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Inspection Summary


Overall summary & rating

Good

Updated 24 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trafford Out of Hours GP Service (Part of Mastercall Healthcare) on 6 March 2017. Overall the provider is rated as good.

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

  • The provider demonstrated an open and transparent approach to safety; and a clear cohesive system was in place for reporting, recording and providing feedback on significant events, identified risks, near misses, patient complaints and safeguarding referrals.
  • The Quality and Safety Team held profiles relating to identified risks, complaints, significant events and safeguarding referrals. Risk ‘champions’ had been identified amongst the workforce to encourage high levels of reporting amongst staff.
  • The service was monitored against the National Quality Requirements (NQRs) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners in relation to the level and quality of service being delivered. Where variations in performance were identified, the reasons for these were reviewed and action plans implemented to improve the service.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received appropriate training and updating which provided them with the skills, knowledge and experience to deliver effective care and treatment.
  • Performance monitoring processes were in place. Clinicians received weekly audits of their clinical practice using the Royal College of GPs (RCGP) urgent care tool the ‘Clinical Guardian’ system.
  • The provider had developed in-house software to support individual ‘My Performance’ reports which benchmarked individual clinicians against their peers in relation to assessment outcomes, for example in relation to percentage of patients who received telephone advice, or who attended treatment centres or hospital.
  • Following initial assessment by NHS111 service, patients were triaged by clinicians at International House and offered telephone advice, a face to face appointment at Stockport or Trafford; or a home visit, in accordance with the disposition (outcome) of the assessment.

  • Information about services and how to complain was available on the provider website and in house at treatment centres. Complaints were investigated and patients received an apology and explanation of actions taken as a result of their complaint.

  • Staff had access to safeguarding policies and procedures and received training appropriate to their role. Staff demonstrated their awareness of their safeguarding responsibilities in relation to vulnerable children and adults; including frequent callers to the service.

  • Vehicles used to transport GPs to home visits were clean, well maintained and appropriately equipped. Patient Transport Services were available for those patients without transport, who needed to access a treatment centre

  • There was a clear leadership structure within the organisation. Staff we spoke with described feeling supported by immediate and senior managers.

  • The provider proactively sought feedback from staff and patients, and acted on this feedback.

  • There were systems in place to provide integrated person-centred care. Staff had access to information relating to end of life care through the use of Special Patient Notes, EMIS viewer and Electronic Palliative Care Co-ordination System (EPaCCS).

  • The provider was aware of, and complied with the requirments of the duty of candour.

We saw areas of outstanding practice:

  • The provider was the first out of hours service to be awarded ‘Daisy’ accreditation, which originated from the National Dignity Council, and had been adopted by Community Healthcare Trusts for Tameside, Glossop and Stockport; for dignity in care. Dignity champions had been identified throughout the service to reinforce this approach.

However the provider should:

  • Improve uptake of annual appraisals, particularly in relation to nursing staff.

  • Continuously monitor, review and develop action plans in relation to their performance against National Quality Requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 May 2017

The provider is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. The quality and safety team held detailed profiles relating to significant events and safeguarding referrals.

  • Lessons were shared to make sure action was taken to improve safety in the organisation. The provider made use of external peer review of significant events to facilitate an open culture and enhance learning.

  • The provider had systems in place to ensure that staff working at Mastercall out of hours service were appropriately recruited and vetted to ensure their eligibility and suitability for their role. We saw that medical indemnity was checked for all GPs and was reviewed annually. The total number of hours worked by GPs was also monitored to ensure that excessive hours were not undertaken.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The provider had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and managed. The Risk Management Committee oversaw risk assessments and maintained the risk register. Risk champions had been identified amongst the workforce to embed a risk management culture at all levels.
  • The provider had good systems in place for medicines management. Effective systems were in place to monitor the use of prescriptions. Prescribing patterns of clinicians were closely monitored to ensure compliance with National Institute for Health and Care Excellence (NICE) guidelines.
  • Vehicles used to take clinicians to patients’ homes for consultations, and those used to transport patients to appointments at treatment centres were well maintained, cleaned and contained appropriate emergency medical equipment and medicines.

  • Emergency equipment was shared with the co-located Trafford Urgent Care Centre. This was maintained and checked by Urgent Care Centre staff.

Effective

Good

Updated 24 May 2017

The provider is rated as good for providing effective services.

  • Data from the National Quality Requirements (NQRs) and Key Performance Indicators (KPIs) showed the provider outcomes were in line with national averages.

  • We saw that systems were in place to ensure all clinicians were up to date with NICE guidance, as well as other locally agreed guidance.

