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NEMS GP Out of Hours Service Good

Reports


Inspection carried out on 11th October to 18th October 2018

During an inspection looking at part of the service

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

The key questions are rated as:

Are services safe? – Good

Are services well-led? – Good

We carried out an unannounced focused inspection at NEMS GP Out of Hours Service 11 October 2018. We carried out this inspection in response to concerns, we looked at safe and well led during our inspection. As part of this inspection, we also inspected the provider’s headquarters (NEMS Community Benefit Services Limited) based in Fanum House, Nottingham on 18 October 2018, this visit was announced. The ratings for safe and well led have not changed since our last inspection in November 2015.

At this inspection we found:

  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
  • Patients were able to access care and treatment from the service within an appropriate timescale for their needs. Processes were in place to identify patients that needed more urgent attention.
  • The service was aware of some of the challenges to deliver quality care and was taking action to address them.
  • This was an unannounced inspection therefore, we were unable to receive feedback from patients during the inspection. However, patient feedback received by the service demonstrated that staff involved and treated people with compassion, kindness, dignity and respect.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.
  • The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
  • The provider demonstrated effective joint working arrangements with key partners to develop-coordinated care.

The areas where the provider should make improvements are:

  • Develop the staff induction programme to include site specific induction.
  • Ensure oversight of all safety systems and processes on the site including oversight of infection control documentation, daily vehicle and medical equipment checks and the processes in place for the security of blank prescriptions.
  • Encourage all staff throughout the service to report incidents and significant events when they occur.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 12 and 13 November 2015

During a routine inspection

We carried out an announced comprehensive inspection at NEMS GP Out-of-Hours Service on 12 and 13 November 2015. Overall the service is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Patients said they were treated with compassion, dignity and respect and pleased with the care and treatment they received from the service.
  • There were innovative approaches to accessing relevant patient information . A system called the Medical Interoperability Gateway (MIG) had been introduced which gave greater access to patient records and made care more effective and safer.
  • Staff understood their needs to raise concerns. There was an open and transparent approach to safety. However the system in place for reporting and recording significant events needed clarification.
  • Patient care was assessed and delivered in a timely way according to need. The service performed well against the National Quality Requirements for GP out-of-hours care.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. However there were some gaps in training.
  • There was a system in place for carrying out audits and we saw evidence that audits were driving improvement in performance to improve patient outcomes.
  • Information about services and how to complain was available and easy to understand.
  • The treatment centres had good facilities and were well equipped to treat patients and meet their needs. The vehicles used for home visits and patient transport were clean and well equipped.
  • There was a clear leadership structure. Overall staff felt supported by management.
  • The service proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • The service worked proactively with other organisations and providers to develop services that supported hospital admission avoidance and improved the patient experience.

We saw areas of outstanding practice:

  • The provider had recognised that their patient population in Nottingham City had low car ownership and many patients could not afford to pay to travel to the treatment centre.Additionally Nottinghamshire County residents without transport were subject to limited public transport in rural areas and had longer distances to travel. In order to reduce the inequalities associated with access they provided a free patient transport service to collect patients from their homes, bring them to the treatment centre and return them home following their consultation, when it was necessary. We received feedback from a number of patients which reflected that they particularly valued that transport was provided and commented that they would not have been able to attend without it.

  • The provider had worked with the local Deaf Society to raise awareness of the out- of -hours service. As a result introduced a ‘walk in’ option for urgent problems for this patient group as they had recognised that telephone assessment was problematic for the deaf.

  • The service liaised with the local police force to carry out ‘safe and well’ checks if there were assessed concerns for patients who had not attended appointments or who they had not been able to contact.

  • The service carried out urgent blood tests during home visits if required and continued to oversee the patient until the outcome of the test was determined..

The areas where the provider should make improvements are:

  • Strengthen the current system for incident reporting to ensure appropriate investigation takes place.

  • Ensure all staff receive training at appropriate intervals, including safeguarding and chaperone training and an annual appraisal.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice