Heartbeat Alliance

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

In May 2022, we rated the provider as requiring improvement in providing a safe service. This was because the provider was unable to demonstrate safe systems oversight concerning recruitment, training, equipment and premises, significant events, patient safety and alerts, prescription security, business continuity planning; and the ability to respond to a medical emergency. At the inspection in May 2023, we found improvement in some but not all areas. At this assessment in May 2024, we rated Heartbeat Alliance as good for providing a safe service. We found the concerns identified in our previous inspections had been addressed.

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.

CQC had not received any feedback from members of the public regarding this service. The evidence we reviewed did not show any concerns about people’s experience regarding learning culture. The provider had arrangements in place to allow patients the opportunity to provide feedback on the service received. The way they managed feedback showed the views of people were listened to and considered.

There was a culture of safety and learning with safety being a priority that involved everyone. There was a willingness to put things right, learn and improve.

The systems and processes in place were based on openness, transparency, and learning from events that had either put people and staff at risk of harm or that had caused them or potentially caused harm. Incidents and complaints were now appropriately recorded, investigated, reported, and reviewed. Systems were now in place to review incidents and complaints at monthly clinical governance meetings. Findings were shared with staff at all levels, including the Board. Lessons were learned from safety incidents or complaints, resulting in changes that improved care for others. For example, action was in progress to manage issues with pathology test results.

CQC had not received any feedback from members of the public regarding this service. The evidence we reviewed did not show any concerns about people’s experience regarding safe systems, pathways, and transitions. The provider had arrangements in place to allow patients the opportunity to provide feedback on the service received. The way they managed feedback showed the views of people were listened to and considered.

Leaders described how care was delivered and reviewed. They told us how care was coordinated when different teams, services or organisations were involved. There was an effective approach to identifying and managing risks to patients as they moved between the enhanced access service, their own GP practice, and other services.

Partners told us the leadership team was keen, and involved system partners who were willing to share with and support wider partners. Examples were provided to support this.

The provider was not always able to provide continuity of care in the way a GP practice may. However, continuity in terms of staffing and being seen in a familiar setting was available in some cases as some enhanced access services operated from local GP practices. The patient’s own GP practice could book patients with less complex conditions into the service, potentially freeing up time for practices to provide continuity for patients with more complex conditions. A collaborative approach to safety that involved the provider working with local GP practices and other partners was evident. Policies and processes about safety were aligned. Staff working at the service had access to each patient’s full clinical record. They were able to view correspondence and test results within the record, and order further tests or make referrals. Safety netting arrangements were in place to ensure any actions requested by the enhanced access service were acted on by the patient’s GP practice. Improved systems were now in place to ensure that patients requiring blood tests in the enhanced access service arrived with the required documentation completed by their own GP practice reducing the risk of patients being turned away.

There was a commitment to taking immediate action to keep people safe from abuse and neglect. This included working with partners collaboratively. Staff were now aware of who the safeguarding lead was and the process for raising concerns. Staff training completion had improved. The provider now had systems of oversight in place. Staff told us they had received training in safeguarding children and adults. Most staff reported knowing who the safeguarding lead was. There was a commitment to taking immediate action to keep people safe from abuse and neglect. This included working with partners collaboratively.

We did not receive any concerns from commissioners or other system partners about safeguarding.

There were effective systems, processes, and practices to make sure people were protected from abuse and neglect. Examples of this were that safeguarding was now a regular agenda item at the monthly clinical governance meeting and regular audits were being carried out. For example, a schedule of regular audits was now in place to check staff were following their policy to ensure that children and vulnerable adults who did not attend or were not brought to their scheduled appointment in the enhanced access service were followed up and highlighted to the patient’s practice. Staff had received safeguarding, chaperone, and Mental Capacity Act 2005 training relevant to their role. Training that had previously been identified as overdue had reduced significantly. Safety arrangements had been introduced whereby no member of staff with training modules showing as overdue was granted a shift in the enhanced access service.

CQC has not received any feedback from members of the public regarding this service. The evidence we reviewed did not show any concerns about people’s experience of involving people in managing risks. The provider had arrangements in place to allow patients the opportunity to provide feedback on the service received. The way they managed feedback showed the views of people were listened to and considered.

Leaders evidenced the quality improvement audit system in place which allowed them to regularly review patient consultations to ensure risks were managed whilst respecting patient choice. Staff had completed training in adult and child basic life support, anaphylaxis, sepsis, and equality and diversity. Staff training completion had improved. The provider now had systems of oversight in place.

Clinicians had access to patient information to enable them to deliver safe care and treatment. There were systems for sharing information with a patient’s GP and other agencies to help manage risk. People were informed about any risks and how to keep themselves safe. Risks were assessed, and people and staff understood them. We reviewed some records of individual patient consultations and found they were written and managed securely and in line with current guidance and relevant legislation. Where relevant, equality and human rights legislation was considered. Processes were now in place to ensure staff completed Equality and Diversity training. Processes, including access to policies, training, and relevant equipment were in place to ensure staff were able to recognise and respond to a medical emergency.

