Getting it right first time, every time
The five standards of the Care Quality Commission (CQC) are: safe, effective, caring, responsive and well led. Quality is the demonstrable and objective achievement in these areas. Within the sphere of clinical governance and quality, all our activity and the data generated is designed to fall clearly into these domains, so that attainment of ultimately an excellent standard becomes routine and demonstrable.
Our goals
- 100% of our inspected services achieve “Good” or “Outstanding” ratings from CQC (or equivalent in Scotland and Wales).
- To innovate within the boundaries of the NHS framework to promote greater patient access.
- To be sector leaders in demonstrating the high quality of our care.
- To be a dynamic employer offering support and development to all employees.
Our goals are underpinned by our values, demonstrating accountability, being respectful, acting with courage, and delivering excellence.
Our primary aim continues to be increasing access to high quality care by delivering a range of services on behalf of the NHS and other healthcare providers.
John McMullan
Medical Director
Delivering outstanding clinical quality
In order to ensure outstanding clinical quality, the CQC’s five standards are embedded in the organisation, and achievement of these goals is demonstrated both internally and externally.
We prioritise patient safety and ensure that all our staff and consultants have the necessary skills and support to enhance patient safety within all our services and across our entire organisation.
We maintain rigorous feedback loops for all patient safety incidents and respond quickly to every incident to ensure the best possible care is delivered at all times.
We have adopted the PSIRF and have rolled out associated procedures and policies to all services.
Safety, quality, effectiveness and patient experience underpin everything we do, with a focus on getting it “Right First Time”. This approach is essential for improving healthcare access and outcomes across the UK and Ireland. At a clinical level, we are dedicated to delivering excellent care, with “Good” or “Outstanding” CQC ratings (or equivalent in Wales) for all of our inspected services, driven by robust patient engagement and feedback. 100% of our inspected services are rated as “Good” by the CQC.
A framework for continuous improvement
At an organisational level, we have a clear Quality Assurance Framework, based on the domains of quality outlined. To ensure standards are met, the Group Clinical Governance Board, a sub-committee of Totally’s Board, oversees this assurance. It is chaired by the Medical Director and, for further Board assurance, joined by a Non-Executive Director.
The Clinical Governance Board’s key responsibilities are to:
- Set standards for clinical governance within the Group;
- Give guidance and direction for service delivery;
- Drive standardisation of approach in policy, process and infrastructure;
- Set expectations for development or recovery and set timescales for delivery;
- Ensure that a clinical governance structure which monitors key quality indicators (“KQIs”) is in place; and
- Hold operational leaders to account in matters of clinical governance
The work of the Group Clinical Governance Board is underpinned by:
Subject matter experts (“SMEs”) work across the Group to ensure we meet national standards for their area of expertise.
Infection prevention and control (“IPC”):
High quality infection prevention and control processes are mandatory in delivering safe healthcare. Our IPC programme is led by a Clinical Nurse Specialist who monitors our approach to IPC, ensures we meet and exceed mandatory requirements and supports SERCLE/relevant audit studies.
Safeguarding:
Safeguarding is about protecting a citizen’s health, wellbeing and human rights to enable them to live free from harm, abuse and neglect. It is a legal, contractual and moral duty of all healthcare providers, and we have worked hard to ensure that our structures, staff and expertise deliver safe systems. Staff have access to safeguarding training, weekly group supervision sessions and regular safeguarding content through our Company intranet, providing updates on work undertaken across Totally and, importantly for clinicians, legal and national updates.
We continue to enhance our training content and schedule, and recent staff feedback confirmed the relevance, depth, and delivery of training for clinicians.
One important part of the work of the safeguarding team, led by our Named Nurse and Doctor for safeguarding, is monitoring the quality of our referrals into social services and local safeguarding teams. Assessing the quality of those referrals feeds an improving standard of practice.
Medicines management:
Medicines management is an evidence-based approach in prescribing, procurement, storage, distribution, administration, and disposal of medicines. The intention is to balance the safety, tolerability, effectiveness, cost, and simplicity of treatments based on current evidence, national guidelines and relevant local policy. Good medicines management ensures that patients receive better, safer, cost-effective, and convenient care.
Medicines management across the Group is provided by our subject matter expert pharmacists and a team of pharmacy technicians, working with local teams to ensure the appropriate storage, use and prescribing of medication and prescription stationery.
Clinical audit is a way to find out if healthcare is being provided in line with standards and lets providers and patients know where their service is doing well and where there could be improvements.
