- Urgent care service or mobile doctor
Sheridan Teal House
Important:
We are carrying out a review of quality at Sheridan Teal House. We will publish a report when our review is complete. Find out more about our inspection reports.
All Inspections
26 April 2022
During an inspection looking at part of the service
We carried out an announced focused inspection of Sheridan Teal House on 26 April 2022. We undertook this inspection as part of a system-wide inspection looking at a range of urgent and emergency care providers in West Yorkshire. This was an unrated inspection.
A summary of CQC findings on urgent and emergency care services in West Yorkshire
Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for West Yorkshire below:
West Yorkshire.
Provision of urgent and emergency care in West Yorkshire was supported by multiple provider services, stakeholders, commissioners and local authorities.
We spoke with staff in services across primary care, integrated urgent care, community, acute, mental health, ambulance services and adult social care. Staff continued to work under sustained pressure across health and social care and system leaders were working together to support their workforce and to identify opportunities to improve. System partners worked together to find new ways of working, linking with community services to meet the needs of their communities; however, people continued to experience delays in accessing care and treatment.
During our inspections, some staff and patients reported difficulties with providing and accessing telephone appointments in GP practices. Some of these issues were caused by telephony systems which were being resolved locally. We found inconsistencies with triage processes in primary care which could result in people being inappropriately signposted to urgent and emergency care services. However, a number of staff working in social care services reported good engagement with local GPs.
We visited some community services in West Yorkshire and found these were generally well run. Service leaders were working collaboratively to identify opportunities to improve patient pathways across urgent and emergency care. These improvements focused on meeting the needs of local communities and alleviating pressure on other services. There were strong partnerships with social care and community teams, so patients had the right support in place on discharge.
However, we inspected one intermediate care service and found it could only take referrals from an acute trust, which meant there were no step-up facilities for patients in the community. The service struggled for ward space to deliver therapeutic activities and there were no communal spaces for patients to meet together or engage in group therapy. Plans were in place to provide additional facilities and to reconfigure the existing layout to provide communal spaces.
The NHS111 service was experiencing significant staffing challenges and were in the process of recruiting a high number of new staff. Staff working in this service had experienced an increase in demand, particularly from people trying to access dental treatment although a system was in place to manage the need for dental advice and assessment. Due to demand and capacity issues, performance was poor in some key areas, such as providing a call back to patients from a clinician.
The ambulance service had an improvement programme in place focused on performance and staffing. Whilst we saw some improvement in ambulance response times and handover delays, performance remained below target. We identified impact on other services due to the availability of 999 responses; for example, a maternity service had to close temporarily to keep women safe, due to system escalation and because ambulance responses couldn’t be guaranteed in an emergency. Staff working in social care services also experienced lengthy delays in ambulance response times which further impacted on their ability to provide care to their residents.
We inspected some mental health services in Wakefield which were delivering person-centred care and responded to urgent needs in a timely way. Staff worked in multi-disciplinary teams and collaborated with system partners.
People’s experiences of Emergency Departments were varied depending on which service they accessed. Some Emergency Departments had long delays whilst others performed relatively well. In services struggling to meet demand, patient flow was a key factor. Poor patient flow was primarily caused by delays in discharge with a high number of people fit for discharge unable to access community or social care services.
Staff working in some social care services reported significant challenges in relation to unsafe discharge processes, this included a lack of information to support their transfer of care and we were told of examples when this resulted in people having to return to hospital. Local stakeholders had a good understanding of this problem and were looking to improve pathways and discharge planning.
Staffing and capacity issues in both care homes and domiciliary social care services have at times impacted on timely and safe discharge from hospital.
We found services were under continued pressure and people experienced difficulties accessing urgent and emergency care services in West Yorkshire. System and service leaders across West Yorkshire were working together to seek opportunities for improvement by providing services and pathways to meet people’s needs in the community; however, progress was needed to demonstrate significant improvement in people’s experience of accessing urgent and emergency care.
At the inspection of Sheridan Teal House we found:
- Systems were in place to manage risk so that safety incidents were less likely to happen.
- The provider routinely reviewed the effectiveness and appropriateness of the care provided and ensured that care and treatment was delivered according to evidence- based guidelines.
- Performance was closely monitored by the provider. Most key indicators relating to out of hours, and urgent and emergency treatment services showed performance in line with national and local targets. However, the proportion of patients receiving a face-to-face consultation within their residence according to assessed need was outside the agreed target of 95% in some cases. Results for March 2022 showed:
- 28.4% of patients assessed as requiring a face-to-face consultation within their residence within 1 hour actually received this consultation within this timescale.
- 84.4% of patients assessed as requiring a face-to-face consultation within their residence within 4 hours actually received this consultation within this timescale.
- 93.9% of patients assessed as requiring a face-to-face consultation within their residence within 8 hours actually received this consultation within this timescale.