Staff told us they felt safe to work at the hub sites. They said that facilities, equipment, and technology were well-maintained so they could work safely and deliver a good quality of care to their patients. Staff had completed training in fire awareness. Staff training completion had improved. The provider now had systems of oversight in place.

We found no concerns regarding the hub locations or the equipment within them, risk assessments and safety checks were completed, and the service met the population’s needs. Staff knew how to urgently escalate a safety concern if a patient quickly deteriorated.

The service had monitoring systems in place which they reviewed regularly to ensure risk assessments and actions from the assessments were completed. The service had systems in place to report new and emerging risks should they occur. As a result of one of our site visits, prompt action was taken by the provider, to mitigate an identified potential risk. The provider had put an action plan in place since our previous inspection which included identified improvements to environmental safety. Fire training, fire evacuation drills, health and safety information relating to hub sites, and an inventory of equipment had all been established and made available to staff.

CQC had not received any feedback from members of the public regarding this service. The evidence we reviewed did not show any concerns about people’s experience regarding safe and effective staffing arrangements. The provider had arrangements in place to allow patients the opportunity to provide feedback on the service received. The way they managed feedback showed the views of people were listened to and considered.

The staffing structure across the whole of Heartbeat Alliance had changed significantly. Leaders described a new staffing structure with clear lines of accountability and support for staff. Considerable focus had been placed on ensuring the right structure was in place to ensure safe and effective staffing arrangements. A continued commitment from leaders to work closely with staff and external partners to deliver and enhance these changes was evident. Staff told us about recruitment processes they had undergone to ensure they were suitable for the role and their employment contributed to an effective skill mix. The staff we spoke with told us they had adequate time to complete training, and they could approach leaders to access any additional training or support to meet their needs. They said that one of the benefits of their workplace was the support they received from the whole team. They felt safe at work, due to the protocols and policies in place. Leaders told us that poor performance would be managed appropriately, and there was a policy to support this.

There were now robust and safe recruitment practices to make sure that all staff were suitably experienced, competent, and able to carry out their role. Staff completed training appropriate and relevant to their role. For example, a training package had been put in place for phlebotomy staff. The provider now had robust systems in place for monitoring the completion of training deemed mandatory. Training completion rates were high. One area of training that had not yet received the required completion rates related to learning disability and autism awareness. The provider was, along with all other training closely monitoring this. Concerns previously identified relating to training completion and oversight had been addressed. Staff received the support they needed to deliver safe care. This included appraisal and support where needed to develop, and improve services, and where needed, professional revalidation. A programme of audit to ensure clinical oversight of clinicians was in place. Systems were in place to manage poor performance. Concerns about support for staff that we previously identified had been addressed.

CQC had not received any feedback from members of the public regarding this service. The evidence we reviewed did not show any concerns about people’s experience regarding infection, prevention, and control. The provider had arrangements in place to allow patients the opportunity to provide feedback on the service received. The way they managed feedback showed the views of people were listened to and considered.

There were now clear roles and responsibilities around the management and oversight of infection prevention and control. We were told that information about the risk of infection was shared appropriately with relevant partners. For example, regular engagement had been established with staff in host GP practices and when applicable worked with them to ensure adherence to national guidance. Staff told us they had sufficient personal protective equipment and appropriate handwashing facilities to carry out their clinical duties.

People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. During the site visits, we found the areas where the service was delivered to be visibly clean and suitable personal protective equipment throughout the practice.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. Infection Prevention and Control (IPC) audits were carried out at a minimum of six-monthly intervals. Actions from audits were completed in a timely way.

CQC had not received any feedback from members of the public regarding this service. The evidence we reviewed did not show any concerns about people’s experience regarding the way their medicines were managed. The provider had arrangements in place to allow patients the opportunity to provide feedback on the service received. The way they managed feedback showed the views of people were listened to and considered.

Leaders demonstrated a regular schedule of audits was now in place to monitor the prescribing of certain medicines in the enhanced access service. Clinicians we spoke to told us that they had easy access to medicine safety alerts.

The service held appropriate emergency medicines and a system was in place to monitor stock levels and expiry dates at all hub sites. There was medical oxygen and a defibrillator at all sites and systems to ensure these were regularly checked and fit for use. The governance and oversight of checks was not as robustly developed at one of the hubs, but this was rectified by the provider, on the day of our site visit.

Accurate, up-to-date information about people’s medicines was available as enhanced access staff had access to the patient’s clinical records. The provider was monitoring medicine prescribing in the form of audits. Three audits specifically relating to benzodiazepine, opioids, and antibiotic prescribing were now taking place regularly. Systems were in place to monitor the prescribing of individual prescribers through regular clinical note reviews. Where any issues were identified there was a system for following this up with the prescribing clinician. The service did not hold or administer any medicines which required refrigeration. The service did not dispense any medicines and did not hold any controlled drugs. Prescriptions were sent electronically to a pharmacy of the patient’s choice for dispensing.