29 and 30 August 2018
During a routine inspection
This service is rated as Good overall.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Good
We carried out an announced comprehensive inspection at the Countess of Chester Hospital GP Out of Hours service on 29 and 30 August 2018 as part of our inspection programme.
At this inspection we found:
- The service had systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved their processes.
- There were systems in place to mitigate safety risks including those associated with health and safety, infection prevention and control and dealing with safeguarding.
- 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.
- Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment
- Staff involved and treated people with compassion, kindness, dignity and respect.
- The service was underperforming in one of their targets relating to response times for home visits. The branch location was subject to ad hoc closures due to staffing pressures and relocation of staff. However patient feedback was positive in relation to accessing care and treatment from the service within an appropriate timescale for their needs.
- The service facilities were accessible and well equipped to treat patients and meet their needs. The vehicles used for home visits were maintained and well equipped, however not all the required checks were carried out on a daily basis.
- There were systems in place that enabled staff to access patient records. Out of hours staff provided other services, such as the patient’s own GP and hospital, with the information they needed following contact.
- There was a clear leadership structure and staff felt supported by leaders and management. The provider sought patient views about improvements that could be made to the service; including through the Friends and Family Test, internal surveys and share your experience information. It acted, where possible, on feedback.
- There was a focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider should make improvements are:
- Review the training plan to include chaperone training for those non- clinical staff who undertake chaperone duties.
- Continue to monitor the streaming criteria and protocols to ensure appropriate streaming to GP out of hours is taking place and that full and accurate information is documented and received by the out of hours service.
- Continue to review clinical staffing levels and recruitment in order to meet patient needs and service demands.
- Review the system for documenting action taken in response to safety alerts.
- Continue to plan and carry out fire evacuation drills as required at both sites.
- Review and formalise the system for implementation and monitoring of NICE and other clinical guidance.
- Review the formalisation and documentation of clinical supervision for staff.
- Review accessibility and provision of information and advice leaflets in different languages and formats.
- Review the displaying of the complaints procedure in the waiting areas.
- Continue to monitor equipment checks for the out of hours vehicles to ensure daily checks of all equipment is carried out and recorded.
- Continue to monitor compliance with clinical staff’s safeguarding update training.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice