Holmside Medical Group

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

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 78 (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 strong proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority. The provider had established systems 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.

The practice supplied us with a significant event audit report and reflections for the previous year. The incidents were categorised and there was an investigation and follow up recorded for each. They recognised their key themes and any learning needed.

The practice had carried out a specific audit following a significant event when a patient with prostate cancer was missed from the required 6 monthly monitoring. This resulted in a change in policy.

The practice supplied us with a comprehensive annual complaints’ summary. This broke down outcomes, actions and gave examples of investigations into complaints and themes and trends.

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.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. 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. 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 service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The practice could clearly explain their safeguarding process. They had an administrative safeguarding lead who had a defined job description on their role regarding safeguarding, such as audits and follow up actions. The practice had planned improvements for safeguarding in the coming year in relation to the auditing of clinical coding of this on their electronic system. All staff involved in this process had received safeguarding children level 3 training.

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.

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 service 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 service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs. Safe recruitment practices were followed.

There was a continual development of staff skills. Competence and knowledge were recognised as integral to ensuring high quality safe care, improved access and service sustainability. Staff were proactively supported to acquire new skills and share best practice. All staff had shared and personal objectives, and regular appraisals. Audits were carried out to ensure they were working within their competence.

Training was up to date with additional training tailored to the job role and person, for example care navigation and appointment booking.

Staff told us that there was a culture where they were encouraged to develop. For example, a member of staff had been encouraged to move from the role of receptionist to train as a healthcare assistant and then onwards to a practice nurse. A nurse and pharmacist had completed independent prescriber qualifications. The practice employed a paramedic who then undertook their clinical skills apprenticeship which enhanced urgent and complex assessment capacity. The practice manager is undertaking a strategic management and leadership apprenticeship.

The practice had considered their skill mix and had recently recruited a paramedic rather than an advanced nurse practitioner. They believed this role would bring rapid assessment skills, autonomous decision making and confidence in working independently in community settings.

The practice invested in targeted development of staff to ensure successors were identified for leadership roles. The GP partners were developed and there was GP trainer development to increase educational capacity.

As a result of linking training and development with quality and innovation the practice had expanded or strengthened services which included, providing minor surgery, Intrauterine Device (IUD) fitting and removal, contraceptive implants and pessaries for pelvic floor prolapse. The pathology system was optimised which improved patient care and efficiency in laboratory testing by reducing inappropriate test requests (over or under-testing) and standardising processes. Training and development improved staff confidence in working independently in community settings, including home visits and urgent care. This increased prescribing capacity.

The practice had a nursing and healthcare assistant skills competency framework template. This was comprehensive and was used to discuss skills and ensure staff compliance including, general duties, annual review, injections, cardio, respiratory, diabetes, wound care, and women’s health. Nurses provided their revalidation topics and work covered which was held centrally for information.

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 practice had a designated infection, prevention and control lead. They had comprehensive systems in place to manage ensure the practice was meeting the correct standards. All staff had received relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

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.

We carried out remote searches of clinical records as part of our assessment to check how the practice monitored patients’ health in relation to the use of high-risk medicines. We saw that patients received appropriate monitoring at the required intervals and prescribing was safe.

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 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 medicines reviews and monitoring.

Medicines including controlled drugs were stored securely and at appropriate temperatures. 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. We saw staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. The practice had carried out audits on prescribing data and monitored and enhanced services where required.