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Archived: SELDOC OOHs at Queen Mary's Hospital Good

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Inspection Summary


Overall summary & rating

Good

Updated 9 July 2018

This service is rated as Good overall. The service was previously inspected by the CQC on 10 August 2017. At that inspection the rating for the service was good overall. This rating applied to effective, caring, responsive and well led and all six population groups. Safe was rated as requires improvement.

The report stated where the service must make improvements:

  • Develop effective systems and processes to ensure safe care and treatment including ensuring the proper and safe management of medicines, and assessing the risk of not providing Oxygen and Automatic External Defibrillator on service vehicles used for home visits and, where appropriate, mitigate their absence.

The areas where the provider should make improvement are:

  • Review how GP equipment trolleys are checked.
  • Review how non-clinical staff are regularly communicated with, in line with clinical staff.
  • Review how the service ensures information reaches its intended audience, including bank and agency staff.

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 a focused inspection of the SELDOC Out of Hours Service at Queen Mary’s Hospital on 21 May (a visit of the hub centre) and 22 May 2018 (a visit of the main site). The focussed inspection was to check if areas within the safe domain which were in breach of CQC regulations were now resolved

At this inspection we found:

  • Cars used by the service had Oxygen and an Automatic External Defibrillator available for use.
  • The service utilised prescriptions where GPs provided medicines to patients directly in line with guidance.
  • The service had implemented new systems for how medicines were supplied to the site. Stocks were monitored and relevant drugs were available.
  • Medicines audits had been completed and the service showed improved antibiotic prescribing following audits.
  • Equipment trolleys were stocked and contained relevant equipment.
  • Regular newsletters had been implemented for communication with staff.

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

Inspection areas

Safe

Good

Updated 9 July 2018

At our previous inspection on 10 August 2017, we rated the provider as requires improvement for providing safe services and stated that the practice must:

  • Develop effective systems and processes to ensure safe care and treatment including ensuring the proper and safe management of medicines, and assessing the risk of not providing Oxygen and Automatic External Defibrillator on service vehicles used for home visits and, where appropriate, mitigate their absence.

The areas where the provider should make improvement are:

  • Review how GP equipment trolleys are checked.
  • Review how non-clinical staff are regularly communicated with, in line with clinical staff.
  • Review how the service ensures information reaches its intended audience, including bank and agency staff.

At this inspection we found that these areas had been addressed, and we rated the practice, and all of the population groups, as good for providing safe services.

Information to deliver safe care and treatment

Staff had the information they needed to deliver safe care and treatment to patients.

  • The service had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. There were a series of newsletters containing relevant information which were sent to all staff, and clinical meetings were scheduled where required.

Safe and appropriate use of medicines

The service had reliable systems for appropriate and safe handling of medicines.

  • The systems and arrangements for managing medicines, including medical gases, emergency medicines and equipment, and controlled drugs and vaccines, minimised risks.
  • The service kept prescription stationery securely and monitored its use. This included the implementation of lilac prescriptions for medicines which were either administered or dispensed by the GP. Prescriptions were kept securely in the relevant sealed medicines trays.
  • Arrangements were also in place to ensure medicines and medical gas cylinders carried in vehicles were stored appropriately. Oxygen and an Automatic External Defibrillator were available in all cars.
  • The service had developed a system with an external provider that medicines were stored in secure boxes that were checked once a week. When medicines were used there was a “yellow flag/red flag” system in place to determine whether the box may still be used or would need to be replaced.
  • The service had carried out regular audits of the use of broad spectrum antibiotics and prescriptions of painkillers. The analysis of the first audit of antibiotics showed that the service was only prescribing first choice antibiotics for urinary tract infections 50% of the time. Following training of all clinical staff at the second audit this had improved to a compliance rate of 79%.
  • Equipment trolleys at the service contained relevant equipment.

Effective

Good

Updated 17 October 2017

The service is rated as good for providing effective services.

  • The service was consistently meeting National Quality Requirements (performance standards) for GP out of hours services to ensure patient needs were met in a timely way.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits of GP performance against standards and guidelines demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 17 October 2017

The service is rated as good for providing caring services.

  • Feedback from patients through our comment cards and collected by the provider was positive.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Patients were kept informed with regard to their care and treatment throughout their visit to the out of hours service.

Responsive

Good

Updated 17 October 2017

The service is rated as good for providing responsive services.

  • Service staff reviewed the needs of its local population and engaged with its commissioners to secure improvements to services where these were identified.
  • The service had good facilities and was well equipped to treat patients and meet their needs.
  • The service had systems in place to ensure patients received care and treatment in a timely way and according to the urgency of need.
  • Information about how to complain was available and easy to understand and evidence showed the service responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 17 October 2017

The service is rated as good for being well-led.

  • The service had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The service had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The service had identified and responded to concerns raised around monitoring and prescribing of medicines in the service; however, improvements had not yet been fully implemented and their effectiveness assessed.
  • The provider was aware of and complied with the requirements of the duty of candour. The provider encouraged a culture of openness and honesty. The service had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The service proactively sought feedback from staff and patients, which it acted on; however there was not as much communication aimed at non-clinical staff as clinical staff.