Hollyns Health and Wellbeing

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

At our last inspection in April 2023, we rated this key question as requires improvement due to concerns identified in relation to medicines management. At this assessment, the rating has changed to good as these concerns had largely been addressed. However, there were some issues around the actioning of patient safety alerts which needed improvement. The service had a good learning culture and people could raise concerns. Complaints and incidents were discussed and used to make improvements. There were designated safeguarding leads and appropriate safeguarding processes in place. Staff understood and managed risks. The facilities and equipment were clean and tidy. However, much of the required refurbishment work in respect of infection prevention and control had not yet been undertaken. Staff received training and regular appraisals to maintain high-quality care.

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 practice listened to concerns about safety and investigated incidents and complaints. Managers encouraged staff to raise concerns when things went wrong, and staff felt supported to do so. There were policies and processes in place to record, investigate and take action from incidents and complaints. These were discussed in clinical meetings, and minutes were made available to staff. Lessons were learnt to continually identify and embed good practice. For example, an incident whereby a faecal immunochemical test(FIT) was given to the wrong patient resulted in a change in process which included labelling of the test envelope on the outside, and an additional check by staff to ensure the correct test is handed to patients.

There were policies in place to support the workflow and pathways for appointments, referrals, records summarising and correspondence. There were processes to monitor and manage care when patients were moved between services, such as out of hours, after referral to secondary care, or admission to hospital. The practice referred patients to virtual wards (also known as hospital at home) in order to avoid hospital admission. Staff we spoke with understood the referrals processes, and how to safely manage medical correspondence. A review of the practice clinical system, which formed part of this assessment, indicated that patient test results were being managed in a timely manner. The practice told us that at the time of the assessment records summarising was up to date.

There was a designated safeguarding children and adult lead and deputy at the practice. Safeguarding policies contained relevant contact details and processes to follow. Staff were appropriately trained in safeguarding, and those carrying out chaperoning had received specific training for this process. Staff told us how they used the clinical system to record and alert others to safeguarding concerns, and explained how they escalated any concerns. There were monthly multidisciplinary meetings where safeguarding cases were discussed, and these were attended by practice staff as well as external staff such as district nurses and members of palliative care teams. The practice used a self-assessment tool to assure itself of good safeguarding practice, including identifying any potential gaps or areas of improvement and implementing action plans to address these. The latest self-assessment indicated that there were good safeguarding processes in place.

There was a policy in place for managing emergencies. Staff we spoke with knew where to locate emergency drugs and equipment. We saw that checks on emergency drugs and equipment were carried out and recorded regularly at both sites. Staff received training in sepsis awareness and basic life support and were able to explain how to act safely in an emergency, including alerting clinical staff and emergency services.

There were policies and processes in place for health and safety risk management. For example, regular fire alarm tests and evacuation drills were carried out, and risk assessments were undertaken at both sites. We saw that some actions from recent risk assessments had been completed, and others were still in progress. Staff we spoke with told us that they had no concerns related to health and safety in the practice. There was appropriate signage in place, such as for fire doors and escape routes. Designated fire marshals had received training for their role. We saw that equipment at both sites was maintained regularly, stored safely and was suitable for use. Some of the required refurbishment work highlighted at the last inspection in April 2023 had begun at the main site. We saw that meetings regarding refurbishment work had taken place with the landlord and with other occupants at the branch site but were yet to be formalised. The lift at the main site was out of operation, however all clinical rooms were based on the ground floor, and at the time of the assessment we were told that no members of staff required use of the lift.

Policies on recruitment, induction, and staff appraisals were in place. Staff received regular appraisals, and induction packs were provided. We reviewed 3 staff personnel files as part of this assessment and found that documentation was in line with guidance. This included Disclosure and Barring Service (DBS) checks, immunisation records and appraisal records. Leaders told us about the ways in which they ensured staff were qualified and skilled to carry out their roles, and the support that they offered them. They told us that recruitment was underway for additional staff including patient services administrators, nurses and a healthcare assistant. Non-medical prescribers and GP trainees were appropriately supervised, for example through daily debrief sessions with a GP, and through audits of prescribing. Staff told us they had enough support to carry out their role and could seek further guidance from senior staff when needed.

