPC) at both sites was assessed and that risks of infection were appropriately managed. The service had a designated IPC lead. IPC audits had been carried out at both sites, and the provider had monitored that actions to mitigate any risks identified had been taken.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were told who to contact if their condition did not improve or they experienced any unexpected symptoms.

Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. Prescription stationery was managed appropriately and securely. Although there was no oversight monitoring record kept of actions taken, staff were able to explain the system for acting on safety and medicine alerts. There were suitable processes for staff to follow when dispensing medicines in an emergency. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. For example, the provider had completed a two‑cycle antibiotic audit assessing correct dosing, course length and clinical documentation. Actions were implemented after the first cycle, and the re‑audit showed improvement, with compliance increasing from 82% to 100% for dosing and documentation, and to 95% for course length.