The Care Quality Commission
  • Doctor
  • Out of hours GP service

Devon Doctors - Osprey House Also known as Devon Doctor

Overall: Requires improvement read more about inspection ratings

Osprey House, Osprey Road, Sowton Industrial Estate, Exeter, Devon, EX2 7WN (01392) 822345

Provided and run by:
Devon Doctors Limited

All Inspections

3, 4, 5 November 2021 site visit. 12 November 2021 end of evidence gathering

During a routine inspection

We are mindful of the impact of COVID-19 pandemic on our regulatory function. We therefore took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate.

Background to this inspection in November 2021.

In July 2020 we carried out a focused inspection in response to concerns received. After this inspection we imposed urgent conditions on the provider’s registration with a timeframe to make urgent improvements in the service provided. We also made requirements related to meeting the fundamental standards: safeguarding service users from abuse and improper treatment; good governance; and staffing.

We carried out a focused inspection in December 2020 to follow up on the urgent conditions imposed and the requirements made. We looked at the following key questions: safe, effective, responsive and well-led. During the three-day inspection we found further information of concern. Therefore, we converted the inspection from focused inspection to a full comprehensive inspection, to include the caring domain.

Following the December 2020 inspection, we took regulatory action and varied the urgent conditions placed on the service. In addition, we imposed two new urgent conditions on the provider’s registration. We also made requirements related to meeting the fundamental standards; complaints handling; provision of staff training, appraisals and supervision; and health and safety. We also placed the service into special measures, as the key questions of effective and well led were rated as inadequate.

We carried out an announced focused desk-based review of Devon Doctors Limited, in May 2021 to check compliance with the conditions imposed on the provider’s registration. We judged that the conditions had been met and removed them from the provider’s registration. The requirement notices made at our inspection in December 2020 were still in place. We also made recommendations for the provider to consider:

  • Implementing protected meeting times and time for learning from significant events to promote effective engagement with staff.
  • Provide training as described in the action plans related to the inspection in December 2020.
  • Review how significant events were documented, to enable decisions made on level of harm to be clear.
  • Continue work on staffing needs and building resilience into service provision when possible.
  • Provide clarity on how low harm incidents were used to drive improvements in the service provision.

This service is rated as requires improvement overall. (Previous inspection December 2020 – Inadequate)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Devon Doctors – Osprey House on 3, 4 and 5 November 2021, to follow up on breaches of regulations and to determine whether the service could be taken out of special measures.

At this inspection we found:

  • There had been improvements to prioritising safeguarding to minimise risk to patients. All staff had received training appropriate to their role.
  • Staff we spoke with were able to identify what constituted a safeguarding concern and knew what actions to take.
  • Work was ongoing in the recruitment of sufficient staff numbers to provide the service. There were still issues with high staff turnover, but changes had been made to the recruitment process and there was a broader range of opportunities for allied health professionals.
  • Regular monitoring of staffing levels and performance occurred. The service aimed to minimise risk to patient safety whenever possible, if there were insufficient staff to operate all of the sites.
  • Risks to patients were assessed, monitored and managed to maintain patient safety.
  • Improvements had been made to ensure learning or actions taken from incidents were understood and acted on by all relevant staff, but this needed time to be fully embedded.
  • The provider had implemented a programme of appraisals and one to ones.
  • Training records showed what training had been provided and what training was required- infection control and safeguarding training was up to date. Staff reported that professional development was discussed in supervision sessions and had started to be provided.
  • Staff treated patients with kindness, respect and compassion.
  • Staff understood patients’ personal, cultural, social and religious needs. They displayed an understanding and non-judgmental attitude to all patients.
  • There were arrangements and systems to support staff to respond to people with specific health care needs such as end of life care and those who had mental health needs.
  • Improvements had been made in monitoring service provision and performance to improve timely access and patients were informed of any delays to care and treatment. However, there were still shortfalls which the provider was regularly monitoring and taking action when they were able to.
  • The whole of the board and governance structure had been reconfigured.
  • There were systems and processes to support good governance and were starting to become embedded.
  • Audits of clinicians were used to measure performance and address areas which required improvement.
  • Systems had been implemented to monitor learning; further development was needed to ensure these were embedded in practice.

