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Inspection Summary

Overall summary & rating

Updated 30 September 2014

Lincolnshire Community Health Services NHS Trust provided out-of-hours General Practitioner (GP) services for patients living in 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 county. 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 John Coupland 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 (referred to in this report as ‘The provider’) provides OOH GP services for patients living across Lincolnshire from eight locations. We have inspected the eight locations and this reports is in relation to our inspection of the location at John Coupland Community Hospital

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.

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

The reception used Language Line for interpretation purposes if required. They had a laminated sheet available in numerous languages for patients to identify the language they spoke. There was a book available specifically to assist Polish speaking patients. Lincolnshire has a large number of resident Polish migrant workers.

There were systems in place to help ensure patient safety through learning from incidents and infection prevention and control.

Staff were trained and supported to help them recognise the signs of abuse of children and vulnerable adults.

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 and 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 at provider level. They had taken action to help ensure their values and behaviours were shared by staff through regular engagement.

At John Coupland Community Hospital out-of-hours there was only one GP on duty. The GP told us that he felt supported by the clinical lead and held positive views of the management team and their leadership. He told us the senior managers were approachable and listened to any concerns or suggestions he might have to improve the level of service provided to patients.

Inspection areas


Updated 30 September 2014

The out-of-hours service at John Coupland Community 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 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 clear 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 GP’s who were suitable to work in a healthcare environment and we have told the provider that they must take action to improve.

The out-of-hours (OOH) service at the hospital did not keep any medicines. Emergency medicines were held in the Minor injuries Unit (MIU) and those could be accessed by the OOH GP if required. Because of that we looked at records and found that all necessary checks had been completed and that the medicines held in MIU were in date.

Staff observed appropriate infection prevention practices. The consulting room was cleaned by the MIU cleaners according to a cleaning schedule.


Updated 30 September 2014

The out-of-hours service at John Coupland Community 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

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.

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

The provider was effective in sharing information about patient consultations with the patients’ own GP practices.

There were effective joint working arrangements with the Minor Injury Unit (MIU) which included the use of MIU reception staff to assist with appointments and with chaperone duties.


Updated 30 September 2014

The out-of-hours service at John Coupland Community 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 had made positive steps to meet the needs of patients from the gay, lesbian, trans-gender and bi-sexual community.

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 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.


Updated 30 September 2014

The-out-of hours service at John Coupland Community Hospital was responsive to patients’ needs. We saw that the reception used Language Line for interpretation purposes if required. They had a laminated sheet available in numerous languages for patients to identify the language they spoke. There was a book available specifically to assist Polish speaking patients.

We saw that available patient information was maintained by the Minor Injuries Unit. It gave advice on how to make a complaint to Lincolnshire Community Health Services NHS Trust, advocacy support to do this and how to access information about complaints for other languages (Portuguese, Chinese, Kurdish Sorani, Lithuanian, Polish and Russian). We were told 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 locate 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 and told us they had on one occasion met with a member of staff in private to discuss issues raised.

The provider responded to changing levels of demand for services, for example in periods of high patient numbers in the winter months. 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 service which had resulted in a measurable decrease in 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.


Updated 30 September 2014

The out-of-hours service at John Coupland Community 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 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. There was a programme of staff engagement events being held across the county of Lincolnshire aimed at reaching as many staff as possible.

We were told 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 John Coupland Hospital can be found at Lincolnshire Community Health Services NHS Trust.