Burnley Group Practice

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

Recruitment records did not provide assurance that appropriate checks to support the safe recruitment of staff had taken place. The practice did not carry out all the required checks or retain the required information. Managers did not record and retain evidence to demonstrate that staff received regular supervision and monitoring to ensure high-quality care. Training records showed gaps in key training around safeguarding. Staff did not manage prescription security medicines well. Although the practice had a good learning culture and people could raise concerns, documentation of what action had been taken was not well recorded. The facilities and equipment met the needs of people, were clean and well-maintained and any risks identified were mitigated.

This service scored 53 (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 had a culture of safety, based on openness and honesty. They listened to concerns about safety and looked into reported safety events. However, the records kept did not always enable a full understanding of the issues at hand, what had happened and what the outcomes were. It was not always clear whether lessons were learned and what changes or improvements were identified and implemented as a result.

The practice took concerns seriously and both staff and patients were able to raise concerns and report when things went wrong. The practice was large and staff worked across 3 sites, as such not all staff were able to attend all meetings in which incidents and complaints might be discussed and so relied upon minutes of meetings or word of mouth. It was not evident that all staff were involved in discussions, were kept informed and learnt from potential issues. Feedback we received from staff and staff we spoke to were not always clear about the nature and cause of incidents, nor what was done and what the outcomes or learning were. The documentation kept in relation to incidents and complaints was disjointed and difficult to follow and outcomes were not clearly documented. Minutes did not enable the reader to understand what had happened and the learning outcomes. Summary logs had missing information and it was not clear who was investigating the issues.

The practice had processes for staff to report incidents, near misses and safety events. We found documentation and record keeping was inconsistent at times and this did not provide an effective system to enable full assurances that incidents and complaints had been followed up appropriately and what the outcomes were. There was a system to record and investigate complaints, and when things went wrong, but similarly this was inconsistent. We did however see evidence that staff apologised and gave people support with complaints were appropriate. It was not evident that learning from incidents and complaints resulted in changes that improved care for others.

The practice worked with people and healthcare partners to establish and maintain safe systems of care. However, they did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Referrals and test results were not always managed in a timely way, as there were some issues with the oversight of incoming diagnostic results and workflow. We reviewed the outstanding workflow for the practice and found that there were outstanding diagnostic results from 6 months earlier. Whilst this appeared to be an anomaly and not suggestive that the practice did not review results, it identified more of a system issue, which demonstrated that the practice did not have an effective system in place for oversight of the outstanding reports in the global workflow inbox. This posed a risk of potential delays in acting on results. Following the inspection, the practice looked into the cases and cleared the results. They advised they had implemented a new system where results would be checked and cleared, with an individual having responsibility to ensure the results were cleared appropriately to ensure nothing had been missed.

There were systems in place for processing information relating to new patients, however this did not appear to be working effectively, as summarising of notes was not being completed in a systematic or timely way. We found some notes that had not been summarised, which dated back several years. The practice stated they would review the system to ensure these were cleared in a chronological way.

The practice acted on concerns working in partnership with other organisations. The practice worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The practice shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, however, the policies for vulnerable adults and children, were still labelled as a ‘sample’ policy and contained some inaccuracies and references to Clinical Commissioning Groups (CCGs) and an old telephone number which was out of service.

Safeguarding training was evidenced as complete and to the correct level for the majority of staff; however, there was no evidence of any safeguarding training for all 11 partners. Additionally, the practice had evidence of level 2 training for both children and vulnerable adults for 2 of the 4 salaried GPs and no evidence of the recommended level 3 safeguarding training for all 4 salaried GPs.

We found some inconsistent use of safeguarding flags and annotations on people’s records. We found some household members were missing the relevant flags when they were living in the same household as those with safeguarding needs or child protection orders. Managers stated they would review these cases following the inspection.

The practice worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The practice told us parents of children who had not attended for childhood immunisations and people who had not attended for cancer screening, were followed up and further encouraged to attend.

The practice offered flexible options to engage with and encourage people to take up screening and immunisation programmes, particularly in communities with low take up levels.

The practice detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

The practice had enough qualified, skilled and experienced staff, however they could not evidence that staff received effective support, supervision and development and that this could be evidenced. There were a range of clinical and non-clinical roles within the practice. We found that the majority of staff training was up to date, the practice did not have evidence of mandatory training for 2 of the 4 salaried GPs, and kept no mandatory training records for any of the GP partners, so had limited oversight and assurance of their continuing competency.

Whilst staffing numbers and their retention was good, the practice did not have in place structured and documented formal supervision. There were clinical governance meetings, GP meetings and nurse meetings which were reported to be helpful, but there was no formal framework or documentation for individualised clinical supervision, nor specifically to meet the requirements of effective supervision for non-medical prescribers. Staff stated they felt supported, but this was ad hoc and informal. The practice participated in the Integrated Commissioning Board (ICB) reviews for prescribing to ensure it met with the ICB formulary, but there was no documented formal oversight or review of performance, such as dip sampling of consultations or record keeping or documentation reviews, and therefore, assurance of the competence of staff was limited. The practice stated they had recognised this and were planning to strengthen this process in the future.

The practice did not have a documented recruitment policy, they did have a checklist of what they checked for recruitment. During our inspection we checked a sample of recruitment records. We found that records kept by the practice were missing some key evidence. We found that the practice did not keep copies of photographic evidence of identity as stipulated in schedule 4 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We checked 7 recruitment records, none had evidence of identity documentation on record. We found that the most recently recruited staff member had other relevant documentation recorded. However, 4 had no evidence of a Disclosure and Barring Service (DBS) checks, 4 had no evidence of references on record, and one had only 1 reference recorded. 4 had no full employment history on record, 5 had no appraisals on record. Furthermore, none of the required documentation was on record for GP partners, however they did check they were on the performer’s list periodically. It was not possible to evidence that the practice had carried out Right to Work checks for staff using a non-UK passport, as no passports were kept on record.

The practice was able to show evidence that new staff receiving an induction to the practice, however historical records for staff employed for some time were not routinely retained.

The practice did not have an appraisal policy in place. Most staff had not had appraisals since 2022. Managers told us they had started to implement a new programme of appraisals and they had completed this for secretaries to start with. They were planning to continue to roll this out to other staff groups.

The practice supplied us with a tracker of the staff who they have evidence of immunisations for. The record had significant gaps where the practice did not have assurance that staff were appropriately immunised.

The practice did not have a policy which determined if and when DBS checks for staff were revisited or renewed, nor did they have a system of self-declaration by staff that circumstances had not changed since their last DBS. We were informed that a decision had been made by partners that they would not seek to renew any DBS checks regardless of the period of time, but this was not written into a policy.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The practice had a designated infection prevention and control lead, and all staff had received relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, however, the follow-up and actions taken in response to audits were not always clearly documented.

The practice did not have an infection prevention and control (IPC) policy in place. They stated they had a suite of documents and guidance covering a range of topics around IPC, but no individualised standard operating procedure or practice policy. The suite of guidance documents shared with us appeared to relate to another provider.

The IPC audit did not always give clear information when the area audited was not compliant or did not meet the standard required. Nor was it clear that the areas highlighted had been rectified and by whom, and when the action was closed off, therefore, assurances that action had been taken and in a timely way was limited. We did learn however, that IPC audits identifying issues of non-compliance led to the termination of the former cleaning contract and a new contract secured which better met the needs of the practice.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff mostly followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews, however there were some issues identified with monitoring as described below.

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, vaccines, and controlled drugs. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The practice 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. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the practice was similar or lower to local and national averages.

However, the practice did not have a programme of regular clinical audits that focused on improving care and treatment. They did not have an annual audit programme and did not have any completed two-cycle audits. Audits shared with us were ad hoc audits completed to support the doctors’ education, they were not repeated and did not lead to meaningful action or improvements.

We carried out a series of searches on the practice’s clinical systems as part of this assessment.

We looked at people prescribed methotrexate, used to treat inflammatory conditions such as rheumatoid arthritis and psoriasis. Blood tests are required every 3 months for patients prescribed this medicine to ensure they are not causing toxicity or organ damage. We identified 3 patients who were overdue monitoring, 2 were being managed by the hospital and another had not had their bloods checked for 10 months, however, the practice had followed this up with the patient to arrange a blood test.

We looked at people prescribed azathioprine, used to treat inflammatory conditions such as Crohn’s disease. Blood tests are required every 3 months for patients prescribed this medicine to ensure they are not causing toxicity or organ damage. We identified 1 patient who was overdue monitoring as they had not had their bloods checked for 6 months, however, the practice had followed this up with the patient to arrange a blood test.

We looked at people prescribed angiotensin-converting enzyme inhibitors (ACE inhibitors) angiotensin II receptor blockers (ARBs) which are used to treat high blood pressure and other cardiac conditions. We identified 186 out of 2845 people on this medication, who appeared may not to have had the required monitoring, which is recommended every 6 months. We looked in detail at 5 cases and found monitoring had not been completed for over 18 months in all 5 cases, and some had not had monitoring for 3 years. However, we saw that all 5 had been contacted by the practice the day before the inspection and asked to attend for monitoring.

We looked at people prescribed mirabegron which is used to treat urinary problems. We identified 18 out of 127 people on this medication, who may not have had the required monitoring. We looked in detail at 5 of those people and found all 5 needed to have their blood pressure taken and recorded. We saw that 1 had been invited to attend 1 year prior, 1 had been invited to attend 2 months before and 3 did not appear to have been invited.

We looked at certain cohorts of people prescribed non-steroidal anti-inflammatory drugs (NSAID) a medicine to reduce pain, fever, and inflammation. Guidance suggests should a proton pump inhibitor (PPI) medicine should also be prescribed to protect the stomach from ulcers and gastrointestinal bleeding. We found 172 out of 651 people that were being prescribed NSAIDs but who may not have also been prescribed PPIs. We looked in detail at 5 of these records and found this applied to all 5 cases and 1 of those was also on another medication which further increased the risk of bleeding.

We reviewed a sample of 5 medicines reviews completed and found they were completed to a good standard.

Potential issues identified from the clinical searches were raised with the practice. Managers confirmed they had reviewed these patients, arranged for their monitoring and followed up on the issues raised.

Staff did not manage prescription stationery appropriately and securely. We saw that the processes in use by the practice were not working effectively. For electronic prescriptions, we saw they made a record of the prescription serial numbers that went into the printers, but the records made and the numbers kept in the printers did not match. Some stationery was not accounted for and recorded. The serial numbers did not match records, not the box numbers in use and were out of sequence and comprised of different batches of prescriptions. The system did not provide a system of accounting for prescriptions nor did it provide a means of determining if prescriptions had been misappropriated. Managers were informed about these issues identified and stated they would take immediate action.