Heswall and Pensby 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

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 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 service had a positive learning culture. Staff we spoke with felt able to raise concerns and report incidents, near misses and safety issues. Leaders encouraged learning and improvement and reviewed incidents, significant events and complaints to identify themes and opportunities for improvement.

The service had established systems to record, review and learn from incidents. Learning was shared with staff through meetings, newsletters and team discussions. Leaders used learning to inform training, policy updates, governance processes and service improvements.

The provider was able to demonstrate that learning led to changes in practice. For example, a learning event relating to patient recall processes resulted in improvements to coding, monitoring and follow-up arrangements, as well as wider reviews of patients receiving similar treatment.

The service had effective systems to assess people's needs and ensure they were directed to the most appropriate clinician or service. Staff used a GP-led triage system to review requests for care and prioritise people according to their clinical needs. Urgent requests were prioritised and patients requiring urgent assessment were directed to appropriate emergency or urgent care services.

The service had established processes to support the safe management of test results, referrals and clinical correspondence. Staff monitored referrals and follow-up actions to reduce the risk of people being lost within care pathways. Systems were in place to ensure test results and correspondence continued to be reviewed when clinicians were absent.

The service reviewed people's medicines following discharge from hospital and specialist care. People whose medicines had changed were routinely offered additional support and review to help ensure their treatment remained safe and appropriate.

The provider had arrangements in place to support the secure management of patient information and the safe management of deteriorating patients. Staff received emergency response training and emergency equipment was monitored and readily available.

The service had clear safeguarding arrangements for children and adults. Staff we spoke with understood their safeguarding responsibilities, knew how to report concerns and were able to access advice and support from safeguarding leads when required.

The provider had effective systems to identify, record and monitor safeguarding concerns. Safeguarding information was clearly recorded within patient records and safeguarding registers were used to support oversight of people who may be at increased risk. Family and household information was considered where appropriate to help identify wider safeguarding concerns.

The service had established arrangements to identify and respond to children and adults who were not brought to appointments. Staff monitored patterns of non-attendance and safeguarding concerns were reviewed through regular safeguarding meetings and multidisciplinary working arrangements. For example, children who were not brought to appointments were routinely reviewed and followed up.

The provider worked effectively with partner agencies and shared information appropriately to protect children and adults at risk. Staff received safeguarding training appropriate to their role.

The service had effective systems to identify, monitor and manage risks to people's health. Staff used recall systems, clinical searches and population health information to identify people who required additional monitoring, support or intervention.

Long-term condition reviews included monitoring, prevention and risk reduction activities. People who did not respond to recall arrangements were followed up to help ensure they received appropriate care and support.

The provider had established systems to identify and manage risks associated with medicines. Monitoring arrangements supported the safe prescribing of medicines and helped identify people who required additional review or support.

The service used population health approaches to identify people at increased risk of poorer health outcomes and support earlier intervention. Learning from incidents and concerns was used to improve systems and strengthen patient safety.

The service had arrangements in place to support the safety and security of patients, staff, premises and information. Environmental risk assessments had been completed and building safety systems, including electrical, gas and fire safety checks, were monitored and maintained. However, the risk assessment processes were not always effective in providing assurance that all environmental risks had been identified and appropriate control measures put in place.

We also found that the Legionella risk assessment had not been completed by a suitably competent person and did not provide assurance that all relevant risks had been identified. Following the assessment, leaders submitted evidence to demonstrate these issues were being addressed.

Emergency equipment was available and monitored, and staff understood how to respond during medical emergencies. Fire safety arrangements were established and included trained fire marshals, emergency procedures and regular servicing of equipment. The premises were well maintained and suitable for the services being provided.

The service had systems in place to ensure there were enough suitably skilled and experienced staff to meet people's needs. Leaders monitored staffing levels, workforce risks and future workforce requirements, and had taken action to improve staffing capacity through recruitment and workforce planning.

However, the records reviewed did not always provide assurance that workforce assurance processes were being consistently maintained. Recruitment records did not provide assurance that pre-employment occupational health screening had been completed for newly appointed staff. In addition, whilst some staff immunisation records were available, the provider did not have a clear system to record, monitor and retain this information consistently. Following the assessment, leaders submitted evidence to demonstrate these issues were being addressed.

Staff received training appropriate to their roles and the provider monitored completion of mandatory training requirements. Staff we spoke with described receiving support, supervision and opportunities for professional development. Clinical supervision, appraisal and competency review processes were used to support safe practice and ongoing learning.

The service had infection prevention and control arrangements in place, and a designated lead provided oversight of this area. External audits had been completed at both sites and demonstrated good levels of compliance across a range of areas. The premises were visibly clean, well maintained and suitable for the services being provided.

While leaders undertook routine checks of cleaning standards and addressed concerns when identified, these checks were not formally documented. We also found the provider had not undertaken a clinical waste audit to provide assurance that waste management arrangements were effective. Following the assessment, leaders submitted evidence to demonstrate these issues were being addressed.

Staff received training appropriate to their role and leaders reviewed findings from audits and inspections and acted where concerns were identified.

The service had effective systems in place to support the safe prescribing, review and monitoring of medicines. A clinical pharmacist led medicines management, supported by GP oversight and established governance arrangements.

The provider had systems to identify and monitor people prescribed medicines that required regular review or monitoring. Staff used clinical searches, prescribing reviews and safety alerts to identify people who required additional support, monitoring or follow-up.

Structured medication reviews were used to help ensure medicines remained safe and appropriate for people's needs. Reviews took account of people's health conditions, risks, preferences and treatment burden. People at increased risk of medicines-related harm were prioritised for review.

The provider had arrangements in place to review and act on medicines safety alerts. Staff reviewed people affected by safety alerts and acted where changes to treatment or monitoring were required. Medicines-related incidents were reviewed, and learning was used to improve prescribing and monitoring processes.

The provider used audit activity to improve the quality and safety of prescribing. For example, an audit of antibiotic prescribing identified opportunities to improve prescribing practices. Changes were introduced and a repeat audit demonstrated improved compliance with guidance and a reduction in inappropriate long-term prescribing.