Beech House

Updated 20 August 2018

Lincolnshire Community Health Services NHS Trust (LCHS) provides GP out-of-hours services for the population of Lincolnshire. Services are commissioned on behalf of the four Lincolnshire clinical commissioning groups (CCGs) by NHS Lincolnshire West CCG. In addition, the Trust provides other healthcare services including, but not limited to, urgent care centres, community nursing, health visiting, community hospitals and children and young people’s services.

The Trust employs approximately 2200 staff and provides services for a population of approximately 784,000 (Office for National Statistics data) living in Lincolnshire, dispersed across an area of 2,350 square miles, Lincolnshire is the second largest county in England. Road communications can be difficult with few miles of dual carriageway and no motorways. The public transport infrastructure from the outlying villages to the county towns is generally poor. The Lincolnshire coastal holiday destinations have a high number of transient, temporary residents coupled with high levels of deprivation. The Trust employs the services of 88 self-employed GPs from local GP practices who work in the primary care centres.

Out-of-hours care is provided from eight primary care centres across the county of Lincolnshire. They are located at:

• Boston Accident & Emergency Department, Pilgrim Hospital, Sibsey Road, Boston, PE21 9QS.

• Grantham and District Hospital, 101 Manthorpe Road, Grantham, NG31 8DH.

• Louth Urgent Care Centre, Louth County Hospital, High Holme Road, Louth, LN11 0EU.

• Lincoln Accident and Emergency Department, Lincoln County Hospital, Greetwell Road, Lincoln, LN2 5QY.

• Skegness Urgent Care Centre, Skegness and District Hospital, Dorothy Avenue, Skegness, PE25 2BS.

• Minor Injuries Unit, Johnson Community Hospital, Spalding Road, Pinchbeck, Spalding, PE11 3DT.

• Stamford and Rutland Hospital, Ryehall Road, Stamford, PE9 1UA.

• Gainsborough Minor Injuries Unit, John Coupland Hospital, Ropery Road, Gainsborough, DN21 2TJ.

We visited the primary care centre at Lincoln. We also visited the Trust headquarters located at Beech House, Lincoln as part of this inspection.

The service provides a 24 hour 7 day a week provision at Lincoln A&E through an integrated urgent care service.  The service provides a clinical assessment service (CAS) in alliance with East Midlands Ambulance Service and 111 which has been in operation since August 2016. CAS takes non-urgent 999 calls, referrals from 111 and directly from care homes.  CAS provides; support, advice & guidance, hear and treat, via call backs to those with less urgent needs, see and treat by directing patients to primary care centres and a rapid response home visiting team all supported by multi-skilled clinical staff including GPs, urgent care practitioners and pharmacists. An urgent care streaming service provides an initial navigation for all A&E walk-in patients. Patients navigated to the primary care streaming service are clinically assessed within 15 minutes. This is provided by a mix of skilled clinicians with primary care/minor illness/minor injury expertise and skills alongside GP’s.

Updated 20 August 2018

This service is rated as Good overall. (Previous inspection August and September 2017 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced focused inspection at Lincolnshire Community Health Services NHS Trust (LCHS) GP out-of-hours service on 10 July 2018. This inspection was carried out to follow up on a breach of regulation in relation to safe care and treatment found at our previous focused inspection in August and September 2017. At that inspection the key question of safe was rated as requires improvement and therefore this inspection focused on the key question of safe.

At this inspection we found:

• There was a process in place to ensure blank prescriptions were tracked throughout the service.

• Patient Group Directions ensured that the prescriber evaluated the risks associated with high risk medicines which were to be left in a patient’s home.

• The provider now had a system in place to ensure that medicines were dispensed safely and in the appropriate packaging.

• Staffing at the Lincoln primary care centre had been reviewed to ensure that staff could observe patients in the waiting room at all times to ensure they were aware of deteriorating patients.

• The provider was progressing the implementation of a medical workforce model to ensure staffing levels across all primary care centres were at the required minimum safe staffing level. Recruitment was still ongoing.

• The risk register held clear information on the risk and impact or mitigating actions were recorded.

The areas where the provider should make improvements are:

• Ensure that the planned signage improvements are implemented at Lincoln primary care centre.
• Continue with the programme of recruitment to ensure staffing levels are appropriate and sustainable.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice