BARDOC - Rochdale UCC

Updated 23 May 2017

Rochdale Urgent Care Centre Out of Hours service is part of Bury and Rochdale Doctors on Call Out of Hours Service. (BARDOC). BARDOC is a social enterprise organisation which was formed from a GP co-operative in 1996 covering the Bury, Heywood, Middleton and Rochdale areas.

BARDOC provides emergency out of hours telephone advice, treatment at treatment centres via an appointment system and home visits to patients when appropriate.

 BARDOC provides out of hours GP cover for 134 GP practices, encompassing around 700,000 patients, and covers a geographical area of around 260 square miles.

Rochdale Urgent Care Centre Out of Hours Service is housed alongside Rochdale Urgent Care Centre. The Out of Hours service provides GP out of hours and triage services for patients requiring assessment and treatment during periods of time that their own GP practice is closed. The centre is open between 6pm and 11pm Monday to Friday; and Saturday and Sunday from 8am until 11pm. Calls are triaged by clinicians at Moorgate Primary Care Centre or Waters Meeting Heath Centre and appointments made for patients to attend Rochdale Urgent Care Centre out of hours facility when appropriate.  The centre is staffed by GPs, nurse practitioners and reception staff. Staff told us that a reciprocal arrangement existed between the out of hours service and the urgent care centre where patients were accommodated by the other service when patient demand was high, or patient need dictated.

BARDOC also provides the following services:

• Dental triage service for patients requiring assessment and treatment during periods of time that their own dental practice is closed.

• Telephone answering service for several practices within the Bury area between 6pm and 6.30pm. Messages are then passed to the GP on call for the practice in question.

• Booking centre for the seven day access scheme for patients within Heywood, Middleton and Rochdale. This service is available 24 hours a day, seven days a week.

• North West Ambulance Service (NWAS) alternative to transfer – providing cover for the alternative to transfer scheme for Heywood, Middleton, Rochdale and Bury 24 hours a day, seven days a week.

• Answering service for the Oldham district nursing team between 4pm and 8.30am Tuesday to Friday and between 4pm and 8am on Monday.

• Single Point of Access for crisis response and Pennine Care Direct. Referrals are processed and forwarded to the relevant departments for Bury, Heywood, Middleton, Rochdale and Oldham.

• Dental triage service and treatment centre for patients living in the Bury and Bolton areas. The service operates between 6pm and 10pm Monday to Friday and between 8am and 10pm on Saturday and Sunday in the Bury area; and between 6pm and 10pm Monday to Friday and 12 midday until 10pm Saturday and Sunday in the Bolton area.

• BARDOC has access to over 150 working GPs to cover across the service, as well as 26 advanced nurse practitioners, 70 telephone triage nurses,11 pharmacists, 70 non-clinical call handlers, 38 drivers and a range of administrative support staff.

Our inspection focussed on the GP out of hours service only.

In 2016 BARDOC out of hours service received over 86,000 patient calls to the service.

BARDOC GP out of hours service operates from the following locations:

• Moorgate Primary Care Centre 22 Derby Way, Bury BL9 0NJ

• Fairfield General Hospital Foulds Suite, Rochdale Old Road, Bury BL9 7TD

• Phoenix Centre, Church Street, Heywood OL10 1LR

• Rochdale Urgent Care Centre, Whitehall Street, Rochdale OL12 0NB

• Waters Meeting Health Centre, Waters Meeting Road, Bolton BL1 8TT

BARDOC provides the out of hours GP service for NHS Bolton CCG, NHS Bury CCG and NHS Heywood, Middleton and Rochdale CCG.

Updated 23 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rochdale Urgent Care Centre, part of Bury and Rochdale Doctors on Call Out of Hours service ( BARDOC) on 7 February 2017. Overall the provider is rated as good.

Our key findings across all the areas we inspected were as follows:

• The provider demonstrated an open and transparent approach to safety, and systems were in place for reporting, recording and providing feedback on significant events. Staff at this site completed details on the BARDOC ‘web’. Staff at other sites completed details on the BARDOC 'hub’, whilst others gave shift leads the information. Staff we spoke with were aware of their responsibilities to raise concerns and report incidents.
• The service was monitored against the National Quality Requirements (NQRs) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners about the level and quality of service being provided. Where variations in performance were identified, the reasons for these were reviewed and action plans implemented to improve the service.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received appropriate training and updates which provided them with the skills, knowledge and experience to deliver effective care and treatment.
• Clinical supervision and appraisal processes were in place. Clinicians received regular audit of their clinical practice using the Royal College of GPs urgent care tool the ‘Clinical Guardian’ system, and were provided with feedback, including areas for improvement. Call handling staff of all disciplines received regular call audits to monitor effectiveness and safety standards.
• Patients were triaged by clinicians at Moorgate Primary Care Centre or Waters Meetings Health Centre, and appointments were offered at Rochdale Urgent care centre when appropriate, in accordance with the disposition (outcome) of the assessment.
• Information about services and how to complain was available on the provider website. We saw that verbal complaints were recorded as ‘patient feedback’. Complaints were investigated and patients received an apology and explanation of actions taken following their complaint
• Staff had access to comprehensive safeguarding policies and procedures, and received training appropriate to their role. Staff demonstrated their awareness of their safeguarding responsibilities in relation to vulnerable children and adults; including frequent callers to the service.
• Vehicles used to transport GPs to home visits were clean, well maintained and appropriately equipped.
• There was strong and clear leadership from a clinical and senior management perspective. Staff felt supported by management who were visible on shifts on a daily basis to support the smooth running of the service.
• The provider proactively sought feedback from staff and patients, which it acted on.
• There were systems in place to provide integrated person-centred care. Special patient notes were used to record relevant information about patients who were nearing end of life or those with complex medical and/or social needs.
• The provider was aware of and complied with the requirements of the duty of candour.
• We saw areas of outstanding practice:
• Vulnerable citizens’ packs were in use, and carried in each of the cars in the fleet. These contained basic essential items such as water and a blanket; they also contained details of where out of hours treatment and dispensing centres were located. These were issued to members of the public who appeared to be vulnerable or in need, observed by the driver or visiting doctor en route to home visits.
• We saw evidence that inappropriate referrals to accident and emergency at Bolton hospital had been reduced between February 2016 and October 2016. This had been achieved by raising awareness amongst staff, training, and the additional clinical support provided by clinical floor walkers.

The areas where the provider should make improvement are:

• Consider taking steps to standardise and streamline the incident reporting system to create one system for all staff to use. At the time of our visit the method of reporting incidents varied according to level of connectivity with the main server.
• Review their arrangements for monitoring working hours for GPs and other staff working on a sessional basis.
• Maintain clear communication with facilities and premises management to ensure that premises’ risk assessments are appropriately updated and identified actions completed.
• Signage for patients attending the out of hours service at the Rochdale Urgent Care Centre was not clear, and the provider should take steps to improve the signage to ensure patients are clearly directed to the out of hours reception desk.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice