Archived: Care UK - Bucks

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Care UK-Bucks Out of Hours Service on 12 December 2016. The overall rating for the service practice was good. However a breach of regulation was found resulting in a rating of requires improvement for provision of well-led services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Care UK-Bucks Out of Hours Service on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 26 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 12 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the service remains rated as good and the rating for provision of well-led services has been amended to good.

Our key findings were as follows:

• The provider had instituted regular calibration of blood glucose monitors to ensure these items of medical equipment were fit for use.
• Prescribing of high risk medicines followed the providers prescribing policy and there were checks in place to ensure this happened.
• Compliance with national quality requirements was improving.
• There was a system in place to monitor that relevant recruitment checks were completed.
• Blank prescriptions were held safely and there was a system to track them through to issuing.
• Completion of mandatory training was monitored and action taken to ensure staff completed training relevant to their roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Care UK-Bucks Out of Hours (OOH) service on 12 December 2016. The service operates from a single call centre and headquarters in Aylesbury. We visited the call centre, headquarters and Stoke Mandeville OOH base during this inspection. Overall the service is rated as good.

Specifically, we found the service to require improvements for the provision of well led services. The service is rated good for providing safe, effective, caring and responsive services.

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

• There was an effective system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• The provider had systems in place to identify, assess and manage risk but the systems were operated inconsistently. Some risks associated with monitoring of fire safety procedures at the head office and call centres had not been identified during monitoring of the service.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The National Quality Requirements (NQRs) standards were monitored and reviewed and improvements implemented.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, the provider did not have a systematic approach to assure themselves that all GPs not directly employed by the Care UK had completed training relevant to their role.
• There were safeguarding systems in place for both children and adults at risk of harm or abuse as well as palliative care (care for the terminally ill and their families) patients who accessed the out of hours service.
• There was a system in place that enabled staff to access patient records, for example the local GP and hospital, with information following contact with patients as was appropriate.
• The service proactively sought feedback from staff and patients, which it acted on.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the 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 and well equipped.
• The service managed patients’ care and treatment in a timely way.
• Information about services and how to complain was available at the out of hours centres. Improvements were made to the quality of care as a result of complaints and concerns.
• There was a clear leadership structure. Communication channels were open and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• The provider must review, assess and monitor the governance arrangements in place to ensure and improve the quality and safety of the services provided. For example:
• Ensure effective monitoring of fire safety procedures at the head office and call centres to ensure appropriate checks had been undertaken.
• Ensure all GPs not directly employed by the Care UK had completed training relevant to their role.

The areas where the service should make improvements are:

• The provider should ensure that prescribers follow the prescribing policies for recording the supply of medicines.
• Ensuring calibration and checking of blood glucose meters is carried out in accordance with the manufacturer’s specification at all times.
• Review and improve the national quality standards relevant to the face to face consultations both at an out of hours base and at patients place of residence within two hours of assessment for those patients classified as ‘urgent’.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice