How Does Your GP Score?

• Recruitment checks were carried out in accordance with policy, with Disclosure and Barring Service (DBS) checks undertaken regularly for all staff.
• There was limited monitoring of the outcomes of care and treatment, and the practice did not have an established clinical audit programme in place.
• Staff had access to emergency equipment and medicines, although the storage of medicines was not always in line with recommendations.
• The practice was proactive in identifying and supporting patients who were carers or had caring responsibilities, with approximately 2.64% of the practice list identified as carers at the time of assessment.
• Improvements could be made in safeguarding, staff recruitment, management and oversight of health and safety, management and oversight or requested referrals and the security, storage and oversight of blank prescriptions
• Areas that were escalated to DHSC included not having effective oversight of the monitoring of patients prescribed high risk medicines or who had long term conditions, the practice did not have effective processes for the management of safety alerts, which included historic drug safety and medication alerts and safeguarding processes were not always effective.

Castletown

• The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. Staff were trained to appropriate levels for their roles, and systems to identify vulnerable patients were consistent.
• Staff had all the information they needed to deliver safe care and treatment.
• The practice had effective systems in place to learn and make improvements when things went wrong.
• Staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people. Staff helped patients to be involved in decisions about care and treatment, and respected patients’ privacy and dignity.
• Improvements could be made with recruitment checks, data sharing, storage of emergency medicines, the management of patients who have had an exacerbation of asthma to ensure they are followed up promptly after their exacerbation and for the identification of patients who are carers or have caring responsibilities.
• No areas were escalated to the DHSC

Finch Hill

• The practice operated a system whereby a specific code could be added to a patient’s care record where staff suspected potential safeguarding concerns. This allowed other practice staff to be aware of any suspicions and allowed patients to be quickly identified and reviewed by the practice
• Staff worked together to ensure care and treatment was coordinated between services. To achieve this, the practice hosted regular multidisciplinary clinical team meetings where local health visitors and long term conditions coordinators were invited to join the practice GP clinical team to discuss relevant clinical cases. Comprehensive minutes were recorded for each meeting, which included details of any patients discussed and any joint actions agreed.
• Improvements could be made with implement safeguarding meetings to discuss vulnerable children, oversight of the checking of medical equipment, childhood immunisation uptakes and obtaining patient feedback.
• Area that were escalated to the DHSC included the practice not having effective oversight of the monitoring of patients prescribed high risk medicines and did not ensure all patients received all required monitoring, assessments, follow-up appointments and medication reviews, not having effective processes for the management of historic drug safety and medication alerts and not having a system in place for translators and interpreters.

Hailwood

• Safeguarding processes were not always effective, as not all staff were trained to appropriate levels for their roles. Systems to identify vulnerable patients on record were not consistent, and data sharing arrangements did not always allow for the effective sharing of safeguarding information. There was limited engagement in local safeguarding processes
• Recruitment checks were not always safe, as not all staff received appropriate Disclosure and Barring Service (DBS) checks. Staff qualifications, professional registrations and vaccinations were not always checked.
• Health and safety risk assessments, which included fire, legionella and hazardous substances risk assessments, had not been completed.
• Appropriate standards of cleanliness and hygiene were not met.
• The practice did not have effective systems in place to learn and make improvements when things went wrong. This included their system for recording and acting on safety alerts, as several safety alerts had not been actioned or addressed by the practice.
• The practice was unable to demonstrate that it always obtained consent to care and treatment in line with legislation and guidance.
• However, the practice did proactively review and discuss the care of patients receiving palliative care during each clinical meeting. Where patients had not been contacted or seen by a clinician since the last clinical meeting, clinicians were tasked to review the patient’s record to confirm their care needs remained met.
• The CQC has recommended improvements in a number of areas, including safeguarding, background checks, health and safety, the storage of patient information, cleanliness, security of blank prescriptions, effective systems to monitor the prescribing of controlled drugs, patient phone access to the practices and several others.
• It has also elevated issues to the DHSC saying that the practice didn’t undertake health and safety risk assessments, didn’t have effective processes in place for the supervision and oversight of staff, its recruitment processes weren’t safe, safeguarding processes weren’t effective and that the practice did not have effective oversight of the monitoring of patients prescribed high risk medicines, amongst others.

