Head Office

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 assessed a total of 8 quality statements from this key question. Our rating for this key question is good. We found incidents were reviewed, acted upon and used to drive improvement. The provider took steps to safeguard people from abuse. There were sufficient staff at the service and procedures to ensure staff were qualified and trained for their role.

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.

Staff reviewed incidents and complaints and took action to improve services for patients. The service undertook patient surveys to identify areas for improvement. Positive feedback was also shared with staff at the service

All of the staff we spoke to were aware of how to raise incidents. They told us that there were regular staff meetings at the practice where learning from incidents was shared. The day on which the meeting was held was varied, in order that part time staff could sometimes attend. Meeting minutes were recorded. Leaders detailed how learning would be shared with individuals, and how more general feedback was shared where required.

There was a system for recording and acting on significant events and incidents. There were adequate systems for reviewing and investigating when things went wrong. The service learned and shared lessons, identified themes and took action to improve safety in the service. The service learned from external safety events and patient safety alerts. The service had an effective mechanism in place to disseminate alerts to all members of the team including sessional and agency staff. The provider took part in end-to-end reviews with other organisations. Learning was used to make improvements to the service.

Patients spoke positively about their experiences with the service, as evidenced in patient surveys carried out by the service.

Staff were aware of care pathways, including referrals. Leaders at the service shared relevant information with staff in team meetings. Meeting minutes were circulated to provide information to staff who were unable to attend.

The provider worked with partners to ensure patients had access to appropriate support and appropriate referrals.

There were systems in place to ensure that where care was shared, information was shared between organisations.

The practice had a safeguarding lead who was allocated time to review patients where there were safeguarding concerns. Staff at the service to whom we spoke were aware of how to make safeguarding referrals and knew the identity of the safeguarding lead if further advice was needed. Leaders told us how advice was available to health advisors and clinicians as required.

The provider worked with partner organisations to share information about patients on the service’s safeguarding register.

The service worked with other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect. The provider carried out staff checks at the time of recruitment and on an ongoing basis where appropriate. Disclosure and Barring Service (DBS) checks were undertaken where required. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns.

The provider shared patient feedback about the service. Patients reported being given clear information and feeling listened to by staff.

Leaders told us that staff were informed in managing risk, and that standing items such as safeguarding and incidents were discussed at the all staff meeting where learning was shared. This meeting was recorded and minuted, staff told us they had an opportunity to review meetings if they couldn’t attend. Staff reported that they were included in risk management, and that they were happy to report when things went wrong.

There were process in place for risks to be discussed with all staff. The service utilised 12 premises, all of which were GP practices in the Bexley area, these GP services provided by other partnerships and companies. The service had been provided with risk assessments and checks of equipment and medicines and equipment to satisfy itself that all of these premises were fit for purpose. We observed the service equipped to respond to medical emergencies, including suspected sepsis, and all equipment was regularly checked. The service had protocols in place to manage the prioritisation of patients. Staff had completed basic life support, anaphylaxis, and sepsis training.

Staff at the service were aware of where all emergency equipment was stored. Leaders at the service were able to detail the policies and procedures that were in place to ensure that the environment was safe.

As part of this assessment, we visited the office at which the service was based, and 4 of the 12 locations at which services were provided while they were open. At all 5 locations, we observed that the premises were fit for use. In all of the locations, equipment had been checked and calibrated as required. The service utilised the emergency equipment and medicines provided by the GP services at which they were based. In all cases, they had access to a full range of emergency medicines and equipment (such as a defibrillator and oxygen) to ensure that emergencies could be safely managed.

The service had either undertaken, or a third party had undertaken on their behalf, a full range of risk assessments to ensure that the environment was safe, including premises, and health and safety. Where there was learning from these risk assessments, we saw that the service acted quickly to address any specific issues raised.

There were sufficient clinical and administrative staff to meet the needs of patients. The provider shared feedback collected from patients. We were told that patients were able to access appointments when they needed them and appreciated the short waiting time for face-to-face appointments.

Staff reported that in general there were sufficient staffing at the service, although at the time of the assessment some roles were vacant, including the Head of Operations. Leaders told us that they had worked hard to recruit to posts. Staff told us that in general staffing was sufficient, both in the main office and in the locations at which direct clinical care was provided.

There were processes in place to ensure pre-employment checks took place before staff commenced work at the service. There was an induction process for new starters and staff received regular appraisals. There were systems to ensure training was completed at set intervals throughout a person’s employment at the service. These systems were monitored to ensure compliance.

Premises were clean and tidy. The provider had completed handwashing audits to ensure staff were aware of correct handwashing techniques. Where areas for improvement were identified, action was taken to reduce the risk of infection.

Leaders told us that although clinical premises were not owned by the provider, they had access to cleaning schedules for the locations at which clinical services were provided, and regular monitoring of cleanliness was in place. All staff were aware of where spillage kits and other cleaning equipment were stored.

The service was clean, and all of the clinical areas at the 4 clinical sites that we visited were fit for use. Curtains were changed regularly, and sharps and other clinical waste management was managed appropriately.

Staff had received immunisations appropriate to their role. There were effective systems to ensure staff were up to date with routine immunisations.

Patients were prescribed medicine in line with best practice guidance. Patient records allowed for good continuity of care. The provider audited clinical records and made improvements as a result.

Leaders told us that there were prescribing protocols in place at the service that were audited. Leads at the service detailed how clinical records were reviewed, both in terms of medicines audits and sample reviews of individual clinicians.

The service sees patients who are registered at Bexley based GP practices, and does not have its own patient list. As such CQC was not able to undertake searches of clinical records. However, we undertook a sample review of notes, and prescribing was in line with best based practice.

There were written protocols for the prescribing of medicines requiring monitoring and management following patient safety alerts.