Background to this inspection
Updated
28 January 2016
The GP
out-of-hours service for Leicester City, Leicestershire and Rutland is provided
by Central Nottinghamshire Clinical Services Ltd. The service is commissioned
by the four Leicestershire Clinical Commissioning Groups (CCG’s), with the lead
for out-of-hours services being West Leicestershire CCG.
The
out-of-hours service provides care to patients who require urgent medical care
from GPs and nurses outside of normal GP hours. The provider employs the
services of 254 GPs, nurses, health care assistants and support staff who are engaged
on a sessional basis to deliver care to patients. The service operates county
wide from 6.30pm until 8am Monday to Thursday, and 6.30pm Friday until 8am
Monday, and all public holidays.
Initial
telephone contact with the out-of-hours service is through the NHS 111 service,
which is provided by another healthcare provider.
The service
provides care to a population of approximately 996,000 residing in the area and
operates from five primary care centres geographically spread across the
county. The five locations are;
Hinckley
& Bosworth Community Hospital, Hinckley
Leicester
Royal Infirmary, Leicester
Loughborough
Community Hospital, Loughborough
Lutterworth
Hospital, Lutterworth
Rutland Memorial Hospital,
Oakham
Updated
28 January 2016
We
carried out an announced comprehensive inspection at Leicester City,
Leicestershire and Rutland Out of Hours service on 10 and 11 November
2015.
Overall the service is rated as good.
This was following an inspection
carried out in March 2015, where the service was rated as inadequate overall
and placed into special measures. Issues identified at the previous inspection
included: -
-
Patients
were at risk of harm because systems and processes were not in place to keep
them safe. For example emergency and urgent patients were not being seen for
face to face consultations in relation to their medical needs and in a timely
manner
-
Staff
were not clear about reporting incidents, near misses and concerns and there
was no evidence of learning and communication with staff.
-
There
was insufficient assurance to demonstrate people received effective care and
treatment. For example we saw evidence of emergency patients waiting far too
long to be seen by a clinician. Despite being aware of issues, the provider had
not look at them in detail to identify the root cause.
Specifically, we found the service to
be good for providing safe, effective, caring and responsive services. It
required improvement for providing well led services.
Our key findings across all the areas
we inspected were as follows:
-
Systems
and processes had been established to protect patients from harm. Emergency and
urgent patients were now being seen for face to face consultations in relation
to their medical needs in a timely manner.
-
Staff
were now clear about reporting incidents, near misses and concerns. We could
see that the provider had implemented more robust mechanisms to enable learning
and communication with staff.
-
The
provider had implemented changes to ensure people received effective care and
treatment. The provider had implemented patient lists for clinicians, with a
person monitoring patient lists across all sites to identify potential breaches
of waiting times enabling them to manage patient flow better.
-
Patients
were positive about their interactions with staff and said they were treated
with compassion and dignity.
-
The
provider had ensured that essential clinical equipment was available at all
sites and in vehicles used. This was routinely monitored and equipment
restocked where necessary.
-
Medication
management was significantly improved following the previous inspection. The
provider had employed a pharmacist three days per week who was responsible for
implementing standard operating procedures and auditing medicines.
-
The
provider had clearer leadership structures, however a large proportion of the
executive team were either interim or acting staff.
However
there were areas of practice where the provider needs to make improvements.
Importantly
the provider must: -
In
addition, the provider should: -
-
Have
appropriate signage at the Loughborough site, so that patients can
differentiate between the out of hours provision and the urgent care centre.
-
Have
appropriate signage in different languages advertising interpretation services
at each of the sites, rather than this being written in English.
On the basis of the ratings
given to this service at this inspection,
I
am taking this service out of special measures. This recognises the significant
improvements that have been made to the quality of care provided by this
service
.
Professor Steve Field
CBE FRCP FFPH FRCGP
Chief Inspector of General Practice