Ashgate Manor

Updated 25 December 2023

DHU Healthcare Community Interest Company (CIC) deliver a diverse range of services to the population across several counties including Derbyshire, Leicestershire, Nottinghamshire, Northamptonshire, Staffordshire and the West Midlands.

These services include urgent and emergency care, primary care, out of hours services (including community nursing services), and the NHS 111 service. The types of service provided in each county differs, for example, DHU CIC provide NHS 111 services across the East and West Midlands, and urgent care services across Derbyshire, Leicestershire and Northamptonshire. DHU was formed in 2006 following a merger of Derbyshire Medical Services and Derbyshire Healthcare.

DHU Healthcare CIC is a ‘not-for-profit’ community interest company, which employs more than 2,000 people in total. The organisation has several registrations with the CQC, but this inspection was focused upon the out-of-hours provision in North Derbyshire delivered by Ashgate Manor. DHU Healthcare CIC is registered with CQC as the provider of out-of-hours services across North Derbyshire to provide the regulated activities of transport services, triage and medical advice provided remotely, and treatment of disease, disorder or injury,

Ashgate Manor is the registered location with the Care Quality Commission (CQC) to deliver out-of-hours services to North Derbyshire. The city of Derby and southern Derbyshire out-of-hours service is also provided by DHU as part of a separate CQC registration.

The out-of-hours service is commissioned by NHS Derby and Derbyshire Integrated Care Board (ICB)/Joined Up Care Derbyshire.

The base is located at:

Ashgate Manor

Ashgate Road

Chesterfield, Derbyshire

S40 4AA

Patients who ring the NHS 111 service out-of-hours have their medical needs assessed by a call advisor or a clinical advisor based on the symptoms they report when they call. If a patient needs to be seen face-to-face by a clinician, appointments are booked directly into the most convenient GP out-of-hours site at one of 8 primary care centres across North Derbyshire; home visits are also provided where appropriate following triage. The out-of-hours primary care sites are:

Chesterfield: Ashgate Manor, Ashgate Rd, Chesterfield, S40 4AA. Open 6pm to 8am Monday-Friday, 24 hours at the weekend.

Buxton: Buxton Hospital, London Road, Buxton, SK17 9NJ. Open 6.30pm to midnight Monday-Friday, 8am to midnight at the weekend.

Clay Cross: Clay Cross Hospital, Market Street, S45 9NZ. Open 9am to 5pm at weekends.

New Mills: New Mills Health Centre, Hyde Bank Rd, High Peak, SK22 4BP. Open 6pm to 10.30pm Monday-Friday, 9am to 10.30pm at weekends.

Ashbourne: St Oswald's Hospital, Clifton Rd, Ashbourne, DE6 1DR. Open 8am to 4pm at weekends.

Bolsover: Castle Street Medical Centre, Castle Street, Bolsover, S44 6PP. Open 9am to 5pm Sunday.

Matlock: Whitworth Hospital, 330 Bakewell Rd, Matlock, DE4 2JD. This site was not operational at the time of our inspection apart from offering some remote advice.

Between 1 October 2022 to 30 September 2023, just over 34,000 patients accessed care at one of these sites. We were unable to obtain figures for contacts where advice was provided (without the need for a face-to-face consultation) and home visits solely for the north of Derbyshire; however combined with the service provided in the south of the county, there were almost 143,500 patients consulted with advice, and just below 22,800 home visits, over the same 12-month period.

This CQC registration also incorporates:

The evening and night community nursing service, which DHU subcontract from the local community Trust, who provide the daytime service. DHU have 9 teams delivering this service across the whole county from 6pm to midnight, with 2 teams covering the service from midnight to 8am, operating 7 days a week.

Chesterfield Royal Hospital: (a pilot primary care streaming service co-located with urgent treatment centre) - Chesterfield Royal Hospital, S44 5BL. Open 8am to 11pm, 7 days. The streaming service is an initial triage at the front door to direct patients to the correct area of the department, dependent on the most appropriate pathway of care.

The 111 service is co-located at Ashgate Manor as part of an integrated and streamlined NHS 111 and out-of-hours service. The 111 service operates from the second floor whilst patients access the out-of-hours service on the ground floor. The NHS 111 service was not part of our inspection as this is a separate CQC registration. The 111 service was last inspected in 2019 and the report can be accessed via this link https://www.cqc.org.uk/location/1-2946395439

During the inspection in October 2023, we visited Ashgate Manor, Chesterfield Royal Hospital, Clay Cross Hospital, Buxton Hospital and New Mills Health Centre.

At the time of our inspection, DHU employed over 400 staff in their out-of-hours service across the whole of Derbyshire including 111 advanced practitioners, 24 clinical practitioners 14 salaried GPs,142 health care assistants or combined reception/health care assistant roles and 60 drivers. Locum staff also supported the service.

Updated 25 December 2023

This service is rated as Outstanding overall. (Previous inspection, 10 November 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Ashgate Manor between 15-17 October 2023. We inspected this service due to the length of time since our previous inspection, in line with the Care Quality Commission’s inspection priorities.

At this inspection we found:

• The leadership, governance and culture within the service drove improvements to deliver high-quality person-centred care. This included collaborative partnerships, multidisciplinary and multiagency working which supported vulnerable patients and tackled health inequalities. The provider was able to demonstrate the positive impact this had on health outcomes for under-represented populations such as homeless people.
• The provider had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the provider learned from them and improved their processes.
• There was a comprehensive and effective system to safeguard children and vulnerable adults. The provider worked proactively and collaboratively with other providers and external agencies to ensure patients were safe.
• The provider routinely and proactively reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment were delivered according to evidence-based guidelines and demonstrated this via a scheduled programme of rolling audits.
• The service made improvements through the use of completed audits. Clinical audit had a positive impact on the quality of care and outcomes for patients. There was clear evidence of action to resolve concerns and improve quality.
• Feedback from people who used the service, those who were close to them, and stakeholders, was continually positive about the way staff treated people. People thought that staff went the extra mile and their care and support exceeded their expectations. The provider proactively canvassed patient feedback and used this to adapt how services were delivered to enhance experience. We observed staff treated patients with compassion, kindness, dignity and respect during our inspection.
• Patients were able to access out-of-hours care when they needed it at an accessible location, or in their own home when this was appropriate. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.
• Leaders strove to deliver and motivate staff to succeed. Staff feedback was highly positive about their experience in working for the organisation and staff felt well-supported and were given opportunities to develop.
• The provider supported staff welfare initiatives. There was a wide and well utilised range of schemes and services to promote and support staff physical and mental health wellbeing. This included access to occupational health, counselling and access to an independent health scheme.
• Leaders promoted organisational values which we found were embedded into all aspects of how the organisation worked.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Leaders embraced innovations and proactively sought out and embedded new ways of working to provide care and treatment. We saw many examples of innovation and the development of services in response to patients’ needs. New evidence-based techniques and technologies were used to support the delivery of high-quality care. We saw how innovations had both positively impacted on the care of individual patients, and the wider health and social care system.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Healthcare