Safeguarding is being improved in GP practices, the executive director of nursing, says.

Paul Moore was speaking after a report from the Care Quality Commission found problems at all but on GP practice in the Isle of Man.

Mr Moore, who had been a specialist advisor at the CQC, said: ‘In terms of training, it’s a very difficult balancing act.

‘When you have shortages of staff, you will always put the care of the patient in front of you before anything else that you have to do, and therefore, many people might be booked to do training on certain days, but on that day, we’re short of staff.’

He added: ‘The most concerning elements for me are the things which are systematic. So across all the practices and wider than that.

'Regarding safeguarding arrangements, I’d like that to be a bit better, but I know there’s a lot of work going on to improve the safeguarding across the island.

‘The other area I’d like to see some improvement on is in relation to the monitoring of patients on high-risk medicines.

‘There were some gaps, all the practices are monitoring patients on highrisk medicines, but some had gaps, and whilst we’ve followed up those patients, and they’re all okay, I think it’s a risk that I’d want to make sure is minimised as much as possible.’

Mr Moore said that extensive work is being done to improve both the safeguarding and the monitoring of patients.

He added: ‘The standards that the CQC used to assess are brand new for the island, and therefore this is the first opportunity to compare ourselves against those requirements.

‘It’s inevitable that it will find issues that we need to improve, it is defining how we want to provide our service going forward in line with those standards, so here’s our baseline assessment.

‘As we go forward in the years ahead we will make continuous improvement against that baseline assessment.’

He added: ‘There are pockets of outstanding practice, which is world-class in the island, that gives me an awful lot of encouragement and confidence that we have the ability to deal with the improvements that have also been recognised.’

The CQC investigation found failings in almost every GP practice.

They include overprescribing, insufficient monitoring, inadequate management of patient information, and a lack of safeguarding.

The report was put together by the Care Quality Commission (CQC), which is an independent regulator of health and social care in the UK. It was drafted in to the Isle of Man to examine healthcare services, following recommendations made by the Jonathan Michael Review in 2019.

The reports, which was published yesterday, marked the island’s GP practices on whether they are deemed to be safe, effective, caring, responsive, and well-led.

The CQC has already published its results on dentists, the accident and emergency department at the hospital and adult social care. CQC reports will become regular occurrences, with the regulating body set to return in the next six to eight months.

As this is the first time the GPs have been reviewed, they have not been given ratings, which is the usual system for CQC reports.

Ratings will be undertaken in the coming year.

Castletown Medical Centre was the only GP practice to meet all of the criteria in the CQC framework.

Of the 13 GPs, in accordance with the CQC framework, one was deemed to be safe, five were deemed to be effective, all were deemed to be caring, 11 were deemed to be responsive, and 12 were deemed to be well-led.

Widespread issues across multiple practices included safeguarding, the monitoring of patients with long-term health conditions and information sharing.

Many of the practices faced issues with the monitoring of patients on prescribed medicines.

At Ramsey Group Practice, a search carried out by the regulator, reviewed the prescribing of a high-risk medicine used to treat high blood pressure.

The search identified 97 patients who were prescribed this medicine, who had not received all recommended monitoring.

A detailed review of five patients’ care records found that all five were overdue monitoring, with two of these patients last monitored eight years ago.

At the same practice, seven patients were being prescribed two medicines that had been found to have a potential negative interaction when prescribed together.

A detailed review of five patients, found that all of them were being prescribed these two medicines together, with two of these patients having been on both medicines for nine years and the other three patients for five years.

There was no evidence of the patients being informed of the risk.

At Southern Group Practice, some patients were overprescribed a short acting reliever inhaler used to treat asthma.

According to the report, the overuse of such medicine is associated with the increased risk of asthma death.

One patient was shown in a review as a 1000% overuse of the inhaler, but the practice had continued to prescribe the medication.

This patient received 26 prescription issues, where the set maximum is six prescription issues.

At Hailwood Medical Centre, patient information was not always managed securely. There were instances of confidential information kept in unlocked drawers and cupboards within unlocked clinic rooms, this included a completed mental health assessment form that contained patient information and details on their medical history.

At Ballasalla Medical Centre, changes made by other services were not always shared with the practice in a timely manner, which impacted the practice’s ability to make timely amendments to patient medications.

In addition, across many of the practices, staff did not receive all of the necessary checks when joining, for example, not all staff received Disclosure and Barring Service (DBS) checks, which checks your criminal record, and not everyone had the required vaccinations.

Many of the staff did not receive all of the necessary training for safeguarding.

For example, Hailwood Medical Centre had 16% of the staff required to complete level 2 safeguarding training.

Issues identified across multiple practices have been reported to the Department of Health and Social Care.

Minister for the Department of Health and Social Care Lawrie Hooper MHK said: ‘I understand people may have concerns when they read the report for their general practice, but I want to reassure residents that our GP surgeries are safe places to receive care.

‘I am pleased that all of the surgeries have taken on board the comments from the CQC, and have already started making the changes to improve their services.

‘We need to take these reports in context, the surgeries haven’t met CQC standards, but this is to do with administrative or in-practice processes, not the patient care.’

He added: ‘As a department we have been assured by Manx Care that these issues are being addressed through action plans and monitoring, and we will receive regular process updates.

‘We want to make sure that all of these recommendations are well implemented, to ensure the people of the Isle of Man are receiving a high-standard of quality service.’

The reports can be found on the government’s website.