Primary Care Sheffield

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 good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks and any risks identified were mitigated. The facilities and equipment met the needs of people, were clean and well-maintained, with the exception of some equipment used by staff when doing home visits which had not been tested or maintained according to manufacturers' instructions. 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 carried out audits to monitor prescribing. For example, antibiotic prescribing. All sites had appropriate emergency medicines, although the frequency checks at 2 of the sites we visited did not align with the provider’s policy.

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.

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, an additional sample collection time was scheduled after a previous sample became unusable due to it not being collected.

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 systems in place to communicate with the patient’s own GP to ensure referrals and test results were managed in a timely way.

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 quickly and appropriately. Safeguarding policies and procedures were in place and known to staff including locum staff, who were appropriately trained in safeguarding procedures.

The service provided care to meet people’s needs that was safe and supportive. Staff could recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Emergency equipment was available. However, we observed monitoring checks were not carried out weekly at 2 of the sites we visited as specified in the provider’s policy, which was in line with recommended guidance and the defibrillator pad at one of the sites we visited was out of date. This was replaced immediately at the time of the assessment. Appropriate risk assessments were in place and actions taken to mitigate risk, including lone working arrangements, violence and harassment.

The service detected and controlled potential risks in the care environment. They made sure facilities, and technology supported the delivery of safe care, and they had good overarching monitoring systems in place to be assured of the safety of all the sites where regulated activities were being carried out. This included systems to monitor that health and safety risk assessments and audits had been undertaken and that any risks identified had been addressed. We saw evidence that equipment the service used was portable appliance tested (PAT) and calibrated. However, some staff told us that they used their own equipment when doing home visits. The service did not have a system to check if this equipment was suitable or had been tested or maintained according to manufacturers' instructions. The provider confirmed immediately following the assessment that staff had been instructed to use the kits provided that were appropriately tested. The premises we visited during the assessment were well maintained. There was a detailed business continuity plan in place which was monitored and reviewed.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. For example, administration staff had received training in phlebotomy. Staff worked together well to provide safe care that met people’s individual needs. There were a range of clinical and non-clinical roles within the service. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed.

The service had good systems in place to ensure that infection, prevention and control (IPC) at all the sites were assessed and that risks of infection were appropriately managed. The provider ensured appropriate IPC risk assessments and audits had been completed and 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. Staff at the sites we visited managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely. Staff regularly checked the stock levels and expiry dates for medicines, although 2 of the sites we visited were not following the provider’s policy with regard to frequency of checks of emergency medicines and equipment. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment including an audit of antibiotic prescribing in the extended access service. Fifty patients’ notes were selected from approximately 21,000 patients’ prescribed antibiotics, clinical notes were reviewed by the clinical lead and actions taken as a result. For example, recommended treatment options for sinusitis were included in the staff newsletter to keep staff informed of the latest guidelines.