Archived: Leicester City, Leicestershire and Rutland Out of Hours Also known as Central Nottinghamshire Clinical Services

Updated 28 January 2016

The GP out-of-hours service for Leicester City, Leicestershire and Rutland is provided by Central Nottinghamshire Clinical Services Ltd. The service is commissioned by the four Leicestershire Clinical Commissioning Groups (CCG’s), with the lead for out-of-hours services being West Leicestershire CCG.

The out-of-hours service provides care to patients who require urgent medical care from GPs and nurses outside of normal GP hours. The provider employs the services of 254 GPs, nurses, health care assistants and support staff who are engaged on a sessional basis to deliver care to patients. The service operates county wide from 6.30pm until 8am Monday to Thursday, and 6.30pm Friday until 8am Monday, and all public holidays.

Initial telephone contact with the out-of-hours service is through the NHS 111 service, which is provided by another healthcare provider.

The service provides care to a population of approximately 996,000 residing in the area and operates from five primary care centres geographically spread across the county. The five locations are;

Hinckley & Bosworth Community Hospital, Hinckley

Leicester Royal Infirmary, Leicester

Loughborough Community Hospital, Loughborough

Lutterworth Hospital, Lutterworth

Rutland Memorial Hospital, Oakham

Updated 28 January 2016

We carried out an announced comprehensive inspection at Leicester City, Leicestershire and Rutland Out of Hours service on 10 and 11 November 2015.   Overall the service is rated as good.

This was following an inspection carried out in March 2015, where the service was rated as inadequate overall and placed into special measures. Issues identified at the previous inspection included: -

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example emergency and urgent patients were not being seen for face to face consultations in relation to their medical needs and in a timely manner 

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• There was insufficient assurance to demonstrate people received effective care and treatment. For example we saw evidence of emergency patients waiting far too long to be seen by a clinician. Despite being aware of issues, the provider had not look at them in detail to identify the root cause.

Specifically, we found the service to be good for providing safe, effective, caring and responsive services. It required improvement for providing well led services.

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

• Systems and processes had been established to protect patients from harm. Emergency and urgent patients were now being seen for face to face consultations in relation to their medical needs in a timely manner.

• Staff were now clear about reporting incidents, near misses and concerns. We could see that the provider had implemented more robust mechanisms to enable learning and communication with staff.

• The provider had implemented changes to ensure people received effective care and treatment. The provider had implemented patient lists for clinicians, with a person monitoring patient lists across all sites to identify potential breaches of waiting times enabling them to manage patient flow better.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• The provider had ensured that essential clinical equipment was available at all sites and in vehicles used. This was routinely monitored and equipment restocked where necessary.

• Medication management was significantly improved following the previous inspection. The provider had employed a pharmacist three days per week who was responsible for implementing standard operating procedures and auditing medicines.

• The provider had clearer leadership structures, however a large proportion of the executive team were either interim or acting staff.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must: -

• Start recruitment to strengthen the permanent leadership with substantive posts.

In addition, the provider should: -

• Have appropriate signage at the Loughborough site, so that patients can differentiate between the out of hours provision and the urgent care centre.

• Have appropriate signage in different languages advertising interpretation services at each of the sites, rather than this being written in English.

On the basis of the ratings given to this service at this inspection, I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service .

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice