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Gloucestershire Out of Hours Requires improvement

This service was previously registered at a different address - see old profile

Reports


Inspection carried out on 13 August to 15 August 2019

During a routine inspection

This service is rated as Requires Improvement overall. (Previous inspection September 2018 – Requires Improvement)

We carried out an announced comprehensive inspection at Gloucestershire Out of Hours in September 2018 and rated the provider requires improvement in effective and well led and good in safe, caring and responsive. On the 13 -15 August 2019 we carried out a comprehensive inspection to follow up on breaches of regulations found during the inspection carried out in September 2018.

At this inspection 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? – Requires Improvement

At this inspection we found:

  • When incidents happened, the service learned from them and improved their processes.
  • There were gaps in systems to assess, monitor and manage Health and Safety, such as identifying and managing the deteriorating patient, for non-clinical staff, they were in place and followed by clinical staff
  • There were systems in place for the appropriate and safe use of medicines, including medicines optimisation.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Consistent improvements had been made towards meeting performance targets.
  • Staff involved and treated people with compassion, kindness, dignity and respect. Patient feedback was positive.
  • Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
  • Complaints were listened and responded to and used to improve the quality of care.
  • Whilst clinical staff and staff working at the head office felt there had been improved engagement with the leadership team, many of the non-clinical staff we spoke with and who worked at the bases reported a lack of visibility and support from the management teams.

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 to improve and sustain performance against targets.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 3,4 and 5 September

During a routine inspection

This service is rated as Requires Improvement overall. This service has not been previously inspected

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? –Requires Improvement

We carried out an announced comprehensive inspection at Gloucester Out of Hours on 3, 4 and 5 September 2018 as part of our inspection programme and regulatory functions under Section 60 of the Health and Social Care Act 2008.

At this inspection we found:

  • The service had systems to manage risk so that safety incidents were less likely to happen. For example, there were systems to fill any gaps in the rota to ensure appropriate clinical cover at all sites. When safety incidents did happen, the service learned from them and made efforts to improve their processes.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • The service was not consistently meeting performance targets; however, a detailed and measurable recovery plan was in place to address these areas.
  • Staff involved and treated people with compassion, kindness, dignity and respect. Feedback from patients for all aspects of care was positive.
  • Patients could access care and treatment from the service within an appropriate timescale for their needs.
  • 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.
  • There had been significant recent management changes which had impacted upon the operating of effective governance processes. For example, staff training and appraisals.
  • Leaders were not visible and not all staff felt supported, respected and valued.

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.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice