CQC Inspection statement

Barnsley Healthcare Federation response to CQC inspection of i-HEART

In February 2018, i-HEART received its first inspection from the Care Quality Commission.

In response to the overall rating of ‘inadequate’, Marie Hoyle, Chief Executive, Barnsley Healthcare Federation has made the following comment:

“i-HEART is a service unique to Barnsley. It was borne out of a clear need to re-think the way in which GP services are delivered, providing opportunities for patients registered with a Barnsley-based GP to access same day appointments during evenings, weekends and bank holidays – times when GP surgeries are typically closed.

“Since the service was launched in 2015, i-HEART has helped thousands of people across Barnsley to avoid often unnecessary trips to hospital. The feedback we have received from users of the service has been overwhelmingly positive.

“As part this work we have conducted an extensive review of the way all Federation operated services are delivered. We have also introduced a number of new measures to ensure the services are responsive to the needs of patients and provide a safe and effective care environment.”

“Having said this, we acknowledge there are clear lessons which must be learned – something which we have taken extremely seriously. There has been quite a lengthy delay since the initial inspection took place and the publication of this report. I would like to reassure patients that work began to addressing the findings raised during the inspection immediately.

Dr David Shutt, Medical Director, Barnsley Healthcare Federation said:

“The CQC inspection took place in February, a time when nationwide NHS services faced intense levels of demand due to winter pressures.  Barnsley Healthcare Federation was not alone in facing these challenges. However, I would like to reassure patients that delivering a service which places their needs first and foremost is our highest priority.

“Whilst the inspector’s findings make for difficult reading, the measures we have implemented have resulted in significant changes to the way in which i-HEART operates. I would like to reassure patients that we have treated the comments received by CQC extremely seriously. Our priority is, and always has been to support the needs of patients throughout Barnsley, helping to increase capacity within Primary Care Services, providing a safe and effective service, whilst helping to reduce the high levels of demand on the town’s A&E department.

“I would also like to remind patients that if they have any concerns about the treatment they have received from i-HEART, or indeed any other services provided by Barnsley Healthcare Federation, that we welcome all feedback and I would urge them to contact us by emailing: bhf.patientfeedback@nhs.net.”

In response to the findings of the CQC inspection of i-HEART, Barnsley Healthcare Federation has implemented the following measures:

Patient feedback and complaint handling:

We have conducted an extensive review of the way in which all patient feedback is managed, delivering a clear, open and transparent way in which patients can share issues or concerns relating to treatment they have received. A summary of the steps Barnsley Healthcare Federation has taken include:

• We have reviewed and updated our formal patient feedback and complaints policy, helping to ensure patients can share their experiences of care received from the services provided by Barnsley Healthcare Federation quickly and easily.
• New guidelines to help patients submit feedback has been produced. Signs have been displayed in all patient waiting areas within all clinics.
• We have created a dedicated patient liaison team, responsible for working with clinical teams, practices and patients, to ensure feedback about patient experiences is reviewed, assessed and outcomes of investigations are used to influence the way in which services are delivered.
• We are ensuring both formal and informal patient concerns are recorded and handled appropriately.
• We have improved the way in which verbal complaints are recorded and handled. The CQC noted that a formal process was in place at the time of inspection, all patient feedback is logged and investigated by the patient liaison team.
• Clearer guidelines have been published providing patients with alternative courses of action should they not be satisfied with the outcomes of investigations undertaken by Barnsley Healthcare Federation.
• Clear timescales relating to investigations have been implemented, ensuring that all feedback/ complaints are investigated within a timely manner.
• We have also updated our internal policies and procedures for handling patient feedback, creating greater levels of transparency between different services delivered by Barnsley Healthcare Federation, enabling best practice and lessons learned to be shared throughout the organisation.

Staffing (Clinical staff competencies):

• Dr M Ghani has been appointed as Chairman of Barnsley Healthcare Federation in May 2018. He has assumed responsibility for ensuring our clinical oversight and performance management of clinical staff is appropriate.
• New policies have been adopted to oversee staff recruitment, to check the competencies and skills of GPs employed by Barnsley Healthcare Federation, including ensuring that all training and appraisals, are up-to-date.
• An audit of all staff (including locums) employed by i-HEART has been completed
• All appropriate checks regarding eligibility to work (including DBS certificates, professional indemnity and training) are up-to-date.
• Implementation of new software, to ensure all clinical staff are familiar with and have easier access to all HR policies and procedures.
• New processes implemented for oversight of recording of clinical information ensuring prescribing is appropriate, in addition to our clinical oversight we have engaged with NHS Barnsley CCG Medicines Management Team.

Assessing Patients who access GP streaming and out-of-hours services

• Barnsley Healthcare Federation has adopted the Manchester Triage standard, designed to help determine the most appropriate care, based upon the presentation of symptoms.
• Additional staff training has taken place and quarterly teaching sessions have been implemented based upon the analysis of training needs and significant events.
• Engaged the support of A&E clinical staff to ensure patients who are suspected of having sepsis can be transferred smoothly from our team into A&E.
• Adoption of sepsis toolkit for both telephone and out of hospital working.

Sepsis Management:

Barnsley Healthcare Federation’s Medical Director, Dr David Shutt, has taken on the role of sepsis champion for the federation led services and has been instrumental in the development of a sepsis aware system.  This involves ensuring all staff are able to recognise possible sepsis and act accordingly.  Posters displaying the sepsis decision support tool have been displayed in all clinical areas and staff have been trained in the use of the NEWS2 score for communicating with the ambulance service and secondary care.

We have also:

• Reviewed and implemented changes to GP systems used within i-HEART to ensure clinicians receive prompts to check for sepsis.
• Increased awareness of sepsis detection amongst clinical staff.
• Clinical staff have undertaken training in the recognition and management of sepsis.
• Sepsis protocols decision support tools are included in all locum induction training.
• The Federation is developing a sepsis action plan which will include sharing best practice and promoting awareness of sepsis to the public.

Clinical Governance

We have implemented a new clinical governance policy, laying out clear guidelines with regard to:

• Recording baseline observations during patient consultations.
• Managing safety alerts.
• Systems used for monitoring and auditing clinical staff performance.
• Mentoring and peer supervision.
• Quality checks on record keeping.
• Ensuring all work delivered by i-HEART and Barnsley Healthcare Federation complies with current NICE guidelines.
• Greater scrutiny of significant events, including sharing lessons learned and ensuring systems and procedures are reviewed regularly.

We would like to assure patients in Barnsley and members of the public of our continued commitment to providing high-quality, safe, effective, responsive and well-led services.

The CQC Report can be accessed here

For all media enquiries relating to the publication of this report, please contact: Matthew Ridsdale, Cannon PR, Tel: 01709 321585