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

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, including but not limited to infection control; sharing of learning from significant events and complaints; and monitoring of service performance in line with their action plan.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

The areas where the provider should make improvements are:

  • Consider how policies and procedures are communicated to staff.
  • Consider completing the two outstanding actions from the external health and safety inspection.
  • Review processes to make sure medicines and equipment are stored securely when not in use.
  • Review the significant event register to make sure any concerns identified from complaints received is included on the register.
  • Continue to make sure staff received appraisals at regular intervals.
  • Review how call handling data is displayed in clinical assessment service centres.
  • Continue with their plan to make improvements using information from complaints.
  • Continue to train staff to be Freedom to Speak Up Champions.

I am taking this service out of special measures, as the provider has made sufficient progress in complying with the regulations.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

12, 13, 14 and 20 May 2021

During an inspection looking at part of the service

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 review was carried out in a way which enabled us to undertake the review remotely, without the need for a site visit. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider

This service is rated as inadequate overall. This review, undertaken in May 2021, was carried out to check compliance with the urgent conditions imposed on the service following our inspection in December 2020 and therefore we did not amend the rating.

At this review we reviewed the regulations and key lines of enquiry for safe, effective, responsive and well led, as these were key focus areas with risk from the last inspection. The rating for caring is based on the previous inspection in December 2020. The current rating reflects our judgment following the inspection in December 2020, when the service was rated as inadequate overall and placed into special measures.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We carried out an announced focused desk-based review of Devon Doctors Limited, on 12,13,14 and 20 May 2021. We spoke with and interviewed a range of staff across the service, including call handlers, senior leaders, junior managers, clinicians, and members of the Board. We also reviewed documents relating to the running of the service and information on our systems. We received feedback from the two clinical commissioning groups who commissioned the service.

At this focused review we found the conditions had been met and we have therefore removed them from the provider’s registration:

  • The Care Quality Commission received an action plan within the specified timescale. The plan set out how the provider would ensure there were adequate numbers of suitably qualified, competent and skilled members of staff for the provision of the Out of Hours service and the NHS 111 service. The plan showed how the service intended to assess capacity and resources, and how this would be implemented to meet patients’ needs.
  • We found work has commenced on developing a hybrid model of staffing, which included other clinicians as well as GPs.
  • We found appraisals and one to one supervision sessions had been planned for and some had commenced. Those that had taken place had been welcomed by staff.
  • The action plan showed the process for reviewing all significant events and complaints, and the progress made on this work.
  • Evidence from executive meetings showed that this information was shared at Board level and learning was cascaded to staff. However, further work was needed to ensure this was embedded in the service.
  • Systems were in place to identify deteriorating patients, and staff were aware of these.
  • We found the lead clinician role had a positive impact at weekends and Bank Holidays, as they monitored the clinical queue and were able to reprioritise calls with the aim of ensuring patients received the right advice.
  • Positive feedback was received from frontline staff and lead clinicians about how this role was starting to bridge the operational gap between the OOH service and the NHS 111 service.
  • Safety calling (comfort calling) was in place, when advice or treatment from clinicians were delayed. Anecdotal reports from staff indicated that these were reducing and were happening within specified timescales. Data provided by the provider showed that safety calling was completed in accordance with the targets the provider had set for this.

Although the conditions were met, the service still has requirement notices from our inspection in December 2020. These covered governance systems; privacy breaches; health and safety in the service; medicine management; infection control; complaints handling; recruitment process; consent to care and treatment; and staff training. The provider submitted an action plan detailing how they would meet these requirements. The concerns found at this review are covered by the requirements made after our inspection in December 2020 and are subject to an inspection within 12 months of the report being published.

The service remains in special measures until we carry out a full comprehensive inspection within six months of the previous inspection report being published.

