GPS Healthcare - Tanworth Lane

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• 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 carried out an announced assessment of all 8 quality statements (Learning culture, Involving people to manage risks, Safeguarding, Safe and effective staffing, Safe systems, pathways and transitions, Medicines optimisation, Safe environments, and Infection prevention and control). We have combined the score for this area with scores based on the rating from the last inspection, which was requires improvement. At the previous inspection in December 2018, the provider was rated as requires improvement in safe services because systems and processes were not always applied consistently. Also, some areas such as the management of safety alerts, elements of performance monitoring and the system for monitoring patients on high-risk medicines required embedding further. At this assessment we found leaders and staff had implemented systems and processes to ensure safety which were applied consistently. There was effective management of safety alerts, performance monitoring and medicines.

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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the patient participation group (PPG) felt the provider took concerns seriously and proactively made improvements to the service.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Overall, staff felt there was an open culture and that safety was a top priority. However, some staff reported they did not always feel confident to raise concerns and felt that senior managers did not always listen to staff concerns. The provider had taken action to support staff by the formation of a staff council, having a new Freedom to Speak Up Guardian in place and plans to appoint Freedom to Speak Up Champions.

The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others. The provider had received 237 complaints for all 6 sites between April 2023 and April 2024. Managers had analysed the complaints which were mainly around making an appointment, referrals and prescriptions. Learning was discussed at site meetings between managers, clinical staff and administration team staff. Processes to report and manage significant events were effective. Staff had reported 24 significant events at all 6 sites between April 2023 and April 2024. Managers had analysed the significant events which resulted in an annual report with learning and actions for clinical and administration staff.

We carried out remote searches of patient records and found patients were consulted about their pathway of care.

Staff told us administration and secretarial tasks were up to date, including summarisation of new patient notes, and processing letters from external organisations such as secondary care. The provider shared their engagement with local partners to improve patient awareness of services they could access. An example was engaging with the local Primary Care Provider Alliance through staff training events to increase the profile of local services available to patients such as referral for dermatology, contraception and respiratory conditions.

There were systems for sharing information with other agencies to enable them to deliver safe care and treatment.

Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals. There was appropriate clinical oversight of test results, including when non-clinical staff initially reviewed results in order to send them back to the clinician for action.

Staff told us there were 2 safeguarding lead GPs and staff were aware of who these were. There was also a safeguarding care coordinator who managed the provider’s safeguarding systems. Staff told us they understood how to spot signs of abuse and knew how to raise concerns.

There was active and appropriate engagement in local safeguarding processes. There were regular discussions between the provider and other health and social care professionals such as health visitors, school nurses, community midwives and social workers to support and protect adults and children at risk of significant harm.

Safeguarding systems, processes and practices were developed, implemented and communicated to staff. Partners and staff were trained to appropriate levels for their role. There were flags in the systems to identify vulnerable patients on clinical records. Disclosure and Barring Service (DBS) checks were undertaken where required.

The 2024 GP patient survey data showed that patient satisfaction with being involved in decisions about their care and treatment remained high. Of the people that responded to this question, 91% responded that during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment. This is the same as the national average. The PPG were kept informed about issues affecting the GP practices run by this provider; this included concerns that would have a direct impact on care delivery. We viewed a sample, at random, of 5 care records for patients with chronic obstructive pulmonary disease (COPD) and saw that people with COPD were involved in their care plans. We reviewed a sample, at random, of 5 care records for patients that had a DNA CPR (do not attempt cardiopulmonary resuscitation) in place. We found that discussions had taken place with patients and their family members and consent was sought appropriately.

Patients were informed about any risks and how to keep themselves safe. Staff would use alternative methods of communication where needed. Risks were assessed, and patients and staff understood them. Staff told us they had training on responding in emergencies and knew what to do if an emergency occurred. Staff told us there was a balanced and proportionate approach to risk that supported patients and respected the choices they made about their care.

The provider had processes in place to manage risks. For example, there were protocols in place to manage emergencies. Guidance for staff was displayed on the walls at all sites so they knew what actions to follow in an emergency. The provider monitored patient satisfaction and was aware of the 2024 GP patient survey results. They also checked the NHS website for patient feedback. They have taken action to improve in areas where patient satisfaction was poor for example, accessing appointments.

Staff told us the provider completed risk assessments of buildings and checks of equipment and these were audited regularly. We found some clinical rooms were carpeted at the Village Surgery and at Park Surgery work was ongoing to repair damage to the main entrance. Access was via a back entrance and although this system had been appropriately risk assessed it was difficult for both staff and patients. Since our assessment we have seen evidence from the provider that the carpet at the Village Surgery has been replaced with flooring that meets infection prevention and control standards. Also, since we visited Park Surgery, the provider has completed the repair work and the site is now accessed by automatic doors at the front entrance.