  • Staff were equipped with the skills, knowledge and experience to deliver effective care and treatment.

  • Staff received weekly audits of their consultations, calls and prescribing activity. Staff were assessed using the ‘Clinical Guardian’ system.Following audits, staff were given feedback on their performance, with indicators of where improvement needed to be made. ‘My Performance’ feedback provided feedback benchmarked against peers in relation to assessment outcomes.

  • The provider undertook ongoing audits of prescribing activity to demonstrate that patients received appropriate treatment.

  • A system of appraisals and personal development plans were in place for staff employed by the service. We saw evidence that 72% of nursing staff and 96% of operational staff had received an appraisal in the previous year.

  • Staff received training and updates relevant to their role, and systems were in place to monitor update of mandatory training for all staff.

  • The service worked closely with the patients’ own GPs and other healthcare providers. Information was shared between these and the out of hours service.

Caring

Outstanding

Updated 24 May 2017

The provider is rated as outstanding for providing caring services.

  • Data showed that patients rated the service similar to others in relation to the care and treatment they received.

  • Patients told us they were treated with dignity and empathy. They told us staff were helpful and caring; and they felt satisfied they were involved in decisions about their care and treatment.

  • In line with Accessible Standards guidelines, information for patients about the service was available and easy to understand.

  • We saw and heard staff treated patients with kindness and respect during telephone and face to face interactions. We saw that patient confidentiality was maintained.

  • 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.

  • Patient transport services were available to provide transport to treatment centres where patients did not have access to their own transport.

  • The provider gave examples where their staff had ‘gone the extra mile’ to help patients in need, when regular services were not immediately available.

  • The organisation had received ‘Daisy’ accreditation for dignity in care. Dignity champions were identified to raise staff awareness of this approach in all aspects of patient care.

Responsive

Good

Updated 24 May 2017

The provider is rated as good for providing responsive services.

  • The provider had recently appointed a communications and engagement lead who was developing a new communication and engagement strategy. The service was endeavouring to establish regular interface with patients. We saw that all patients were contacted following their contact with the service, in order to elicit their feedback in relation to the care they had received.

  • The service collated Friends and Family Test data and reviewed information provided by Healthwatch in order to evaluate and improve patient care.

  • The service understood the needs of the population it served, and engaged with relevant Clinical Commissioning Groups (CCGs) to provide services which were responsive to the needs of their population.

  • Plans were shared with patients’ own GPs and the out of hours service for those patients with complex needs, including people with long term conditions and complex physical and mental health needs. Special Patient Notes, Electronic Palliative Care Co-ordination System (EPaCCS) and electronic patient notes were available to staff to help in proactively managing care for these patients.

  • Patients said they were offered appointments at a time and location which was convenient to them.

Information about how to complain was available and easy to understand. Evidence showed the service responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 24 May 2017

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

  • The provider had a clear set of aims and objectives which included to provide safe and accessible care with patients, and to ensure patient safety and dignity was respected at all times. Staff were clear about the organisation’s objectives; and their responsibilities in relation to these.

  • There was a clear leadership structure and staff told us they felt supported by immediate and senior management.

  • The provider had a range of policies and procedures to govern activity. Regular Quality and Safety meetings were held.

  • There was an overarching governance and performance management framework which supported the delivery of the aims and objectives. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The senior management team encouraged an ‘open door’ policy. The service had systems in place to record and manage safety incidents, and ensured this information was shared with staff, and any necessary action was taken.

Checks on specific services

People with long term conditions

Good

Updated 4 January 2017

The practice is rated as good for the care of people with long-term conditions.

  • The practice was open from 8am until 8pm seven days a week.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Indicators for diabetes and other long term conditions were in line with local and national averages.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 4 January 2017

The practice is rated as good for the care of families, children and young people.

  • The practice was open from 8am until 8pm seven days a week.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 4 January 2017

The practice is rated as good for the care of older people.

  • The practice was open from 8am until 8pm seven days a week.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • They supported patients living in residential and care homes and undertook two visits each year for holistic review.These visits were carried out by GPs and practice nurses and each patient had a holistic and informative care plan.

Working age people (including those recently retired and students)

Good

Updated 4 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice was open from 8am until 8pm seven days a week.

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Performance for mental health related indicators was worse than local and national averages. The practice attained 89% which was 5% below the CCG average and 4% below the national average.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 4 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice was open from 8am until 8pm seven days a week.

  • The practice held, what they referred to as, a VIP register which included patients with dementia, learning disabilities, mental health issues, complex needs and safeguarding concerns. These patients were regularly reviewed and discussed to ensure that their needs continued to be met.
  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.