Jurby

• Safeguarding processes were not always effective, as not all staff were trained to appropriate levels for their roles. Systems to identify vulnerable patients on record were not consistent, and data sharing arrangements did not always allow for the effective sharing of safeguarding information.
• The practice’s systems for the appropriate and safe use of medicines, including medicines optimisation, was not effective as documentation did not always demonstrate that staff had appropriate authorisations to administer all medicines.
• Blank prescriptions were not always stored securely.
• Patients prescribed high-risk medicines did not always receive all required monitoring, and changes made to patient medications by other services were not always received by the practice.
• Medication reviews were not always completed when required, and documentation regarding completed reviews was limited.
• The practice’s system for recording and acting on alerts was not effective, as several safety alerts had not been actioned or addressed by the practice.
• However, the practice operated an annual flu clinic and health information day within their local community, during which staff offered patients a range of services in addition to flu vaccinations, which included height, weight, blood pressure and blood sugar checks. Additional urgent appointments were made available at the practice to allow for any abnormal observations to be promptly assessed.
• Improvements have been recommended in areas including safeguarding, storage of blank prescriptions, storage of emergency medicines, the monitoring and oversight of patients prescribed high risk medicines to ensure patients receive all required monitoring, assessments, follow-up appointments and medication reviews, childhood immunisations and to implement a system to ensure patients with a do not attempt cardiopulmonary resuscitation (DNACPR) decision are regularly and appropriately reviewed.
• The CQC has also escalated areas to the DHSC, noting that the practice didn’t have effective oversight of the monitoring of patients prescribed high risk medicine, didn’t have effective oversight of the monitoring of patients with long term conditions, didn’t have effective processes for the management of safety alerts, which included historic drug safety and medication alerts, didn’t have an effective system in place regarding the use of patient group directions and safeguarding processes were not always effective.

Kensington

• Safeguarding processes were not always effective, as not all staff were trained to appropriate levels for their roles. Systems to identify vulnerable patients on record were not consistent, and data sharing arrangements did not always allow for the effective sharing of safeguarding information.
• Appropriate standards of cleanliness and hygiene were not always met.
• The practice’s systems for the appropriate and safe use of medicines, including medicines optimisation, was not effective as documentation did not always demonstrate that staff had appropriate authorisations to administer all medicines.
• Patients prescribed high-risk medicines did not always receive all required monitoring. Medication reviews were not always completed when required, and documentation regarding completed reviews was limited.
• There was limited monitoring of the outcomes of care and treatment, and the practice did not have an established clinical audit programme in place.
• However, staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people. Staff helped patients to be involved in decisions about care and treatment, and respected patients’ privacy and dignity.
• There was compassionate, inclusive and effective leadership at all levels. The practice had a culture which drove high quality sustainable care.
• Improvements could be made in safeguarding, staff checks, data sharing, implementing an effective system regarding the use of patient specific directions, a formalised programme to review clinical staff competencies, including the prescribing competencies of non-medical prescribers, improved management of patients with long-term conditions and improved telephone access for patients.
• Areas escalated to the DHSC include not always meeting appropriate standards of hygiene and cleanliness, not having effective oversight of the monitoring of patients prescribed high risk medicines and an effective system in place regarding the use of patient specific directions.

Laxey

• The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. Staff were trained to appropriate levels for their roles, and systems to identify vulnerable patients were consistent
• Recruitment checks were carried out in accordance with policy, and Disclosure and Barring Service (DBS) checks were undertaken regularly for all staff.
• Hygiene standards were met.
• Staff had all the info they needed to deliver safe care and treatment.
• The practice’s system for the appropriate and safe use of medicines, including medicines optimisation, was not always effective.
• The practice had a culture which drove high quality sustainable care.
• To ensure patients were booked in with the most appropriate clinician, in a timeframe that was appropriate for their condition, the practice had implemented a flowchart that receptionists followed to help determine the severity of the patient’s condition.
• Improvements could be made with data sharing, management of controlled drugs, emergency equipment checks, improve the oversight of vaccines and identifying patents who are carers or have care responsibilities.
• Areas escalated to DHSC included oversight and management of emergency equipment and vaccines and the practice not having effective processes for the management of historic safety and medication alerts.