As a minimum, clinical audit seeks to provide assurance of compliance with contractual and clinical standards (whether these are national, professional or statutory). It identifies suspected or hidden risk, clarifies underlying activities involving waste and inefficiencies, identifies opportunities for the improvement of care and patient outcomes and supports the re-validation process for clinical staff.
During 2023/24 Totally conducted 43 audits focused on quality assurance or quality improvement, as follows:
- 39 quality assurance audits including medicines management, safeguarding, infection prevention and control, record keeping, clinical decision making and patient experience. A further 19 quality assurance audits were active at the end of the period that will be completed during 2024/25.
- Four quality improvement audits covering missed torsion, antimicrobial stewardship, palliative care prescribing and clinical performance as per NICE guidance. Nine quality improvement audits were in progress or planned for 2024/25 including the care of babies under three months, children’s experience of care and the reporting of dog bites.
The progress of the audit programme is reported to the Clinical Assurance Group on a monthly basis and audit outcomes are shared with all clinical staff via the Company intranet and during staff meetings.
Our internal SERCLE review process carries out formalised service inspections matched against the CQC’s criteria to provide quality assurance in between CQC inspections. The processes identify opportunities to capture best practice across equivalent services or, where there are shortfalls, address them with the local teams.
During the year, formal SERCLE visits were carried out in our Sunderland and Staffordshire-based services. Both visits were well received and staff were proud to show the quality of the care they deliver. Following the Sunderland visit the CQC was invited to the Sunderland service on an informal basis.
In addition to these formalised service inspections, quality reviews were conducted in all services, utilising personnel from the organisation not employed in the service itself to act as a critical friend.
The professional status and competence of our staff is of fundamental importance to providing safe and effective care. The Company is developing an innovative interactive database to ensure full compliance with registration, mandatory training and vaccination. This will support service team leaders who continue to take responsibility for the compliance of frontline staff.
FFT feedback
We encourage all our personnel to actively pursue feedback in as wide a manner as possible. The friends and family test (“FFT”) remains central to the collection of feedback from our service users and as planned we have migrated to an increasingly text-based route of data collection.
We recognise that the FFT has limitations in the range and detail of the feedback and captures only a small percentage of our service users. To collect information from a wider group of patients and to get greater depth of information we extended the text-based service to gather delayed feedback from urgent care users and have started inviting groups of patients and other potential service users to visit our facilities and provide verbal commentary.
As we increase the level and quality of feedback, we are seeing a slight reduction in those patients who rate our service as “Good” or “Very Good”. We see this as an opportunity to understand how we can improve more and encourage this enhanced feedback.
Complaints
Totally values complaints as an important source of patient feedback. During the year, we updated our complaints policy and are improving ways for service users to send feedback to the Company. We provide a range of ways in which patients and families can give feedback, raise concerns or make complaints. All concerns, whether they are presented in person, in writing, by telephone or by email, are assessed and acknowledged within three working days wherever possible and all complaints are investigated.
We aim to respond to informal concerns quickly. If the concern or issue cannot be dealt with informally or if the enquirer remains concerned, the issue is always categorised as a formal complaint and processed accordingly. Formal complaints are rare and are acknowledged and investigated appropriately with both individual lessons and Company-wide lessons being actively promoted.
Clinical risk is the assessed chance and severity of an adverse event occurring to a patient or group of patients. All clinical activity carries risk. Appropriate identification of areas of risk is of vital importance and requires assimilation of raw performance data as well as incidents identified from Datix, complaints and litigation.
It also requires attention to external events, policy changes and anything that impacts on the provision of healthcare.
Risks are identified at every level of the organisation and they are recorded and graded on risk registers with a plan formulated to minimise or, where possible, to eliminate them entirely. Every service area carries its own risk register with risks seen as relating to the wider organisation being reviewed and monitored centrally.
The quality of our services is dependant on the professionalism and dedication of our staff. As such their views and engagement
are fundamental to understanding how we can improve.
Our recent staff survey placed our colleagues’ views of patient safety and the quality of our services at its heart.
The Company-wide appraisal system has been rolled out and is aimed to both enhance an individual’s experience of working for the Company and assist in promoting the Company’s programme of delivering high quality patient care.
Our bi-monthly clinical learning forum is held online and brings together senior clinical leaders and clinical frontline staff to formally engage on matters of clinical development as well as quality issues.
