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Shropshire Doctors Co-Operative - Longbow Close

We are carrying out checks at Shropshire Doctors Co-Operative - Longbow Close using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Updated 28 May 2014

Shropshire Doctors Co-operative Ltd (Shropdoc) is a not for profit organisation established in 1996. Shropdoc has 279 local GP members who deliver out-of-hours care to a population of 600,000 patients within Shropshire,Telford &Wrekin and Powys.

The service opening times are from 18.30 until 08.00 Monday to Thursday and 18.30 Friday through to 08.00 Monday with 24 hour cover for all bank holidays.

Shropdoc provides care to approximately 140,000 patients per year.

Shropdoc currently has six centres in England. We visited the two largest centres during this inspection at Telford and Shrewsbury alongside the head office location where virtually all triage takes place.Shropdoc primary care centres are located within community or district hospital sites.

Shropdoc operates a ‘triage’ model where all patients have clinical telephone assessments. This prevents unnecessary journeys for patients and enables appropriate coordination of home visits and appointments according to clinical urgency and demand. Shropdoc does not use decision supporting software for assessing patients, all clinical decisions are based on evidence based knowledge and clinical guidelines for best practice.

We found patients accessing the service were kept safe and protected from harm. Care and support was delivered to patients by a caring team who were responsive to the changing needs of the patients.

We found policies and procedures to support staff whilst carrying out their roles were robust and up to date. Staff had all received appropriate training to carry out their roles.

We spoke with patients, parents attending with children, staff, the senior management team, looked at feedback from local healthwatch organisations and collected comments cards from the public at each of the locations visited. We also listened to call handlers and triage consultations with patients and observed consultations being carried out at the care centres.

Feedback from patients suggested they were happy with the care they had accessed, were treated with dignity and in a sensitive manner.

We found that the service was well-led and managed by an enthusiastic, experienced and knowledgeable senior management team, and their values and behaviours were shared by staff.

Inspection areas

Safe

Updated 28 May 2014

We found that the provider had in place robust and rigorous systems to ensure that staff seeking to work at Shropdoc were appropriately recruited and vetted to ensure their suitability to work with potentially vulnerable people. GP’s and nursing staff had been subject to competency testing for triage, clinical skills and continuing clinical audit to ensure their effectiveness and help maintain patient safety.

There were clear procedures and policies that staff were aware of to enable them to recognise and act upon any serious events or incidents and any learning was shared with staff and the public through the provider’s website and patient groups.

The provider had good systems in place to safeguard patients at risk of harm.

We found there were systems in place to help protect people from the risks associated with the management of medicines and infection control.

Vehicles used to take GP’s and community nurses to patients’ homes for consultation were well maintained, cleaned and contained appropriate emergency medical equipment. Emergency equipment held at head office and the care centres were well maintained and serviced.

Effective

Updated 28 May 2014

We found that the provider was providing effective care to a wide range of patient groups with differing levels of need often with limited information available to clinicians. The clinical triage process at Shropdoc allowed GP’s and nurse to ensure the most effective and appropriate service was offered and delivered to the patient in a timely manner.

Clinicians were able to prioritise patients and make the best use of resources.

Reception staff at the care centres told us they had been trained and were able to see that a patient might need earlier intervention and took steps to ensure they were assessed by a clinician for example breathing problems or increased levels of stomach pains. We saw within the waiting areas a large sign that informed patients of actions to take if they felt their symptoms were worsening whilst awaiting consultation.

There was an effective system in pace to ensure information about patients was shared with the patient’s own GP at the earliest opportunity.

There was good collaborative working between the provider and other healthcare and social care agencies to help ensure patients received the best outcomes in the shortest possible time via their Care co-ordination centre (CCC). Shropdoc supported the local prison service for their immediate out of hours care requirements.

Caring

Updated 28 May 2014

Patients and carer's we spoke with were all positive about their experience with Shropdoc and said they found the staff friendly, caring and responded to their needs.

We observed examples of good interaction between patients and staff and noted that staff treated patients with respect and kindness and protected their dignity and confidentiality.

Responsive

Updated 28 May 2014

We found Shropdoc had an effective system to ensure that, where needed, GP’s could provide a consultation in patients’ homes.

The provider had in place effective systems to engage and collaborate with other health care and social care providers. This included direct access to beds within local health care establishments which helped ensure patients received the best outcomes in the shortest possible time

Shropdoc had special arrangements via a complex needs rota to provide out-of-hours GP support for patient groups such as people confined in a nearby prison or those struggling with a mental health need.

Shropdoc also supported patients requiring community nurse care between 19.00 and 12 midnight seven days per week. Calls for this service were coordinated via the care coordination centre within Shropdoc head office or passed through to them by in hours community nursing teams within the areas. Community nursing is not available after midnight and Shropdoc doctors fill the consequent gap in service.

The was an easily accessed and transparent complaints system and we saw that any learning from those complaints was shared with staff and the public.

The provider undertook continual engagement with patients to gather feedback on the quality of the service provided.

There was an effective system in place to ensure information about patients was shared with the patient’s own GP at the earliest opportunity.

We found adequate provision for patients accessing the service with sensory needs and the service had access to a translator service. However we did not find any information leaflets within the care centres that were in languages other than English. This meant we could not be assured that patients with a first language other than English were fully informed of the care they received.

Well-led

Updated 28 May 2014

Shropdoc had a stable management structure; the nominated individual who is the medical director and Chef Executive were very knowledgeable and were an integral part of the staff team. They displayed high values aimed at improving the service and the patient experience.

Staff we spoke with all displayed a similar commitment. Staff turnover was low with many staff having been employed at the service since the serviced started. Staff told us they felt very well supported and were all important within the team.

There was a clear leadership and management structure and staff we spoke with were clear who they could approach with any concerns they might have.

We saw that staff underwent an annual appraisal and regular supervision or coaching to enable them, amongst other things, to reflect upon their own performance with the aim of learning and improving the service.

Shropdoc had recently embarked on ‘Foundations Improvement Science in Healthcare’ programme for continuous quality improvement within the service. This is being hosted in the initial stages by an external company engaged to assist the service to change the way they identify and understand the root cause of problems and ultimately to design a new model of delivery. 20 staff members across the service had been selected to take part in the process with other staff to be registered as the process continued.

We spoke with staff who told us that when new ideas or working practises were suggested they were fully consulted and their opinions counted. They told us they all pulled together to embrace change and facilitate better outcomes for patients.

There was a clear commitment to learn from problems, complaints and incidents.

There was an open and transparent culture within Shropdoc and they were keen to celebrate all aspects of their care provision and detail where they felt they could make changes and their progress with these changes.