This service is rated as Good overall. (At the previous inspection, published 15 March 2019, the service was rated requires improvement 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
Following our previous report published March 2019, Suffolk GP Federation C.I.C. - Head Office was rated requires improvement overall and for providing safe, effective and well led services. The ratings for caring and responsive services were good. The full reports for previous inspections can be found by selecting the ‘all reports’ link for Suffolk GP Federation C.I.C. Head Office on our website at www.cqc.org.uk
We carried out an announced comprehensive inspection of Suffolk GP Federation C.I.C. – Head Office, as part of our inspection programme on 4, 7, 9 and 14 June 2021. This was to follow up on the requirement notices for Regulation 12 and Regulation 17 issued at the previous inspection and to inspect the Suffolk GP Out of Hours service which Suffolk GP Federation C.I.C. (the provider) had taken responsibility for providing since April 2019.
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently. This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
- Requesting and reviewing evidence from the provider
- Reviewing patient records
- Conducting staff interviews using video conferencing and by telephone
- Reviewing staff questionnaires
- Requesting feedback from other stakeholders and patients who use the service
- Short site visits
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.
- Improvements had been made to infection control, prescription stationery security, availability and calibration of equipment, and emergency medicines were stocked in line with current guidelines. However, we found three weighing scales at the Riverside site which had not been calibrated and improvements were needed to the system for monitoring oxygen availability across the GP+ and Out of Hours sites.
- The service routinely reviewed the effectiveness and appropriateness of the care it provided. Systems were in place to keep clinicians up to date with current evidence-based practice and the provider had an ongoing programme of audits to check evidence-based practice was followed. Templates were in place at the minor injury unit which enabled a detailed history, assessment, clinical observations, examination, treatment and advice to be documented. Work had been undertaken to identify competencies for clinical staff and there were systems to ensure all staff were competent to do their role.
- Staff involved and treated people with compassion, kindness, dignity and respect.
- Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
- Arrangements were in place to respond in a timely way to complaints, however, although information to escalate a concern to the Parliamentary Health Service Ombudsman was available for patients, it was not always documented that this had been provided to patients who made a complaint. The service took complaints and concerns seriously and learnt from them to improve the quality of care.
- There was a strong focus on continuous learning and improvement at all levels of the organisation. Feedback from staff demonstrated they felt supported and were proud to work for the service. The service was involved in a range of pilot projects and initiatives.
- The provider had made significant improvements to address concerns raised at our previous inspection, however a new concern was identified during this inspection and the actions the provider has taken to address the concern required further monitoring, review and embedding to ensure they were effective.
We saw two areas of outstanding practice:
- Following proactive analysis of the needs of patients who may use the Felixstowe minor injury clinic service, a range of comprehensive templates had been developed in response to those areas. These included for example, minor injury, eye injury, head injury assessment, musculoskeletal injury and neurological examination. These templates ensured a full assessment of the patient’s needs, including a set of baseline clinical observations, had been completed. When this service had changed from a walk in centre (no pre-booked appointments necessary) to a walk in clinic (pre booked appointments only) the service manager contacted the council to change all the signage in the local area so patients were no longer directed to this facility, but the nearest hospital in Ipswich.
- The North East Essex Diabetes services (NEEDS) were a Quality in Care Diabetes 2020 award winner for their emotional wellbeing programmes for people with diabetes. The team collaborated with the local health in mind/improving access to psychological therapies (IAPT) team to improve access, care and treatment. Initially IAPT therapists were invited to diabetes patient education events, but this led to other developments, for example, new clinics and a diabetes and well-being course. The service includes fast track appointments, with upskilled practitioners in a familiar location. An audit from June to August 2020 analysed caseload trends of the mental health practitioner within NEEDS. It identified the average patient contacts were five per day, with referrals mainly from GP practices, diabetes specialist nurses and from secondary mental health teams asking for additional support. Integrating support from NEEDS with psychological care from IAPT, helped to break down barriers for diabetes patients accessing medical care which resulted in improved glycaemic control and reduced psychological stress. A survey was sent to 90 patients who had used the service from November 2019 to September 2020 of which 14 patients responded. 78% of patients reported the contacts were helpful, 86% felt listened to and supported, 100% were treated with dignity and respect, and 72% felt the contact had helped with their diabetes management.
The areas where the provider must make improvements as they are in breach of regulations are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
- Continue with plans to include relevant equipment used but not owned by the provider, as part of their calibration programme.
- Continue work to document the Hepatitis B vaccination status of clinical staff.
- Confirm, in writing, information given to patients verbally in response to complaints raised.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care