Dearne Valley 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

At our previous assessment in March 2016, we rated the practice as Good for providing safe services. At this assessment we have rated the practice as Requires Improvement.

Patients’ needs were not always assessed, and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways. Patients on high-risk medicines were not always recalled for monitoring in a timely manner. Systems and processes for dealing with MHRA alerts and safeguarding procedures were not completely effective and required strengthening.

Managers told us that at the direction of their local ICB they used a clinical search system called Eclipse. However, this did not always identify patients requiring regular monitoring or follow up, such as those with long term conditions or prescribed high risk medicines. We expect all GP Practices to have systems in place to review these patients in line with best practice guidance.

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. 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.

This service scored 59 (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. Leaders encouraged staff to raise concerns when things went wrong. There were systems in place to record and investigate complaints when things went wrong. We saw there was a process for staff to report incidents, near misses and safety events. Feedback from staff highlighted a positive culture for reporting incidents or learning events. We saw evidence from practice meetings that these were discussed and cascaded to different teams to ensure learning was achieved. The practice showed us examples of a new mental health template, following a learning event. Patients who required an appointment due to their mental health were taken through a series of questions which produced a score. If their scores indicated they required an emergency appointment they would be offered one that day. If the score was moderate, they would be offered an appointment within 2 days. If the score was low, they were offered a routine appointment.

The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. Through clinical searches we conducted on the practice’s clinical system we identified that the practice did not have robust systems for dealing with Medicines and Healthcare products Regulatory Agency (MHRA Alerts). Searches identified potentially 7 patients over the age of 65 on a high dose of citalopram (a medicine to treat low mood and panic attacks). We looked in detail at 3 patient records and found that 2 of the patients had not received recent medicine reviews, it was not clear if patients had been consulted on the risks of taking this medicine. We also found other MHRA alerts that were not being reviewed as they should have been. This included patients on clopidogrel and either omeprazole or esomeprazole. Also, we could not be sure that all women on a teratogenic medicine of childbearing age had been consulted on the risks of taking this medicine and that an annual risk assessment form had been signed. Following this assessment the practice provided further information on how MHRA and safety alerts would be handled going forward. A lead GP was now responsible for reviewing these patients and safety alerts and we were told that it would become a standard item discussed at all clinical meetings. We saw systems in place for processing information relating to new patients. Referrals and test results were managed in a timely way.

The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. We found that there was an understanding of safeguarding and how to take appropriate action across the practice. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. All staff we spoke with were able to inform us who the practice’s safeguarding lead was.

Through searches we ran on the practice’s clinical system we saw that there were safeguarding lists for both adults and children, though we did not have assurance that these lists were being appropriately managed and reviewed. We found that safeguarding registers required strengthening to include all patients who were at risk of harm or abuse. We found that the practice was not reconciling their safeguarding list with the local authority, which meant that potentially vulnerable patients were not being coded appropriately. Following the assessment the provider had engaged with their local authority however they found that they did not have processes in place to align their safeguarding register with the practice.

Following the assessment the practice provided an action plan on how safeguarding was being reviewed and managed. This included further engagement with the local authority to align safeguarding registers, working through safeguarding letters and discussing these at monthly practice clinical meetings. The practice had arranged for additional training on using safeguarding searches within their clinical system from an external specialist.

The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe. We found that although there were systems in place to understand and manage risk, but they were not always consistent. The practice had registers in place to support patients who were vulnerable or who had mobility or communication needs, however we found a lack of processes and oversight in ensuring these were routinely monitored.

We found some clinical risks in relation to patients prescribed high risk medicines, those that had long term conditions and those with a potential missed diagnosis. We found that some patients had not been monitored appropriately or followed up to ensure they were receiving the correct care and treatment.

There were processes in place to ensure the practice prioritised care for the most clinically vulnerable, including those that were experiencing mental health crises. Staff were aware of actions to take if they encountered deteriorating or acutely unwell patients. Emergency equipment was available and maintained.

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. The practice provided us with evidence of health and safety risk assessments and audits had been undertaken and risks identified had been addressed at both sites. We also saw there was a fire safety policy in place and regular checks were undertaken. There was a business continuity plan in place which was monitored and reviewed. We saw that all staff had completed mandatory training which applied to maintaining a safe environment.

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. There were a range of clinical and non-clinical roles within the practice. 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. The practice was a training practice for GP registrars, these are doctors who are currently training to become a qualified GP. The practice had a positive history of training registrars and employing them when they had qualified as GPs. We saw evidence that non-medical prescribers had their competencies assessed and monitored in-line with national guidelines. Safe recruitment practices were followed. As part of this assessment, we looked at recruitment files of 4 members of staff, this included 2 administrative roles and 2 in clinical roles. All files had appropriate checks carried out.

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 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 observed the practice to be clean and tidy throughout. As part of our site visit, we reviewed a nurse room, treatment room, consulting room and stockrooms.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning. We found that, although some systems were in place to ensure patients were recalled, processes and procedures requiring strengthening to avoid potential harm for patients.

Through searches we ran on the practice’s clinical system we identified that there was not a robust system in place for monitoring patients on an Aldosterone Antagonist. This is medicine used to treat high blood pressure and heart failure. We identified 24 patients that were potentially overdue monitoring. We looked in detail at 5 patient records and found that all 5 were overdue monitoring. All 5 patients were also overdue medicine reviews. We found that current systems in place did not identify patients who were on ACE inhibitors or Angiotensin II receptor blockers from receiving the required monitoring. This is medicine used to treat blood pressure abnormalities. We identified that 231 patients (15.5%) of patients on this medicine potentially required monitoring.

Searches also identified that current systems in place for treating patients on direct oral anticoagulants, blood thinning medicine (DOACs) were not effective. We found that 111 patients (40.8% of patients on this medicine) had not had their creatinine clearance calculated using the Cockcroft and Gault formula recorded correctly. Therefore, we did not have assurances that these patients were on the correct dose of DOAC medicine. We also found that systems in place to manage medicines and healthcare products regulatory agency (MHRA alerts) required strengthening. Searches identified 7 patients over the age of 65 on a high dose of citalopram (medicine which is used to treat low mood and panic attacks). We found that 3 patients were overdue medicine reviews and that risk assessments had not been carried out for patients on this medicine.

Following the assessment, the practice provided us with an action plan on how systems were being strengthened to ensure patients were receiving the reviews they required. It was identified that more phlebotomy clinics were required to ensure patients could receive the required reviews. Additional clinics were added, and an additional member of staff was being trained in phlebotomy to assist with this. A new recall system had been introduced to ensure that patients on Aldosterone, ACE inhibitors or Angiotensin II receptor blockers were being booked in for monitoring earlier than previously to ensure they received the required checks in the correct timeframe. The practice had received training from an external specialist on how to effectively set up recall systems in their clinical systems, and how to correctly record and document creatine clearance of patients on DOAC medicine. A new system was also in place for managing and monitoring MHRA alerts. The practice also had further training planned with specialists on using their clinical system. They had also shared their learning with their local Integrated Care Board to ensure practices in the area could learn from this.