Onchan Village Walk

• The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. Staff were trained to appropriate levels for their roles, and systems to identify vulnerable patients were consistent.
• The practice’s system for the appropriate and safe use of medicines, including medicines optimisation, was effective. Patients prescribed high-risk medicines received all required monitoring and medication reviews were completed when required. Staff had access to emergency equipment and medicines, but the storage of emergency medicines was not always in line with guidance.
• Patients’ needs were assessed, and care and treatment were delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
• The practice had a culture which drove high quality sustainable care.
• The practice had developed their own clinical pathways and protocols, which included antibiotic protocols, and used these to improve the quality of care and treatment. Staff utilised care plans to ensure the individual needs of patients with certain conditions or needs, such as patients with poor mental health or who were living with dementia, were met.
• Improvements could be made with data sharing, cleanliness, prescribed controlled drugs, storage of emergency medicines and equipment and processes for the management and recording of historic safety and medication alerts.
• Areas escalated to the DHSC included appropriate standards of cleanliness and hygiene due to required building maintenance and the lack of an effective process for the management of historic safety and medication alerts.

Palatine

• Safeguarding processes were not always effective, as not all staff had completed required training for their role. Systems to identify vulnerable patients on record were not consistent, and data sharing arrangements did not always allow for the effective sharing of safeguarding information.
• Recruitment checks were not always carried out in accordance with policy, as not all staff were evidenced as having undertaken DBS checks.
• Appropriate standards of cleanliness and hygiene were met.
• The practice’s system for recording and acting on alerts was effective.
• Care and treatment were delivered in line with current legislation, standards and evidence-based guidance. Patients with long term conditions generally received all required monitoring, although did not always receive appropriate diagnoses for their condition.
• The practice proactively worked to improve the uptake of annual health check reviews for patients with learning disabilities. To achieve this, the practice sent letters to all relevant patients from a named receptionist, who patients could contact if they had any queries. Staff also sent an easy read version of a leaflet with the letter that detailed what was involved during a health check and why it was important to attend these appointments. As a result of this work, the practice had seen the uptake of health checks double.
• Improvements were recommended for safeguarding, recruitment, documentation of patient medication reviews, storage of emergency medicines to ensure they are in line with best practice guidelines, a system for staff to be able to speak up and raise concerns externally and childhood immunisation uptake rates.
• Areas escalated to the DHSC include the practice not having effective oversight of the monitoring of patients prescribed high risk medicines, safeguarding processes were not always effective, as not all staff were evidenced as having completed appropriate training for their roles and recruitment checks did not always include all recommended checks, such as the undertaking of Disclosure and Barring Service (DBS) checks, review of staff professional registrations and review of staff vaccination history.

Peel

• Safeguarding processes were not always effective.
• Recruitment checks were not comprehensive.
• Health and safety risk assessments were carried out.
• Staff did not always have all the information they needed to deliver safe care and treatment
• Standards of cleanliness and hygienes were met.
• The practice’s system for the appropriate and safe use of medicines, including medicines optimisation, was not effective as patients prescribed high-risk medicines did not always receive all required monitoring.
• Staff treated patients with kindness, respect and compassion.
• The practice had achieved the World Health Organisation’s (WHO) 95% uptake target for the most common childhood vaccinations and immunisations.
• The practice had developed their own set of practice protocols that were focused on improving the quality of care and treatment provided to patients.
• The practice had established and effective systems in place to collect and collate patient feedback, and used this feedback to improve services for patients.
• Recommendations for improvements were made for safeguarding, recruitment processes, the security and storage of confidential info, the storage of emergency medicines and equipment to ensure they are stored in line with guidance and a process to review unplanned admissions, readmissions and referrals, amongst others.
• Areas escalated to the DHSC include the practice not having effective oversight of the monitoring of patients prescribed high risk medicines or who had long term conditions, did not have effective processes for the management of safety alerts, which included historic drug safety and medication alerts, did not have an effective system in place regarding the use of patient specific directions and safeguarding processes were not always effective.

