Monitoring questions for GP practices

• How do you ensure staff recognise safeguarding issues for adults, children and other vulnerable people, and that they take appropriate action?
• How do you ensure that the management of any safeguarding concerns does not discriminate people, and that their human rights are protected?
• What are your arrangements to respond to medical emergencies?
• Where you have moved to remote consultations (telephone and video consultations), how do you identify vulnerable people or people who might be digitally excluded because of communication barriers (for example, because of a disability or poverty)?
• How are you protecting people’s human rights in relation to consent about health treatment? Particularly in relation to involvement in advance care plans and Do No Attempt CPR (DNACPR) decisions?
• Where DNACPR orders are in place are these always completed with involvement of individuals or the appropriate use of best interest decision making? Do conversations about CPR take place as part of a broader anticipatory care planning (such as ReSPECT)?
• Does the service have access to and is it following guidelines around Treatment Escalation Plans (TEPs), anticipatory care planning and Do Not Attempt CPR (DNACPR) orders and individualised care plans?

Infection control

• What changes have you made to infection control arrangements to protect staff and patients using the service?
• How do you ensure staff have the appropriate time for donning/doffing and cleaning between seeing patients? (not relevant to online services)
• When was your last audit of IPC/PPE/the environment and facilities? What did it tell you and what actions have you taken?

S1. Additional COVID vaccination delivery prompts

• Are infection risks to staff and people using the service being thoroughly assessed and managed? Consider:
  • Patient flow
  • Appropriate access to PPE
  • Processes to manage clinical waste safely and securely.

Safety systems and risks to people

• What actions have you taken in the last six months as a result of learning from serious incidents to ensure people are kept safe?
• How are patients who need urgent care and treatment identified, prioritised and protected from discrimination?
• How do you recognise and manage the deteriorating patient? (not relevant to online services)
• How do you ensure appropriate staffing levels and skill mix to cope with demand? (For example, weekends, bank holidays, seasonal pressures, epidemics)
• How are you assessing risks to staff employed through the primary care network (PCN)?
• How do you identify and manage patients who need a face-to-face appointment?
• What are your systems to support staff to work remotely where this is appropriate and required?

S2. Additional COVID vaccination delivery prompts

Managing adverse reactions

• Is there access to emergency medicines on site and how are these checked?
• What access is there to emergency medical/doctor support on site in the event of an adverse reaction?

• How do you manage clinical records to ensure safe care and treatment?
• How do you manage referrals to and from other providers? (not relevant for online providers)

• Have you made any changes to your approach to medicines management? (for example, in relation to repeat prescribing, ongoing monitoring requirements for high risk medicines)
  • If so, what and how has this affected care?
• How are people’s medicines reconciled, in line with current national guidance, when transferring between locations or changing levels of care?
• Have you made any changes to antimicrobial prescribing? If so, how has this affected care?

S4. Additional COVID vaccination delivery prompts

Receipt and storage

• How are are records kept of the vaccine received?
• How is is the cold chain maintained? What records are kept?
• What is the process to monitor expiry dates?
• What contingency arrangements are in place in case of failure of cold storage?

Administration and delivery of the vaccine

• How is the cold chain monitored and maintained during transport to and from satellite locations?
• How are decisions made on the level of stock that needs to be held to meet the needs of patients coming to the service?
• Are there suitable facilities to prepare doses of the vaccine and how are these monitored and maintained?
• Does the environment in which the vaccine is administered maintain patient’s privacy and dignity and are they suitable for people with access or other needs?
• How are roving vaccinations services (for example vaccinations carried out at care homes or other remote locations) managed to ensure the safe and secure transport, preparation and administration of the vaccine?
• Is the provider ensuring staff at the satellite site are working to relevant Patient Specific Directions (PSDs), Patient Group Directions (PGDs) or National Vaccination protocols when preparing and/or administering a vaccine?
• What information about the vaccine is provided to patients at the vaccination site?

Standard operating procedures and governance

• Are there standard operating procedures (SOPs) or policies in place to cover all aspects of vaccine administration and storage at the location?
• Are there clear records of temperature monitoring from receipt through to administration?
• Are there clear stock control records from receipt through to administration?

• How are you identifying, cascading and keeping up to date with changes in clinical guidance?
• What are your oversight arrangements for clinical care provided by clinical and non-clinical staff?
  • to people in care homes
  • to vulnerable people in their own homes

• How do you ensure that all staff (clinical and non-clinical), including those being flexibly re-deployed, have the skills and knowledge to carry out their roles and responsibilities effectively?
  • How do you ensure that the staff who deal with patients are operating within the appropriate scope of practice at the point of recruitment, and ongoing? For example, audit of consultations?

E3. Additional COVID vaccination delivery prompts

Training and supervision

• How have staff and volunteers been trained for their roles? Are there records of training available?

• How do you ensure that people who are affected by health inequalities are receiving the care they need?
• How are you promoting good health/targeted approaches in response to coronavirus (COVID-19) and people at risk?
• How are you identifying people who have missed screening tests/immunisations? What actions are you taking to promote people to access these services?
• What are your arrangements for your patients to receive flu vaccinations?

• How have you adapted how you support and engage with patients and their families/loved ones (for example, in the context of more remote working)?

• How do you support people to express their views and actively involve them to make decisions as far as possible?

• How do you take into account patient choice about how, when, where they want to be seen? (not relevant to online services)
• How do you ensure that people with information and communication needs are able to access appointments and services in ways that meet their needs?
• How does care provision take account of the needs of individual people? (for example, Trans people, people who have a disability, people with long term conditions or mental health needs)
• Have you identified any barriers to care provision, particularly for patients with protected characteristics? For example, disabled people, older people, different ethnic groups. If yes, what actions have been taken to combat them?
• How do you engage with patients who are unable to use the telephone or digital/online platforms, so that you can understand their health needs and offer them care or treatment?

• How are you managing access to services?
  • Do you have backlogs of activity and long waiting times as a result of coronavirus? How are you managing this? What are your recovery plans?
  • How are you ensuring that high-risk/vulnerable patients and pathways are being identified and prioritised appropriately? (not relevant to online services)
  • What are your arrangements to follow-up and support patients whose care and treatment was delayed due to coronavirus? For example, patients with non- coronavirus related issues.
  • How are you ensuring equitable access to appointments when they are needed, especially for people with protected characteristics and vulnerable groups? For example, Trans people, people who are housebound, people at the end of their life. (not relevant to online services)
  • How do you ensure that patients are receiving appropriate types of appointments to meet their needs?
  • How are you supporting and working with care homes to ensure patients receive the right care at the right time?
  • How do you ensure that people are able to register with the practice? For example, refugees, asylum seekers, migrants, homeless people.
  • How is the service working with partners to maintain and improve access? (for example, PCN, third-party providers, carer services, local services such as ambulance service etc)
  • What are your arrangements for clinician call-backs (including online and video) i.e. specified time/date offered to patient? How do you ensure patients are not missed or lost through this arrangement?

• What actions are you taking to protect and support the health, safety and wellbeing of staff, particularly those who are high-risk/different ethnic groups? For example, coronavirus testing
• How do you promote equality and diversity, and check that staff feel supported, respected and valued?
• What training and support is available for staff using new technology to deliver care? (not relevant to online services)
• How are you supporting staff who work remotely and how are you assessing them?

• Has your business model/operating model changed since the pandemic? If so, how and what has been the impact on staff and people who use your services?
• How do you assure yourself that you are providing a safe service? For example, regular audits and increased supervision etc.
• How are you monitoring business risks and issues, and what actions are you taking to respond to them?
  • What are the arrangements for business continuity? For example, arrangements for diverting calls, contingency planning for staff shortages/ outbreak onsite, changes made in light of coronavirus. How are you flexing the service/models of care to adapt to changing circumstances, including second wave of coronavirus?
  • How are you working with partners to review and update local pathways?
  • How do you ensure oversight and governance of care provided by external staff who are working with your patients? For example, staff employed by PCN or third-party provider?

W5. Additional COVID vaccination delivery prompts

• What systems and processes are in place to manage risks/issues in relation to COVID vaccination delivery? Consider:
  • Ensuring a designated person has clinical oversight of the staff at the location
  • Maintaining oversight of the vaccine’s storage and use
  • Managing drug alerts and recalls and cascading relevant information to staff
  • Systems are in place to respond to relevant medical devices and medicines alerts
  • Systems and processes to ensure consent is obtained in line with guidance.

• What systems are in place to support people (staff/people who use your services and their families/carers) to speak up and raise concerns?
• How do you support people to provide feedback?