GATDOC

We carried out a desktop inspection review of GATDOC on 17 October 2019 to follow up on a previous breach of regulation when we last inspected on 10 December 2018.

This inspection looked at the following key questions: safe.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

At the last inspection, we rated the practice as requires improvement for providing safe services.

We found that:

• In contravention of Home Office guidance and the Misuse of Drugs Regulations 2001 the provider did not have a licence to stock or dispense controlled drugs. The provider immediately took steps to obtain a licence and, in the meantime, had obtained confirmation from the Home Office that they could continue to stock and dispense controlled drugs pending their licence application being processed.

We also recommended that the provider should:

• Undertake clinical audit activity that can lead to and demonstrate improvements in patient care and outcomes.

We have now rated this practice as good overall and good for all population groups.

We found that:

• The provider had obtained and furnished us with a copy of the necessary licence to stock or dispense controlled drugs.
• The provider also supplied copies of clinical audits on subjects including antiobiotic use and diazepam prescribing to demonstrate adherence to clinical guidelines and improvement in patient outcomes.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at GatDoc out of hours service on 10 December 2018 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• The service provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Risks to patients were assessed and well-managed.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The service organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the service was led and managed promoted the delivery of high-quality, person-centre care.
• The service shared information appropriately with other services, such as a patient’s own GP when required.
• There was evidence of improvements being made because of complaints and incidents.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission when appropriate and improved patient experience.
• The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean, well equipped and appropriately maintained.
• Patients’ care needs were assessed and delivered in a timely way according to need. The most recent available results showed that the service generally met the National Quality Requirements.

However, we rated the practice as requires improvement for providing safe services because:

• In contravention of Home Office guidance and the Misuse of Drugs Regulations 2001 the provider did not have a licence to stock or dispense controlled drugs. The provider immediately took steps to obtain a licence and, in the meantime, had obtained confirmation from the Home Office that they could continue to stock and dispense controlled drugs pending their licence application being processed.

The provider must therefore:

• Ensure the proper and safe management of medicines.

The provider should also:

• Undertake clinical audit activity that can lead to and demonstrate improvements in patient care and outcomes.

We saw an area of outstanding practice:

• The service provider had identified that there was a high proportion of Orthodox Jewish patients in the local area. They had therefore ensured that wheat free medicines were available to ensure compliance with the religious beliefs of Orthodox Jewish patients. A local Rabbi had helped the provider develop a guidance document for clinicians to refer to when treating and caring for Orthodox Jewish patients.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice