The Blackmore Vale Partnership

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 and inspected against four quality statements, Learning culture; Safeguarding; Safe systems, pathways and transitions; Medicines optimisation. During our assessment of this key question, we found incidents were investigated openly and transparently. Actions were recorded and learning was shared with staff to mitigate the future likelihood of incidents reoccurring. Staff were confident in responding to safeguarding concerns and had received training relevant to their role. Systems for the safe management of medicines, including emergency medicines and equipment were in place and regularly reviewed. People received co-ordinated and joined up care when transitioning between healthcare services through the effective management of referrals, correspondence between providers and regularly reviewed local secondary care pathways.

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 told us that they had opportunities to provide feedback and they knew how to make a complaint. We spoke with two members of the Patient Participation Group. Both told us they had positive engagement with the practice and felt that the practice wanted to learn how they could meet people’s needs and were proactively seeking feedback. We received feedback from the local community mental health service who told us that concerns about patient care were discussed regularly in a multi-disciplinary team approach.

Leaders told us that clinical issues were regularly discussed between members of the team at practice meetings. GP partners told us they were responsible for investigating incidents which required clinical review. Staff we spoke with told us there was a no blame culture and staff felt able and told us they were encouraged to raise concerns. Staff were aware the learning that had taken place following the review of safety incidents and the changes that were needed to improve care for people.

During our assessment, we reviewed a significant event relating to medicines monitoring and mental health care provision. We spoke with leaders who demonstrated how the incident was investigated and the actions that had been taken by the practice to implement safe care and treatment. The incident findings had been shared with the appropriate staff and the care plan had been reviewed to identify any areas for improvement. We reviewed the practice’s complaints management processes and found that complaints and concerns had been appropriately investigated. People received responses to incidents in a timely manner and in line with the duty of candour. Meetings were held regularly where significant events were discussed for a wider learning. Learning outcomes were recorded on the action log and shared with staff through practice meeting minutes.

The practice’s national GP patients survey results from 2024 showed that people felt they were treated with care, were listened to and had confidence with staff in line with local and national averages, including staff’s understanding of meeting mental health needs. As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area. The practice collaborated with the Primary Care Network (PCN) and the Frailty (Aging Well) service to co-ordinate care for people with frailty through dedicated ‘carousel’ clinics. People received personalised care based on their level of frailty which incorporated a multi-disciplinary approach, such as independent living assessments, health screening checks and medication reviews.

Staff were aware of their role to monitor and manage care when patients were moved between services such as after referral to secondary care, or admission to hospital. A review of the practice clinical system, which formed part of this assessment, indicated that patient test results were being managed in a timely manner to support transition through services. Leaders told us they worked with stakeholder organisations such as secondary care providers to establish and maintain safe systems of care for patients. For example, the service reviewed referral pathway outcomes to ensure patients received joined up care. They also told us continuity of care for patients was important and achieved this through collaboration with other services. Staff used a clinical decision support tool to log and monitor urgent referrals and this included input from external professionals involved in the patient's care. Staff we spoke with understood the referrals processes and how to manage correspondence. Staff were able to demonstrate how people who were identified by the community ‘carousel clinic’ had care plans arranged by the practice, wellbeing team, community mental health services and the Frailty (Ageing Well) service to improve outcomes.

We received feedback from the local community mental health service who told us that mental health practitioners from the practice would co-ordinate care to ensure that monitoring requirements were met for those people who were prescribed mental health medicines. These staff members were supported by the practice lead GP’s. Feedback was positive in relation to the prompt actions from correspondence including referrals and there were adequate opportunities to discuss clinical queries regarding people’s care and treatment. People received a streamlined transition from the community mental health service when care came to an end through the dedicated mental health practitioners at the practice who managed care planning arrangements. We spoke with the NHS Dorset Integrated Care Board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area.

Policies and guidance were in place to support workflow and pathways for appointments, referrals, records and correspondence. The practice had a system in place for processing new information and summarisation of notes. The practice had kept up to date with patient summarising to ensure accurate information was available for clinicians. The practice initiated a project in line with NHS England’s population groups promotion, specifically, to support the Dorset Aging Well Program. This focused on the need for proactive provision for people who are frail, particularly on the prevention of poor health, whilst tackling health inequalities, including the delivery of good quality end of life care. The practice utilised demographic data to identify people most at risk of falls, social isolation and those who were experiencing poor mental health to be included in the project. The practice had undertaken a review to integrate the Mental Health and Physical Health pathways. This commenced in conjunction with Dorset Mental Health forum which offered peer specialism with lived experience for mental health support. The practice had health coaching support through the wellbeing service, which also offered patients mental health triage. Triage offers a route where patients can be seen by the most appropriate clinician and team on the pathway which includes steps to wellbeing, community mental health services and secondary care services. The practice carried out an audit in relation to the community ‘carousel clinic’ to determine outcomes for people. We identified between March 2023 and March 2024, 181 people were seen during the ‘carousel clinics’ and 85 people were booked for a follow-up appointment to discuss their needs and care plans further. The practice identified their role through the evaluation of the project to support people to become more active in managing their own health whilst also bringing together multidisciplinary teams to support people’s complex health needs.

Staff told us there was a safeguarding register and that vulnerable people who used the service were discussed in clinical meetings. Staff demonstrated their understanding and were able to identify local arrangements for raising safeguarding issues. They had received training in safeguarding and chaperoning and were able to explain their role in these processes, including how to recognise and escalate any concerns. Leaders told us senior staff discussed safeguarding concerns at regular clinical governance meetings, this included information shared by Health Visitors in relation to children of concern. Staff told us they reported concerns with the local authority where required.

We spoke with the NHS Dorset Integrated Care Board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area. Feedback from the community mental health team highlighted that vulnerable people were managed in a way to protect them from harm where possible and worked as a multi-disciplined team to develop treatment plans. Learning was shared across services based on regular evaluation of care.

The practice had a safeguarding policy with safeguarding leads. GP leads were supported by a safeguarding administrator who held oversight of co-ordinating correspondence with local multi-disciplinary teams such as the community nursing team and health visitors. The safeguarding administrator had a vast amount of experience across integrated care systems and demonstrated they were trained to Safeguarding level 5 in a designated professional capacity. They were able to give appropriate advice and support to professionals and could contribute to their appraisal process if required. Systems were in place to appropriately refer people to local authorities safeguarding teams and information was shared amongst community teams where required. A mixture of clinical and non-clinical staff members had chaperone responsibilities as part of their role. Those staff members had completed Disclosure and Barring Service (DBS) records in place. At the time of the assessment, we found that all members of staff were up to date with safeguarding training as well as in the Mental Capacity Act and the Deprivation of Liberty Safeguards, where required. We reviewed a sample of patient records as part of our remote clinical searches and found that care plans had been managed appropriately to protect people from harm.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. From the feedback we received we saw no indication of concern in this area.

Staff were aware of where emergency medicines and equipment were stored as well as procedures for raising urgent concerns. Staff were able to demonstrate how patient correspondence from diagnostic results and letters from secondary care providers were actioned. We identified that there the practice managed patient ‘workflow’ to ensure care and treatment was reviewed in a timely manner. The practice was able to demonstrate that all relevant safety alerts had been responded to. During our remote clinical searches, we reviewed patients who had been prescribed citalopram (>20mg) or escitalopram (>10mg) over the age of 65 years old, as there is a risk of experiencing heart related issues that require further electrocardiogram (ECG) tests to rule out complications. Citalopram is a type of antidepressant used to treat depression. The provider was able to provide evidence that patients had been contacted in line with the safety alert and arrangements were in place for safe care and treatment.

Medicines that required refrigeration were stored and monitored appropriately at the location. We identified staff had checked and logged temperature of the fridges daily to ensure it remained within acceptable parameters of between 2°C and 8°C. We found the practice had a data logger to identify any fluctuations in temperature for periods of time to highlight any temperature breaches and aid decision making in line with the practice’s cold chain protocol. The practice had risk assessed emergency medicines and equipment and these had been checked regularly to ensure they remained safe to use. We found there were suitable arrangements for the storage and ordering of oxygen cylinders and medical devices such as defibrillators had been maintained and calibrated. There were updated resuscitation guidelines for both adults and paediatric life support available for staff in the case of emergency. We saw examples of actions taken against national evidence-based guidelines of care, for example, regarding medicine optimisation of people prescribed high-dose opioids (>120mg morphine daily equivalents) within clinical audit activity. This identified patients who were contacted to develop a tailored dose reduction plan based on documented review of safety, effectiveness and tolerability of their treatment in the last 12 months.

As part of our assessment, we undertook remote clinical searches of patient records on the practice’s clinical system. Overall, the searches showed that medicines had been effectively managed by the practice, which included ongoing monitoring requirements for those patients prescribed high-risk medicines were in line with national guidelines. There were adequate recall processes to ensure medicine dosages remained accurate for people through medication reviews and blood tests were carried out in appropriate time frames to ensure safe care and treatment. There were policies in place covering repeat prescribing, management of prescription forms, and vaccine management. Medicines within the practice were effectively ordered, stocked and monitored. There were Patient Group Directions (PGDs) and Patient Specific Directions (PSDs) in place which were authorised by lead GPs that relevant staff worked to. They allowed specified health professionals to supply and/or administer medicine without a prescription or an instruction from a prescriber. There was a process in place to ensure prescription stationery was logged and stored securely. The practice medicine management team held oversight for managing safety alerts where patient search reports were run routinely. The practice held monthly team meetings which discussed clinical performance, outstanding patient recalls and prescription queries. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed performance was in line with national averages for various medicine indicators.