Archived: Leicester City, Leicestershire and Rutland Out of Hours service

Updated 3 May 2019

Leicester City, Leicestershire and Rutland Out-of-Hours Service is provided by DHU Health Care C.I.C. and is based at Fosse House, 6 Smith Way, Grove Park, Enderby, Leicester, LE19 1SX.

The service provides out-of-hours GP services when GP practices are closed, that is between 6.30pm and 8am Monday to Friday and throughout weekends and bank holidays. The out-of-hours service is accessed by NHS111.There is also direct access for Healthcare Professionals via a Healthcare Professional Phone Line.

It also provides an in-hours acute home visiting service aimed at reducing the numbers of avoidable emergency admissions.

There is also a night nursing service to patients in their usual place of residence, enabling them to make choices, self-manage and maintain control over their quality of life.

The provider, DHU, also provides a clinical navigation hub at this location which was inspected as part of this inspection and provides the access into the home visiting service and night nursing service.

DHU is also the provider of the NHS111 service for Leicester, Leicestershire and Rutland and has a call centre within Fosse House, though generally calls are routed through its NHS111 call centres in Derby and Chesterfield. The NHS 111 service did not form part of this inspection.

The services cover the whole of Leicester City, Leicestershire and Rutland and are commissioned through various contracts with NHS Leicester City, NHS East Leicestershire and Rutland and NHS West Leicestershire clinical commissioning groups. The provider has run this service since April 2016.

In the current year the provider is expected to have more than 200,000 patient contacts which includes 90,000 clinical navigation hub contacts, 37,000 home visiting service, 6,000 night- nursing contacts, 14,000 out-of- hours contacts and 65,000 Loughborough Urgent Care contacts.

Out-of-hours GP face to face consultations are provided from six primary care centres at Leicester Royal Infirmary, Loughborough Urgent Care Centre, Hinckley and Bosworth Communty Hospital, Fielding Palmer Hospital Lutterworth, Rutland Memorial Hospital Oakham and Coalville Community Hospital. Leicester Royal Infirmary, Loughborough Urgent Care Centre and Hinkley and Bosworth Memorial Hospital are open daily, the other three at times to meet predicted demand.

During this inspection we visited Fosse House and the primary care centres at Leicester Royal Infirmary, Hinckley and Bosworth Community Hospital and Loughborough Urgent Care Centre.

Depending on their needs, patients may be seen by a GP or practitioner at the service’s primary care centres, receive a telephone consultation or a home visit. The service does not ordinarily accommodate walk in patients except at the Loughborough Urgent Care Centre.

The provider is registered to provide three regulated activities:

Treatment of disease, disorder or injury;

Transport services, triage and medical advice provided remotely;

Diagnostic and screening procedures;

Loughborough Urgent Care Centre is a location in its own right, as well as a primary care centre for the out- of -hours service and was inspected on the same day as this out-of-hours inspection took place. It is subject of a separate report.

Updated 3 May 2019

This service is rated as Good overall.

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 an announced comprehensive inspection at Leicester City, Leicestershire and Rutland Out-of-Hours Service on 20 and 21 December 2018 and 9 January 2019 as part of our inspection program. The service had not been previously inspected.

At this inspection we found:

• 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.
• Some staff we spoke with said that were reticent to raise concerns for fear of repercussions.
• They also told us that the staffing levels in the home visiting and night nursing service did not always ensure that patients got seen in a timely manner.
• 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.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients could access the out-of-hours service within an appropriate timescale for their needs.
• The service took patient feedback and experiences seriously, and had an effective system and process to gather patient views and act upon them where necessary.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The provider should;

• Review their systems to assure themselves that where sessional GPs used their own equipment, it was safe and appropriate.
• Review the infection prevention and control measures at Leicester Royal Infirmary.
• Review their process to ensure prescription security across all sites.
• Review the process to encourage staff to raise concerns and to feedback on the concerns raised.
• Review the on-call manager system to provide assurance to staff.
• Continue to review staffing levels of the home visiting service and night nursing service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care