England’s Chief Inspector of General Practice has placed theELM Alliance Limited Extended Hours and Out of Hours service, known locally as the Star service into special measures following an inspection by the Care Quality Commission in July.
ELM Alliance Limited is an independent health care provider commissioned by South Tees Clinical Commissioning Group (CCG) to operate the enhanced urgent care service (extended and out of hours service with appointments during the night) across South Tees. ELM Alliance, a not for profit federation of all independent GP practices, took over the operation on 1 April 2017, offering care to around 330,000 patients.
ELM Alliance Limited delivers enhanced urgent care service across the South Tees area from four locations:
- Park Surgery, Linthorpe Road, Middlesbrough
- Redcar Primary Care Hospital
- Hirsell medical Practice in North Ormesby
- Brotton Hospital in Saltburn.
On the evening of our inspection inspectors visited the hub at Redcar and the Park Surgery. The service also has a vehicle which is used to transport clinicians to home visits during the night.
Inspectors rated the service; inadequate for safety, effectiveness and well led, requires improvement for responsiveness and good for caring, Overall, the service has been rated as inadequate.
The report can be found on our website.
The report highlights a number of areas of concern including:
There was no open and transparent approach to safety and no effective system in place for recording, reporting and learning from significant events. Furthermore, inspectors saw that risks to patients were not adequately assessed or acted upon and found concerns about the management of medicines.
Additionally, the vehicle used for home visits was not well equipped and some emergency equipment was not readily available at the sites visited. CQC also found that there was an ineffective system for handling complaints and complaints handling was not used to improve services.
Alison Holbourn, Deputy Chief Inspector of General Practice for the North, said:
“As a response to some safety concerns raised with the Care Quality Commission, we undertook an unannounced inspection of ELM Alliance Limited on the evening of 11 July 2017 and 12 July 2017.People who use these services should be able to rely on getting high quality care."
“I was concerned to read thatstaff were not clear about reporting incidents, near misses and concerns. Additionally, investigations were not thoroughly carried out by the provider when there were unintended or unexpected safety incidents. Lessons learned were not demonstrated or communicated and so safety was not improved."
“Therewas no clear leadership structure and staff did not feel supported by management. The service did not hold regular governance meetings. Issues were discussed at ad hoc meetings but these were not effectively cascaded to staff."
“The service did not value the importance of feedback from patients, the public and staff. Staff told us they had not received regular performance reviews and did not have clear objectives. In addition there was no system held by managers to verify that staff had attended training sessions."
“The ELM Alliance Limited Extended Hours and Out of Hours service will need to focus sharply on a number of issues and due to the concerns identified during the inspection CQC has placed this service into special measures. It will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action and if there is not enough improvement we will move to close the service.”
Following the inspection CQC have told the service they must make a number of improvements, including:
- Medication and emergency equipment was not readily available in case of emergencies.
- Records were not being made in accordance with relevant legislation or the terms of the provider’s Controlled Drugs license.
- The provider did not have effective systems in place for recording and managing risks in all areas.
- There was a lack of effective safeguarding procedures in place. Urgent safeguarding referrals were not followed up to ensure that correct processes had been adhered in order to keep vulnerable patients kept safe.
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