Grantham 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 inspection focused on the out-of-hours service at Grantham and District Hospital.

Updated 10 July 2014

Lincolnshire Community Health Services NHS Trust provided out-of-hours General Practitioner (GP) services for patients living in 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 county. 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 Grantham 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 provides out-of-hours General Practitioner (GP) services for patients living across Lincolnshire. It is registered to provide the regulated activities of diagnostic and screening procedures and the treatment of disease, disorder or injury at Grantham and District Hospital.

Patients told us that they were happy with the care and treatment they received and felt safe. We spoke with representatives of three care homes, which provided care for older people some of whom lived with dementia. They told us the practice was helpful and responsive to their patients’ needs. We received one comment card from a patient, which said they had found the service to be excellent.

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

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

We saw that leaflets to inform patients about how they might raise a complaint were only available in English but we saw documentary evidence that the Clinical Commissioning Group had instructed that they should not be printed in other languages due to cost.

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

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

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.

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.

Some members of the staff team we spoke with felt well supported by management whilst others did not always hold positive views of the management team and their leadership. They told us there had been some recent improvements but they did not always feel well supported in their roles. They told us some managers did not listen and act on their concerns or suggestions to improve the level of service provided to patients.

We found the provider did not have reliable and safe medicine management systems in place. 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.    

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.