Archived: Grabadoc

Updated 27 June 2017

Greenwich and Bexley association of doctors on call (GRABADOC) Healthcare Society Limited are registered with the CQC as an out of hours service providing the regulated activities of:

• Transport services, triage and medical advice provided remotely;
• Maternity and midwifery services;
• Treatment of disease, disorder or injury;
• Diagnostic and screening procedures.

The provider does not currently provide out of hours services, but does offer telephone answering services and the hosting and administration of GP services on behalf of GP practices in the Greenwich and Bexley area.

The GRABADOC service is located at 394 Shooters Hill Road, Woolwich, London, SE18 4LP and operates from converted residential premises over two floors. Ground floor accommodation includes reception and waiting area with patient facilities including accessible facilities and baby change area, consulting rooms, clinical telephone assessment area, staff offices and staff facilities. The first floor has staff facilities, administrative space and a meeting room. There is secure parking for multiple vehicles at the rear of the property.

Telephone answering services are provided on an ad hoc basis as and when practices require them, for example when practices may be closed for training, with one practice also using the service on a regular daily basis from 5.00pm until 6.30pm when the practice is closed. Calls from patients are answered at the GRABADOC service by non-clinical GRABADOC staff. Patients are given advice to call back their practice when it is open for routine calls such as appointment booking, and patients requiring clinical assessment will have their details passed back to their practice on duty GP.

The service also hosts and administers GP clinical services on behalf of three local GP practices weekly on a Thursday afternoon. Patients calling their practice during the hours of 1.30pm until 6.30 pm will be diverted to or directed to call the GRABADOC service. Calls are answered by a GRABADOC call handler. Patients requiring routine, non-urgent action such as appointment booking are asked to call their practice back during normal opening hours. Patients requiring or requesting clinical assessment have their details passed to the GRABADOC GP on duty where a clinical assessment is made and treatment provided over the telephone. In cases where the GP needs to see the patient, they are asked to attend the GRABADOC service in person, or the GP can arrange to visit the patient at home.

GRABADOC services are provided on behalf of GP practices in the Bexley CCG and Greenwich CCG areas. The combined total number of patients who have access to the service is approximately 19,500 patients. In the last 12 months, the service has been accessed 57 times, including two home visits, four face to face consultations, two walk in patients and 49 telephone consultations.

The service is operated by two medical directors and a chief operating officer, supported by an operations manager, finance officer and administrative receptionist. The clinical service is provided through a bank of self-employed GPs from the local practices contracted to the service.

The service has previously been inspected by CQC in 2014 and met the required standards for the GP out of hours service being provided at that time.

Updated 27 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at GRABADOC Healthcare Society Limited on 30 March 2017. There was not sufficient evidence for us to rate the service; however our key findings across all the areas we inspected were as follows:

• The governance arrangements in place were not effective in assessing, monitoring and improving the quality and safety of the services provided, and did not assess, monitor and mitigate risks to service users.
• The provider did not ensure that persons providing care or treatment to service users had the qualifications, competence, skills and experience to do so safely.
• Non clinical staff had been trained to provide them with the skills, knowledge and experience to perform their role effectively with the exception of providing formal chaperone training for staff expected to carry out the chaperone role.
• The provider did not ensure the proper and safe management of medicines by evaluating and monitoring the prescribing of medicines.
• The provider had not reviewed or assessed patient care needs and ensured care was delivered in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best service guidelines.
• The provider did not seek and act on feedback from patients to continually evaluate and improve services.
• Information about how to complain was available and easy to understand.
• The provider did not seek and act on feedback from relevant persons and other persons on the services provided in the carrying on of the regulated activity for the purposes of continually evaluating and improving services.
• The service had good facilities and was well equipped to treat patients and meet their needs, with the exception of facilities for hearing impaired patients.

The areas where the provider must make improvement are:

• Assess services provided to ensure that the care and treatment of service users is appropriate and meets their needs.
• Ensure that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely, and maintain an effective record of this.
• Ensure the proper and safe management of medicines by monitoring and evaluating prescribing.
• Establish and effectively operate systems and processes to assess, monitor and improve the quality and safety of services provided and to assess, monitor and mitigate risks to service users.

The areas where the provider should make improvement are:

• Consider ways to review clinical effectiveness and improve patient outcomes.
• Review how patient feedback is collected, considering a patient survey.
• Review facilities provided for patients with hearing difficulties to ensure their needs are met.
• Review systems and process in place with other services to ensure that; clinical guidelines are followed, patients are effectively safeguarded from abuse, and that clinicians providing clinical services are appropriately trained, qualified and competent for the role.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice