Durham Dales Health Federation

Updated 2 June 2022

The provider of this service is Durham Dales Health Federation, which is a federation serving the needs of the population of the Durham Dales area. The Federation is made up of 12 general practices, with a population of 93,000 patients, spanning three Primary Care Networks (PCNs) in the County Durham Clinical Commissioning Group (CCG). Further details can be found on the provider’s website at www.ddhf.co.uk

They provide an extended GP access service from the following sites;

• Bishop Auckland Hospital, Cockton Hill Road, Bishop Auckland, DL14 6AD.
• University Hospital of North Durham, North Road, County Durham, DH1 5TW. (This site was set up to provide additional support to the local population during the covid-19 pandemic).

As part of this inspection we visited both clinical sites above, as well as the administrative base at:

• Unit 26, Innovation House, Longfield Road, South Church Enterprise Park, Bishop Auckland, DL14 6XB

The extended access services are located in existing hospital accommodation. They use the hospital accommodation to provide this service. The federation employs its own staff.

They provider also provides other supporting primary care functions, such as a community wellness team, care navigation, clinical pharmacists, healthcare coordinators, social prescribing link workers, integrated diabetes service and practice aligned mental health services.

The service employs three GPs (one female and two male, including the GP Medical Director/clinical lead), a nurse clinical services manager and a team of advanced nurse practitioners, junior practitioners, nursing associates and trainee nurse associates. There is a chief operations officer and a business support manager, who are supported by a team of administrative staff. The services use bank and locum staff when necessary. The provider also employs staff on behalf of local practices and primary care networks, such as clinical pharmacists, healthcare coordinators, social prescribing link workers and nursing associates/trainee nurse associates.

The extended hours and overflow (if extra capacity is needed by local GP practices) services operates at both sites as follows:

• Monday to Friday 12 noon to 8pm.
• Weekends and bank holidays 8am to 8pm at Bishop Auckland Hospital and 8am to 1pm at University of North Durham.

These services are provided by GPs and advanced nurse practitioners.

Patients can access appointments via the NHS 111 service; they can arrange either face to face appointments or telephone triage appointments (known as warm transfers). GP practices in the areas covered can book patients into the overflow service. The service for patients requiring urgent medical care outside of these and the GP surgery hours is provided by the NHS 111 service.

Updated 2 June 2022

This service is rated as Good overall. (Previous inspection July 2019 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Durham Dales Health Federation as part of our inspection programme. This was the first time we had inspected this service at this address. We inspected the service under a different location’s registration (prior to them moving premises) in July 2019, when they were rated as good overall.

We looked at the key questions; is the service safe, effective, caring, responsive and well-led.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• Sending out and receiving questionnaires completed by staff working at the service
• A short site visit

On the day of the inspection we interviewed; the chief operations officer, the business support manager, the GP Medical Director/clinical lead, the clinical services manager, two advanced practitioner nurse leads, a GP, an advanced nurse practitioner and a receptionist at the providers sites.

Our finding

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected;
• information from our ongoing monitoring of data about services; and
• information from the provider, patients, the public and other organisations.

We have rated this provider as good overall.

At this inspection we found:

• There were gaps in the oversight of some systems and processes to demonstrate effective governance. In particular, there were gaps in assurance around safeguarding training; the safety and effectiveness of premises; the risks of substances hazardous to health; infection prevention and control arrangements.
• The service had some systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• The service routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff had the skills, knowledge and experience to deliver effective care. However, assurances processes to check staff had received updated training in key areas was not always effective.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• There was a focus on continuous learning and improvement at all levels of the organisation. However, some aspects of assurance in the governance framework had not operated effectively.

The area where the provider must make improvements as they are in breach of regulations is:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care