We visited 3 sites at Tanworth Lane, Park Surgery and Village Surgery. The facilities and premises were appropriate for the services delivered and were mostly well maintained and equipped to support timely diagnosis and treatment of patients. Patients had access to consulting rooms on both the ground and first floor. During our observation of the provider’s premises, we found some clinical rooms were outdated with carpets and fixed patient couches that could not be adjusted. Each site had at least 1 adjustable couch in case of specific patient needs. The provider has provided evidence that since our visit further renovation work has been undertaken to remove the carpet and update the couches.

Reasonable adjustments had been made so that people in vulnerable circumstances could access and use the services. There were disabled toilet facilities and baby changing facilities. There was a hearing loop available for those with a hearing impairment. The provider had processes in place to test electrical equipment to ensure its safe use. We saw the provider had health and safety and fire risk assessments in place to assess, mitigate and monitor safety issues related to the premises. Updated risk assessments by external companies for all 6 sites were completed by the end of September 2024.

CQC received 11 complaints between September 2023 and June 2024 about difficulty getting an appointment which suggested a lack of clinical staff to provide enough appointments. The provider had carried out work on staffing resources to implement improved appointment management. Recent reviews by people who used the service on the NHS website in July 2024 showed 69% of reviews were positive about access and the quality of care provided by reception staff, nurses and GPs.

Staff told us they had the skills, knowledge and experience to deliver effective care, support and treatment. Staff told us they had regular appraisals, 1 to 1’s, coaching and mentoring and clinical supervision. Clinical staff were supported to meet the requirements of professional revalidation. Staff reported they had protected time for learning and development. There were good opportunities for additional training for staff. This included learning to enhance their role or to move on to different roles in the organisation. Leaders told us there were many additional roles working alongside GPs and nurses providing appointments and patient care, including Advanced Nurse Practitioners, Phlebotomists, Pharmacists, Pharmacy Technicians and Paramedics. Staff told us overall workloads were manageable with the staffing numbers in place. However, the daily workload of tasks additional to appointments such as processing letters from secondary care, blood results, and general clinical tasks for salaried GPs was sometimes unmanageable and some GPs were carrying out tasks in their own unpaid time. Locum GPs felt their workload was manageable as they did not get as many additional tasks such as blood test results. In response to these concerns, the provider took action to outsource support for salaried GPs with these additional tasks. Since our assessment we have seen evidence that this has resulted in a 75% reduction in the letters salaried GPs have to review. Staff told us the induction for reception staff was not as good as that for other staff groups. This included an understanding of all the clinical roles working within the provider’s GP practices and what patients they could treat. Since our assessment, the provider has developed a role-specific reception induction pack.

We reviewed the recruitment files for 3 members of staff, both clinical and non-clinical. We found recruitment checks were carried out in accordance with regulations. The provider used a flexible approach to reception staff working across sites to deal with the morning rush of calls. Staff gave positive feedback about this process. Staff had access to and had completed training identified as mandatory by the provider. Clinical staff had opportunities to attend local networks and online events to help maintain skills and development.

People had not expressed concerns.

The provider had leads for infection control. Leads told us they had completed training as required by the provider’s policy. However, we saw the leads had not completed additional training that would have supported them further in this role. Since our assessment the provider has evidenced that lead staff completed additional training provided by a private company on the recommendation of the GP provider support unit.

We found that the sites we visited were visibly clean and uncluttered. There was equipment for staff to use for handwashing and to prevent the spread of infection, such as gloves, aprons and clinical wipes.

The provider had effective processes in place to appropriately manage infection prevention and control (IPC). The provider’s 6 sites all had recent IPC audits carried out in 2024. The provider had IPC policies and processes in place which were easily accessible to all staff. The provider had contracted external cleaners to clean the premises and cleaning checklists were in place and monitored.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. CQC had received 3 complaints from people about the management of their medicines. Complaints included that people had difficulty or delays in getting their prescriptions. In the 2024 GP National Patient Survey, of the respondents, 83% said their needs were met following the appointment. The Provider carried out their own survey in November 2024 which showed that 90% of people now felt their needs had been met at their last appointment. This data was provided by the practice and is unverified. This data was provided by the practice and is unverified. This would include prescribing of medicines. There were 74 reviews on the NHS Website in July 2024 and overall, patients had not raised concerns about prescribing or management of medicines.

Staff received regular training on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff managed medicines-related stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Staff showed how they disposed of expired or unwanted medicines that patients had returned. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. We carried out remote record searches of patient records to look at medicines management. We found monitoring and reviews for patients on medicines for specific long-term conditions and patients on high-risk medicines were being carried out as required.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. There were suitable processes for staff to follow when dispensing medicines.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. There was a programme of regular clinical auditing of prescribing that focused on improving care and treatment.