The areas where the provider should make improvements are:

  • Consider implementing protected meeting times and time for learning from significant events to promote effective engagement with staff.
  • Provide training as described in the action plans related to the inspection in December 2020.
  • Review how significant events are documented, to enable decisions made on level of harm to be clear.
  • Continue work on staffing needs and building resilience into service provision when possible.
  • Provide clarity on how low harm incidents are used to drive improvements in the service provision.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

7, 8 and 9 December 2020

During an inspection looking at part of the service

We are mindful of the impact of Covid-19 pandemic on our regulatory function. We therefore took account of the exceptional circumstances arising as a result of the Covid-19 pandemic when considering what type of inspection was necessary and proportionate.

This service is rated as Inadequate overall. (Previous inspection July 2020 – the overall rating of Good, was carried over form an inspection which took place in May 2017, as the July inspection was focused and therefore unrated.)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We carried out a focused inspection in July 2020, in response to concerns received. After this inspection we imposed urgent conditions on the provider’s registration with a timeframe to make urgent improvements in the service provided.

This inspection of Devon Doctors Limited, on 7, 8 and 9 December 2020 was a short notice announced focused inspection to follow up on the urgent conditions imposed on the provider and requirements made at our inspection in July 2020.

We looked at the following key questions: safe, effective, responsive and well-led. During the three-day inspection we found further information of concern. Therefore, we converted the inspection from focussed inspection to a full comprehensive inspection, to include the caring domain. We spoke with and interviewed a range of staff across the service, including call handlers, senior leaders, junior managers, clinicians, the chief executive officer and members of the Board. We also reviewed documents relating to the running of the service.

At this inspection we found:

  • Staff were able to identify what constituted a safeguarding concern and knew what actions to take, however, not all staff had completed relevant training in line with the provider’s policy.
  • The provider did not consistently ensure that there were sufficient numbers of staff available to run the service, to ensure risk was minimised and the service could respond quickly to an increase in demand.
  • Risks to patients were not adequately assessed, monitored or managed to maintain patient safety.
  • Overall service performance was not always consistently monitored in a way that ensured patient safety.
  • Systems and processes to manage risk were applied inconsistently, whilst learning was not always shared effectively and acted upon. There was a lack of clarity on how significant events and risks were identified and managed. Improvement was still needed to ensure learning and actions taken from incidents were understood and acted on by all relevant staff.
  • There were risks of patients not receiving effective care or treatment.
  • There were shortfalls in systems and processes that did always not enable safe and effective care to be provided.
  • There were still shortfalls in some of the personal development and support provision for staff. Staff did not have appraisals or supervision sessions, to enable them to develop their skills.
  • There was a strategy, but it had not been implemented sufficiently to ensure that a high-quality sustainable and consistent care could be provided.
  • There were shortfalls in communication between senior leaders and staff groups, staff did not consider they had been fully engaged in the running of the service.
  • Governance arrangements were not consistent to support the delivery of a safe, effective and well led service in a consistent manner. Limited attention had been paid to achieving and maintaining compliance with the regulations of the Health and Social Care Act 2008.
  • Performance levels had shown signs of improvement and were now in line with national performance levels remained below expected contracted targets. (Due to the pandemic commissioning bodies were accepting service level performance to be in line with national performance, rather than the defined national targets).
  • Staff were kind and caring and responsive to patients‘ needs.

Following this inspection, we took regulatory action and varied the urgent conditions placed on the service after our inspection in July 2020.Conditions are a requirement of the providers registration with the Care Quality Commission. These conditions were imposed as there were significant shortfalls in systems, which led to delays to care and treatment; call answering targets were not consistently being met; there were often adequate numbers of staff; and governance processes were not effective.

We extended the timescales for the urgent conditions to be met, as evidence gathered during this inspection showed some improvement, but it was insufficient to deem that the urgent conditions had been met.

In addition, we imposed two new urgent conditions on the provider’s registration relating to taking calls from the NHS 111 national contingency service (National contingency is a systematic process available to all NHS 111 providers in England. This enables any other NHS 111 services nationally to route telephone calls of another provider during periods of high demand); and the second condition was for the provider to produce duty rotas which clearly showed which staff were scheduled to work across the service; which staff actually worked; and reasons for absence of staff.

We also made requirements related to meeting the fundamental standards; complaints handling; provision of staff training, appraisals and supervision; and health and safety.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care