Archived: Devonshire House Also known as Primary Care Doncaster Limited

Updated 16 September 2019

The provider, Primary Care Doncaster Ltd (PCD), is a GP federation located in Doncaster. PCD has been commissioned to provide 160 hours per week of extended access services in Doncaster to expand routine primary care capacity. This includes 62 hours of routine pre-bookable GP appointments. These are provided at four hub sites based at local GP surgeries on Saturday mornings. They also provide 18 hours of primary care outreach services, targeting excluded and vulnerable groups. These services are managed from the location Devonshire House and were part of this inspection. The remaining hours, 44 hours of same day access appointments and 36 hours of physiotherapy services, were not included in this inspection as they are subcontracted to other local providers. The provider of the service for the same day access appointments is separately registered with CQC and therefore subject to a separate inspection. The physiotherapy service is not within the scope of CQC.

The Saturday morning pre-bookable appointments are provided at four hub sites based at local GP surgeries on Saturday mornings, 9am to midday as follows:

• The Lakeside Practice, Askern, DN6 0HZ,
• Thorne Moor Medical Practice, Thorne, DN8 4BQ,
• Tickhill and Colliery Medical Practice Tickhill, DN11 9NA
• Conisbrough Group Practice, Conisbrough, DN12 3JW.

They provide 18 hours of primary care outreach services, targeting excluded and vulnerable groups, to three sites:

• Wharf House – Wednesday 1-4pm
• Changing lives – Thursday 1-4pm
• Conversation Club – Thursday 1-4pm

These services were part of the inspection and we visited Devonshire House and Wharf House as part of this inspection on 12 June 2019.

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, and treatment of disease, disorder or injury. These services are delivered from all sites.

The provider employs a team of management and administration staff who work from the main site, Devonshire House. Clinical staff, local to Doncaster, are employed on a sessional basis. Administration staff working at the hub sites are employed and managed by each hub site via a service level agreement with Devonshire House.

Information was gathered and reviewed before the inspection, for example, from stakeholders, notifications and provider information request submissions. We also gathered information on the day of the inspection from people who had used the service, interviewing staff, and observations and review of documents.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 16 September 2019

This service is rated as Requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Devonshire House on 12 June 2019 as part of our inspection programme.

The provider, Primary Care Doncaster Ltd (PCD), is a GP federation located in Doncaster. PCD has been commissioned to provide 160 hours per week of extended access services in Doncaster to expand routine primary care capacity. This includes 62 hours of routine pre-bookable GP appointments. These are provided at four hub sites based at local GP surgeries on Saturday mornings. They also provide 18 hours of primary care outreach services, targeting excluded and vulnerable groups.These services were part of this inspection. The remaining hours, 44 hours of same day access appointments and 36 hours of physiotherapy services, were not included in this inspection as they are subcontracted to other local providers. The provider of the service for the same day access appointments is separately registered with CQC and therefore subject to a separate inspection. The physiotherapy service is not within the scope of CQC.

Thirty-six people provided feedback about the service. All were positive about the care and treatment provided. They said they were pleased to be able to access weekend appointments and were complimentary about the staff.

Our key findings were :

• Services were organised and delivered  to meet patients’ needs.
• There was an effective system in place for reporting and recording significant events.
• Information about services and how to complain was available.
• Most risks to patients were assessed and managed except for infection prevention and control, provision of emergency medicines and equipment and transport of patient information and blank prescriptions.
• A register of policies and procedures which were in place to govern activity. However, not all polices, and procedures were effectively implemented.
• There was a clear leadership structure and staff felt supported by management. Feedback was proactively sought from staff and patients, which was acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

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

• Establish and operate recruitment procedures to ensure only fit and proper persons are employed. Ensure specified information is available regarding each person employed and that they are registered with the relevant professional body where appropriate.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and risk assess procedures for transportation of blank prescriptions by staff.
• Review and risk assess transportation of patient information from the inclusion clinic to the main site.
• Review and risk assess provision of emergency medicines and equipment for inclusion clinics in line with the Resuscitation Council guidelines 2015.
• Review and improve procedures for the oversight of referrals.
• Review and improve systems to monitor that clinical outcomes and prescribing practice is in line with best practice guidelines.
• Review and improve systems to disseminate safety alerts to all members of the team including sessional and agency staff.
• Review and improve systems to monitor standards of infection prevention and control are being maintained at each site.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care