There was an infection prevention and control (IPC) policy in place. Staff received IPC training and those who handled clinical specimens explained how they did this safely. Staff knew who the IPC lead was and how to raise IPC concerns.

We found the practice premises and equipment to be tidy and clean at both sites. Cleaning records were in place and the cleaner’s cupboards were tidy and contained appropriate equipment and cleaning materials. Appropriate personal protective equipment was available to staff. Clinical waste was appropriately managed by an external company. IPC issues were routinely discussed in monthly practice meetings.

Regular internal and external IPC audits were carried out at both sites. At the last inspection in April 2023, we saw that IPC audits highlighted a number of required actions which were reliant on refurbishments planned for both sites. At this assessment, we saw that much of this refurbishment work had still not been undertaken. We saw that meetings had taken place with the building proprietors for the branch site, and the scope of work had been outlined, however the proposed works had not been finalised. Some interim works including redecoration and flooring improvements had taken place at the main site.

Medicines were stored securely and at appropriate temperatures. Refrigerators used to store vaccines and medicines were regularly cleaned, temperatures were monitored and logged, and products were appropriately stored within them. Staff regularly checked stock levels and expiry dates for all medicines, including emergency medicines and vaccines.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this as the practice performance was in line with or better than national averages for all indicators. For example, data for December 2024 showed that the percentage of Co-amoxiclav, Cephalosporins and Quinolones prescribed was at 4.4%, compared to the national average of 7.5%. Clinical audits of prescribing were also carried out which focused on improving care and treatment. There were Patient Group Directions and Patient Specific Directions in place which relevant staff worked to.

As part of our assessment a Care Quality Commission GP specialist advisor undertook searches of patient records on the practice’s clinical system. Overall, our searches showed that medicines had generally been effectively managed by the practice. Where issues were identified, the practice was proactive in addressing these. We found the following:

Methotrexate (a disease-modifying anti-rheumatic drug): We identified 46 patients and found that 1 had not received the required monitoring in the last 6 months. We reviewed this record and found that the patient had been contacted on several occasions to make an appointment, and that booked appointments had not been attended. A further appointment had been booked for the patient to attend for monitoring.

Azathioprine (a disease-modifying anti-rheumatic drug): We identified 16 patients and found that all had received appropriate monitoring.

Leflunomide (a disease-modifying anti-rheumatic drug): We identified 6 patients and found that all had received appropriate monitoring.

Aldosterone antagonists (potassium sparing diuretic): We identified 73 patients with heart failure who were prescribed this medication. Of these, 10 had not had the required monitoring. We looked at 5 records in detail and found that 3 patients were minimally overdue monitoring, and 1 had received monitoring in hospital. For the final patient we saw there had been repeated failed attempts at taking blood and that they had been requested to attend the hospital.

Potential missed diagnosis of diabetes: We identified 82 patients with a potential missed diagnosis of diabetes. We reviewed 5 patient records and found that overall, there were no issues with monitoring.

Medication reviews: There had been 1,851 medication reviews carried out in the last 3 months. We reviewed a sample of these and found that they were clearly documented and contained appropriate information.

There was a process in place for recording and sharing medicine safety alerts. We saw that safety alerts were routinely discussed in monthly multidisciplinary meetings. A review of clinical records on this assessment indicated that safety alerts were not always actioned in line with guidance. For example, patients prescribed a teratogenic drug were made aware of the risks with this medicine in pregnancy and had effective contraception in place where required. However, we also found the following:

Topiramate: 11 females under the age of 55 were identified. We reviewed 2 records in detail and found that discussions about risk were held on initial prescribing, however annual risk assessment forms were not routinely used. The practice told us they would ensure all patients had a valid annual risk assessment form in place.

Pregabalin: 26 females under the age of 55 were identified. We reviewed 2 records in detail and found that both contained a record of discussion about risks, however this had been carried out shortly before the assessment despite the safety alert being issued in April 2022. The practice confirmed that all patients within this category had now been informed of the risks and that they would ensure this formed part of the medication review process for relevant patients.