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Inspection Summary


Overall summary & rating

Updated 10 July 2014

Lincolnshire Community Health Services NHS Trust provides out-of-hours General Practitioner (GP) services for patients living across Lincolnshire. It is registered to provide the regulated activities of diagnostic and screening procedures and the treatment of disease, disorder or injury.

The out-of-hours service conducted clinical audits 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.

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

We saw that leaflets to inform patients about how they might raise a complaint were only available in English, but we saw documentary evidence that the Clinical Commissioning Group had instructed that they should not be printed in other languages due to cost. The out-of-hours service had access to language line, which provided a telephone interpretation service. We were told that interpreters could be brought in if necessary. However this was very rare, as most patients either came with someone who could speak English or were able to make themselves understood.

There were systems in place to help ensure patient safety through learning from incidents, the safe management of medicines and infection prevention and control. Following our inspection we raised concerns with the provider with regard to the management of medicines. We received a swift response detailing what action would be taken to address the concerns.

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

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.

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 that the service was well-led and managed by a knowledgeable senior management team and Board of Directors. They had taken action to 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. However, staff did say that it was very rare to see a senior manager at the out-of-hours service due to the hours the service operated.

Inspection areas

Safe

Updated 10 July 2014

The out-of-hours service at Lincoln County hospital was safe. 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 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 was 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 way.

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. They had not assured themselves that patients were cared for, or supported by GP’s who were suitable to work in a healthcare environment. As a result we have told the provider that they must take action to improve.

Medication was stored in a room with poor ventilation and the temperature within this room was not being monitored. As a result medication could have reached temperatures which rendered it ineffective without the staff being aware.

The equipment within the out-of-hours department and carried on the vehicles showed the service to be well equipped and prepared for many scenarios.

Effective

Updated 10 July 2014

The out-of-hours service at Lincoln County hospital was effective. GPs who delivered 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.

There were effective arrangements in place for staffing the out-of-hours service. There were also arrangements to ensure that agency staff was adequately prepared, prior to starting work at the service.

There were effective arrangements for making referrals to other services. Particularly in relation to patients whose needs could not be met within the service, or who required further support or treatment.

Caring

Updated 10 July 2014

The out-of-hours service at Lincoln County hospital was caring. We saw that patients were treated with dignity and respect and patients and carers we spoke with said staff displayed a kind and caring attitude.

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 effect.

Patients were asked for their consent before any care or treatment was started. Patients were also kept informed with regard to their care and treatment throughout their visit to the out-of-hours service.

Responsive

Updated 10 July 2014

The-out-of hours service at Lincoln County hospital was responsive to patient’s needs. We saw that leaflets informing patients about the complaints procedure were only available in English. We saw documentary evidence that indicated that the commissioners of the service had stated that they should not be printed in other languages due to financial implications. We were informed that information on how to make a complaint was available on the provider’s website, but upon looking at the site we were unable to find this.

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. She told us that she had met with a member of staff in private to discuss issues raised.

The provider responded to changing levels of demand for services. For example when demand for services was high during the winter months and during the holiday season. Particularly at coastal locations such as Skegness. The provider conducted regular checks on the level of service need 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 service which had resulted in a decrease in the number of admissions into accident and emergency departments.

Patients said that they had found access to the out-of-hours service easy through the 111 telephone system. The out-of-hours service was accessible to patients with restricted mobility and wheelchair users.

The out-of-hours service had taken account of patients’ views, and these had been analysed with a view to making improvements to the service.

Well-led

Updated 10 July 2014

The out of hours service at Lincoln County hospital was well-led. 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 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 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 an 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.