Skegness Hospital

Updated 10 July 2014

The GP out-of-hours service for Lincolnshire is provided by Lincolnshire Community Health Services NHS Trust. The service is commissioned by the four Lincolnshire Clinical Commissioning Groups (CCG’s), with the lead for out-of-hours services being Lincolnshire East CCG.

The out-of-hours service provided care to patients who required urgent medical care from a GP outside of normal GP hours.102 GP practices were covered by the service. The provider employed the services of 100 GPs who were engaged on a sessional basis to deliver care to patients. The service operated county wide from 6.30pm-8am Monday – Thursday, 6.30pm Friday – 8am Monday, and all public holidays. Skegness and District Hospital is located north east of Lincolnshire and provides out-of-hours services to people in the surrounding area Saturday and Sunday and bank holidays 08.00 to 20.00.

Initial telephone contact with the out-of-hours service is through the NHS 111 system, a service provided by another healthcare provider.

The out-of-hours service was split into three ‘Business Units’, which comprised the North West, East and South business units. They were geographically aligned to Lincolnshire’s Clinical Commissioning Groups. The out-of-hours service in each was managed by an Urgent Care Matron.

The provider delivers an-out-of hours service care to a population of 723,000 residing in an area of 2,350 square miles from eight primary care centres geographically spread across the county. The eight locations were:

• The County Hospital, Lincoln                                      
• John Coupland Community Hospital, Gainsborough  
• Grantham and District Hospital                                   
• Stamford and Rutland Hospital, Stamford                  
• Johnson Community Hospital, Spalding                     
• The Pilgrim Hospital, Boston                                      
• Skegness and District Hospital                                   
• County Hospital, Louth                                               

In the year 2013/14 in excess of 100,000 patients accessed the out-of-hours service across the county.

This report focussed on the out-of-hours service at Skegness and District Hospital

Updated 10 July 2014

Lincolnshire Community Health Services NHS Trust provided out-of-hours General Practitioner (GP) services for patients living across Lincolnshire. The service was administered from the trust’s headquarters in Sleaford and patient care and treatment was provided from eight primary care centres at locations across the country. We visited the trust’s headquarters on 5 June 2014 where we looked at records and information and talked with staff about issues that related to all eight locations and the service a whole. On the 7 June 2014 we visited the primary care centre at Skegness and District Hospital and spoke with members of staff, patients and carers and reviewed documents and matters specific to that location.

Lincolnshire Community Health Services NHS Trust provided was registered to provide the regulated activities of diagnostic and screening procedures and the treatment of disease, disorder or injury. In addition Skegness and District Hospital was registered to provide the regulated activities of family planning.

The provider conducted clinical audit that addressed specific areas of patient care. Individual clinicians’ practice was assessed on a regular basis to help ensure that patients received safe and effective care and treatment.

The provider had not used effective recruitment processes to assess the suitability of staff to work in this sector. We have told the provider they must improve.

There were systems in place to help ensure patient safety through learning from incidents, the safe management of medicines and infection prevention and control.

Staff were trained and supported to help them recognise the signs of abuse of children and vulnerable adults and provided staff with training to heighten their awareness of domestic violence.

The provider had in place business continuity and contingency plans that would enable the service to continue to operate in the event of a failure of, for example, the information technology or telecommunication systems.

We found the service was effective in meeting patients’ needs and the primary care centres were accessible to those who may have mobility issues.

Patients experienced care that was delivered by dedicated and caring staff. Patients and carers we spoke with said staff displayed a kind and caring attitude. We observed patients being treated with respect and kindness whilst their dignity and confidentiality was maintained.

We found that the service was well-led and managed by a knowledgeable senior management team and board of directors. They had taken action to help ensure their values and behaviours were shared by staff through regular engagement.

Members of the staff team we spoke with held positive views of management and their leadership and felt well supported in their roles. They told us the senior managers were approachable and listened to any concerns or suggestions they might have to improve the level of service provided to patients.

We found the provider did not have appropriate systems in place for the safe and reliable administration and storage of medicines. There were no formal procedures or audits for medicines received and held. Reliable checks would ensure safe administration of medicines, and minimise the potential for error. Following on our visit the provider took steps to improve the medicines management systems to keep patients safe.