Ramsey

• Safeguarding processes were not always effective.
• Appropriate standards of cleanliness and hygiene were met, and key health and safety risk assessments had been undertaken.
• The practice’s systems for the appropriate and safe use of medicines, including medicines optimisation, was not effective as documentation did not always demonstrate that staff had appropriate authorisations to administer all medicines.
• Blank prescriptions were not always stored securely. Patients prescribed high-risk medicines did not always receive all required monitoring, and changes made to patient medications by other services were not always received by the practice.
• Staff worked together to deliver effective care and treatment.
• There was compassionate, inclusive and effective leadership at all levels.
• The practice operated an annual flu clinic and health information day within their local community, during which staff offered patients a range of services in addition to flu vaccinations, which included height, weight, blood pressure and blood sugar checks.
• Improvements were recommended in a number of areas including the security and storage of blank prescriptions, oversight of staff recruitment, monitoring and oversight of patients prescribed high risk medicines to ensure patients receive all required monitoring, childhood immunisation uptake rates and

  availability of translation and interpretation services.

• The CQC escalated several areas to the DHSC, including not having effective oversight of the monitoring of patients prescribed high risk medicines, a lack of effective oversight of the monitoring of patients with long term conditions, effective processes for the management of safety alerts and the practice did not have an effective system in place regarding the use of patient group directions.

Snaefell

• Staff were trained to appropriate levels for their roles and systems to identify vulnerable patients on record were consistent, but data sharing arrangements did not always allow for the effective sharing of safeguarding information.
• Health and safety risk assessments were carried out, which included infection prevention and control assessments.
• The practice’s system for the appropriate and safe use of medicines, including medicines optimisation, was not effective as patients prescribed high-risk medicines did not always receive all required monitoring.
• Medication reviews were not always completed when required and documentation regarding completed reviews was limited. The practice demonstrated the prescribing competence of all staff, but the supervision of prescribers was not always formalised.
• The practice had effective systems in place to learn and make improvements when things went wrong.
• Staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people.
• During each day, the practice held an all staff huddle to discuss how the day was going, whether there were any barriers or challenges that needed to be overcome, and any requirement for support. This was supported with a huddle board, which staff could add any items on during the day. A photograph of this board was taken and shared with any staff who could not attend.
• The practice offered cervical cancer screening appointments on a Saturday morning to allow patients who could not attend the practice during the week to receive care and treatment.
• Recommended improvements included recruitment checks, data sharing arrangements, oversight of blank prescriptions to allow for effective reconciliation to take place, childhood immunisation uptake rates and systems for the identification of patients who are carers or have caring responsibilities.
• The CQC also raised areas to the DHSC, including the practice not always having effective oversight of the monitoring of patients prescribed high risk medicines or controlled drugs, the booking system was not always effective and there was not an effective oversight of equipment, medicines and consumables.

Southern Group Practice

• Safeguarding processes were not always effective, as not all staff were trained to appropriate levels for their roles, systems to identify vulnerable patients on record were not consistent, and data sharing arrangements did not always allow for the effective sharing of safeguarding information.
• Health and safety risk assessments carried out did not always include all recommended areas.
• Appropriate standards of cleanliness and hygiene were not met.
• Patients’ needs were assessed, and care and treatment were delivered in line with current legislation and standards.
• The practice had a comprehensive programme of quality improvement activity, which was supported by an established clinical audit programme.
• The practice always obtained consent to care and treatment in line with legislation and guidance.
• The practice was proactive in ensuring patients from all communities had equal access to inclusive and person-centred healthcare, recently focusing on improving the care, treatment and support for patients from the LGBTQ+ community.
• The practice had a strong commitment to quality improvement through regular and repeated clinical audit.
• Improvements were recommended around ensuring the identification of all vulnerable adults and children is consistent, health and safety risk assessment processes, security, storage and oversight of blank prescriptions and childhood immunisation uptake rates, amongst others.
• Areas escalated to the DHSC included not always meeting cleanliness and hygiene standards, the practice did not have effective oversight of the monitoring of patients prescribed high risk medicines or who had long term conditions, the practice did not have effective processes for the management of safety alerts, which included historic drug safety and medication alerts and the practice did not have effective processes in place for the supervision and oversight of all staff, including non-medical prescribers, amongst others.

You can read all the full reports here.