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Inspection Summary


Overall summary & rating

Updated 10 July 2014

Lincolnshire Community Health Services NHS Trust provided out-of-hours General Practitioner (GP) services for patients living across Lincolnshire. The service was administered from the trust’s headquarters in Sleaford and patient care and treatment was provided from eight primary care centres at locations across the country. We visited the trust’s headquarters on 5 June 2014 where we looked at records and information and talked with staff about issues that related to all eight locations and the service a whole. On the 7 June 2014 we visited the primary care centre at Skegness and District Hospital and spoke with members of staff, patients and carers and reviewed documents and matters specific to that location.

Lincolnshire Community Health Services NHS Trust provided was registered to provide the regulated activities of diagnostic and screening procedures and the treatment of disease, disorder or injury. In addition Skegness and District Hospital was registered to provide the regulated activities of family planning.

The provider conducted clinical audit that addressed specific areas of patient care. Individual clinicians’ practice was assessed on a regular basis to help ensure that patients received safe and effective care and treatment.

The provider had not used effective recruitment processes to assess the suitability of staff to work in this sector. We have told the provider they must improve.

There were systems in place to help ensure patient safety through learning from incidents, the safe management of medicines and infection prevention and control.

Staff were trained and supported to help them recognise the signs of abuse of children and vulnerable adults and provided staff with training to heighten their awareness of domestic violence.

The provider had in place business continuity and contingency plans that would enable the service to continue to operate in the event of a failure of, for example, the information technology or telecommunication systems.

We found the service was effective in meeting patients’ needs and the primary care centres were accessible to those who may have mobility issues.

Patients experienced care that was delivered by dedicated and caring staff. Patients and carers we spoke with said staff displayed a kind and caring attitude. We observed patients being treated with respect and kindness whilst their dignity and confidentiality was maintained.

We found that the service was well-led and managed by a knowledgeable senior management team and board of directors. They had taken action to help ensure their values and behaviours were shared by staff through regular engagement.

Members of the staff team we spoke with held positive views of management and their leadership and felt well supported in their roles. They told us the senior managers were approachable and listened to any concerns or suggestions they might have to improve the level of service provided to patients.

We found the provider did not have appropriate systems in place for the safe and reliable administration and storage of medicines. There were no formal procedures or audits for medicines received and held. Reliable checks would ensure safe administration of medicines, and minimise the potential for error. Following on our visit the provider took steps to improve the medicines management systems to keep patients safe.  

Inspection areas

Safe

Updated 10 July 2014

There  was a clear process for recording patient safety incidents and concerns and the provider had taken steps to investigate such incidents and inform staff of the findings to help prevent any re-occurrence.

We saw the provider had put into place actions plans in response to concerns and saw how they had been held accountable to the trust board in delivering those plans.

There were clear policies and processes that helped to identify and protect children and vulnerable adults from harm, and staff we spoke with were well informed of their role and responsibilities.

There was good evidence of collaborative working with other healthcare providers aimed at delivering care and treatment to patients by the most appropriate route.

We saw evidence that the provider was working with other healthcare providers in an effort to adapt the service to the needs of patients and to ensure its sustainability going forward.

The provider had not taken the appropriate steps to ensure that all staff underwent a thorough recruitment process and had not assured themselves that patients were cared for, or supported by GPs who were suitable to work in a healthcare environment and we have told the provider that they must take action to improve.

The provider did not have appropriate systems in place for the reliable and safe, storage and administration of medicines.

We found the out-of-hours service at Skegness and District Hospital was located in a single room and the layout was clean, well organised and maintained.

We found infection prevention and control measures were in place in treatment rooms, and hand washing facilities were available. Staff had received recent infection control training.

We saw that staff at the out-of-hours unit at Skegness and District Hospital did not have any means of summoning assistance in an emergency or if staff felt threated, other than a panic button on the computer system.

Effective

Updated 10 July 2014

GPs’ who were engaged to deliver care to patients all worked in the practices covered by the out-of-hours service. There was no use of locum or agency GPs.

We found that the provider had undertaken reviews of the clinical practice of individual practitioners. This meant that poor practice could be identified and appropriate action taken to help prevent any re-occurrence.

We saw evidence of robust clinical audits being undertaken but noted that in one instance the audit cycle had not been completed and reviewed on the agreed date.

The provider had been effective in sharing information about patient consultations with the patient’s own GP practice.

Staff told us they delivered care and treatment in line with trust guidance, standards and best practice. They supported patients to make informed decisions and gave informed consent.

Staff told us they  worked well with the minor injuries unit staff and shared information. Staff would seek support and guidance from staff at other out-of-hours services run by the Trust to ensure positive outcomes for patients.

Caring

Updated 10 July 2014

The provider had made positive steps to meet the needs of patients from the gay, lesbian, trans-gender and bi-sexual community. The provider had been ranked in the Stonewell Healthcare Equality Index run by the charity Stonewall.

The provider demonstrated close community links and involvement in networks such as Patient Advice and Liaison Services ( PALS) which offered confidential advice, support and information on health-related matters.

We saw evidence that each month a ‘patient story’ was presented to the board. Patients, carers and relatives affected by a service where care delivery had failed had been encouraged to attend the meetings and share their experience with the directors to help inform them of the impact.

Patients told us they were treated with kindness and respect and had positive relationships with staff delivering their treatment and care.

Responsive

Updated 10 July 2014

The interim Chief Executive had provided staff with their personal email address which could be used if they felt they needed to raise issues or concerns with her directly and told us they had on one occasion met with a member of staff in private to discuss issues raised.

The provider responded to differing levels of demand for services, for example in periods of high patient numbers in the winter months and during the holiday season at coastal locations such as Skegness. The provider conducted regular checks on activity levels at the primary care centres which ensured staffing met  the care needs of patients.

The provider had implemented a system of direct referrals from East Midlands Ambulance Service to the out-of-hours which had resulted in a measurable decrease in admissions into Accident and Emergency departments.

Patients told us they were able to make appointments easily, and were seen in a timely and effective way.

Patients did not know how to raise complaints if they had concerns. We did not see any information on the out-of-hours unit around complaints procedures and ways  to give feedback to the provider.

Well-led

Updated 10 July 2014

We saw that the trust was well led by an experienced and diverse board of directors. The senior management team was knowledgeable and actively demonstrated high values and behaviours aimed at improving patient care.

The provider displayed open and transparent governance arrangements and minutes of the various board and committee meetings were easily accessible on the provider’s website.

We found that the interim Chief Executive was pro-active in seeking the views of staff and there was a program of staff engagement events being held across the county of Lincolnshire aimed at reaching as many staff as possible.

Staff were given the option to undertake various training opportunities pertinent to their role and were supported to improve and reflect upon their performance through annual appraisal and regular supervision.

There was a clear desire to develop and improve the level of service and the trust was working with other health care providers to improve healthcare outcomes for patients.

Other CQC inspections of services

Community & mental health inspection reports for Skegness Hospital can be found at Lincolnshire Community Health Services NHS Trust.