Hillview Family Practice Also known as Dr Montague & Partners

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. 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. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes. The practice had a proactive and systematic approach to safety. Staff, people who use the service, and partners were all actively encouraged to voice their concerns. All team members we spoke with reported feeling part of a collaborative team that worked together to find solutions. The service demonstrated a strong commitment to improving safety.

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.

Policies and procedures for managing safety events were in line with current best practice which supported and encouraged a learning culture. Systems for capturing and monitoring concerns was robust and reviewed by leaders for themes and trends.

Staff understood how to raise concerns and report incidents. Staff told us that learning from safety events were shared with them.

Leaders fostered an open and transparent culture where staff felt confident to raise concerns. There were clear systems to record, investigate and track complaints, with defined responsibilities for taking action. When incidents occurred, staff offered apologies and provided appropriate support to those affected.

Staff knew how to report incidents and escalate concerns and felt comfortable doing so. Learning from events were shared in meetings and followed up with emails to all staff.

People were able to raise concerns about the service, and the feedback about the service was mostly positive. They felt staff treated them with compassion and understanding.

The service worked with people and healthcare partners to establish and maintain safe systems of care in which safety was managed or monitored effectively. They made sure there was continuity of care, including when people moved between different services.

There were systems for processing information relating to new patients. The service worked with other providers to deliver shared care to ensure continuity of care.

Referrals and test results were managed effectively. At the time of assessment, there were no referrals pending for action. Referrals to specialist services were well documented. These were prioritised for routine or urgent action and contained the required information.

Staff were able to explain the referral process to us and how they captured people’s needs, wants and wishes. The referral policy was relevant and up to date with the latest standards and referred policy users to additional guidance. Staff told us communication was effective. Discussions around a person’s care was discussed in meetings and shared with the relevant teams.

Staff understood the importance of continuity of care to ensure the right care at the right time, with the right member of staff.

The service worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always shared concerns quickly and appropriately.

Staff were confident in recognising signs of abuse and understood the process for escalating concerns. They knew who the safeguarding leads were within the service and how to contact them.

Staff said they felt supported to raise issues promptly. They had access to a safeguarding policy, which contained the services requirements to take appropriate action, and it clearly defined who staff can contact for support for safeguarding children, young people and at risk adults. Staff completed the appropriate level of training for their role.

The service maintained up-to-date registers of children, adults and vulnerable people and acted promptly on concerns. They worked collaboratively with partner organisations to protect individuals from harm. These registers were reviewed during regular multidisciplinary team (MDT) meetings, where any emerging risk and trends were monitored and acted upon.

People’s records included safeguarding alerts that were clearly visible to all relevant organisations accessing the shared care record.

The service completed a safeguarding audit where it showed them to be fully compliant.

The service 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.

National GP patient survey data showed that89% of patients stated that during their last appointment, the healthcare professional was very good or fairly good at listening to them (national average 87%) and 90% of patients stated they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment (national average 91%).

Emergency equipment was available and effectively maintained. Staff could recognise a deteriorating person and knew what actions to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

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

Staff were appropriately trained for health and safety, including manual handling and fire safety.

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.

Electrical equipment had been calibrated and tested. All doors were locked with keypad access. Clear signage was displayed around the building which supported people and staff in the event of an emergency evacuation. The service ensured signage was dementia friendly and visible for vulnerable people.

We saw that the practice had effective systems to monitor and comply with risk assessments, including fire safety and legionella testing, to ensure that patients and staff remained safe. Records showed fire alarms were routinely tested. Staff completed fire training and attended regular fire drills. We observed that the service was accessible for all people and included space for wheelchairs and prams.

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.

Staff received effective support, supervision and development. Systems demonstrated appointments were allocated to appropriate clinicians. Staff worked together well to provide safe care that met people’s individual needs.

Staff told us their workload was manageable and there were always enough staff.

There were a range of clinical and non-clinical roles within the practice. We found training was up to date and all staff were enrolled in training appropriate for their role. Learning needs and development of staff were managed appropriately and staff were working within their agreed areas of competence.

Staff had completed mandatory training, and some had also completed specific training in their specialist area. For example, diabetes and respiratory conditions. Staff were given adequate time and support to complete their training.

Safe recruitment practices were followed as staff files were complete with the relevant references, employment history and DBS checks. DBS checks were completed in line with requirements of staff.Safe recruitment practices were followed. Health questionnaires were completed and consideration given to all staff capabilities.

The service had an induction process for all staff and provided a handbook to all new starters which contained relevant information.

Feedback from people collected by the service was very positive, particularly regarding satisfaction with staff and would comment on their friendliness and knowledge.

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

The service had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

We saw cleaning schedules were followed. Policies and procedures were available to all staff and they knew how to find them. The premises were visibly clean and tidy. Sharps bins used to dispose of used needles were safely used and disposed of. Personal Protective Equipment (PPE) was available to staff. All staff had completed IPC training relevant to their roles.

The service recorded staff vaccinations in line with national guidance.

The service used digital technology to improve their IPC standards. Each clinical staff member was responsible for carrying out IPC checks in their clinical rooms at the end of every session. This was recorded using a QR (Quick Response) code. Responses were monitored to check these had been completed or if there were any actions that required attention.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

As part of the assessment our GP specialist advisor performed remote clinical searches. We reviewed the monitoring of people with long-term conditions, such as chronic kidney disease (CKD), diabetes or hypothyroidism. Out of the 5 we reviewed 1 was overdue their medication review for diabetes and 2 out of 5 were overdue their thyroid monitoring. Our searches identified people with heart failure and taking aldosterone antagonist(aldosterone antagonist is used in people to reduce blood pressure and salt and water retention). Out of the people identified in this search we found 4 out of 5 were overdue monitoring.

People prescribed bisphosphonates (medicine used to treat and prevent osteoporosis by strengthening bones and reducing risk of fractures) were not always reviewed in line with national guidance. Monitoring arrangements were inconsistent for 2 out of 5 we reviewed being overdue monitoring. The service had advised they will review their process to ensure monitoring has full oversight.

Staff followed protocols for safe prescribing, medicine reviews and monitoring. Emergency medicines and equipment were checked regularly, stored safely and easily accessible. Medicines and vaccines were stored appropriately, securely and monitored to ensure they were stored within the correct temperatures. The service used digital technology to record and capture vaccine fridge temperatures for accurate and consistent monitoring. Staff made sure people knew about how to be safe with their medicine by explaining risk and giving additional information related to their medicine.

Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines.

Staff managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicine reviews and monitoring.

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. Waste medicines were recorded and disposed of appropriately including medicines returned by patients.

The service implemented a quality improvement project to review its hypertension (raised BP) management process. The aim was to identify uncontrolled symptoms early and reduce the risk of medical emergencies. This initiative led to measurable improvements in the diagnosis, treatment, and ongoing management of hypertension within the service.For example, 22 people were identified to take part in this project, 10 of which had their medicine stopped due to improved symptom management.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring.

There was a regular clinical audit of prescribing that focused on improving care and treatment.