- The provider had an understanding of the challenges faced by their service. This included meeting patient demand to adhere to national and local targets, and workforce planning including meeting staffing levels.
- Staff working at the service had the information they needed to support consistent and safe management of patients’ health needs. Care was coordinated with others, and information sharing processes with other health and care partners were in place.
- The service had an overarching governance framework in place, including policies and protocols.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
- The provider delivered additional services such as NHS 111 Online Emergency Department Validation which sought to reduce unnecessary presentation to Emergency Departments. Of the cases assessed and validated in March 2022 only 17.7% of patients were referred to an ED or directly admitted to hospital.
Whilst we found no breaches of regulations, the provider should:
- Continue to monitor delivery against key performance indicators, and plan mitigating actions to ensure national standards and local targets are met.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
18 March 2021
During an inspection looking at part of the service
We carried out this announced focused inspection of Sheridan Teal House out of hours service, in response to concerns received; specifically regarding the safe, effective and well-led domains. This report covers our findings in relation to those concerns. The service was previously inspected in March 2020 and was rated as good overall.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of pandemic when considering what type of inspection was necessary and proportionate. Consequently, we undertook some of our inspection processes remotely and spent more focused time on site.
We began reviewing information remotely and conducted a range of staff telephone interviews from 10 February 2021, including speaking with the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
On 18 March 2021 we undertook site visits at three locations, during the hours of operation. These were Airedale General Hospital, Eccleshill Community Hospital and Westbourne Green Community Hospital.
The service was not rated as a result of this inspection.
At this inspection we found:
- There were systems in place to support governance and oversight of medicines management, which included stock control and processes relating to controlled drugs. However, we found an inconsistent approach regarding doctors carrying controlled drugs on home visits.
- There were systems in place to support home visits and failed encounters (when the doctor was unable to contact the patient). However, we found that a failed encounter card was not always available in vehicles or left for the patient by the doctor. Also, that some doctors were not correctly following the process for writing up clinical records after a failed encounter.
- There were policies and procedures in place, including a clinical charter, regarding staff responsibilities and time-keeping. However, we found there was no specific ‘clocking in and out’ procedure for clinical staff and not all doctors were adhering to the principles of effective time-keeping.
- The provider had policies in place to support raising concerns, incident reporting and whistleblowing. There was a Freedom to Speak up Guardian, however, not all staff were aware of this person.
- Post-inspection, the provider has put a range of measures in place to address those areas of concern.
The areas where the provider should make improvements are:
- Review the new measures put in place to ensure they are embedded and effective, particularly in relation to controlled drugs and failed encounters.
- Raise increased awareness of the Freedom to Speak up Guardian, to support all staff understanding the role and who to access.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
During a routine inspection
This service is rated as Good overall. (Previous inspection March 2015 – Good)
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 Sheridan Teal House on 11 March 2020 as part of our inspection programme.
At this inspection we found:
- 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 had good systems to manage risk so that safety incidents were less likely to happen.
- Staff working at the service had the information they needed to support consistent and safe management of patients’ health needs.
- Information was relayed to a patients’ own GPs in a timely manner, with appropriate follow up checks in place.
- Staff told us they valued working in the service, and felt supported by the leadership team.
- The service had an overarching governance framework in place, including policies and protocols.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
- The service proactively sought feedback from patients to evaluate the quality of the service being provided.
In addition, the provider should:
- Continue to review national standards to ensure that they are met.
- Review and improve processes to ensure that the organisation has assurance that all staff have completed mandatory training requirements such as child safeguarding training.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
3 & 4 March 2015
During a routine inspection
We carried out a comprehensive inspection visit on 3 and 4 March 2015 and the overall rating for the practice was good. The inspection team found after analysing all of the evidence the practice was safe, effective, caring, responsive and well led.
Our key findings were as follows:
- Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
- Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
- The service was responsive and ensured patients received accessible, individual care, whilst respecting their needs and wishes.
- There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
We saw areas of outstanding practice including:
- Every clinician working in urgent care had three of their cases audited each month by the Clinical Governance lead and a team of six GPs. This information was used by the clinical staff as evidence of their out of hours work when they had their revalidation.
- The service had a flexible transport system. For example, wherever possible the call handlers arranged and the service provided free transport for patients who had insufficient monies to use public transport.
- The service was working 75% above their service contract in meeting patients’ needs and although this had an effect on the waiting time to see a clinician, there was a system in place to alleviate this.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
2 May 2013
During a routine inspection
We did not speak to people using the service. Instead, we observed the telephone operators talking to patients and looked at documentation showing how the provider complied with clinical quality and safety. We observed staff providing information and advice to people in a respectful manner and they were aware of their professional reponsibilities. For example, unqualified staff did not attempt to provide clinical advice.
All of the staff we spoke with were aware of the safeguarding procedures and knew how to raise concerns in accordance with whistle blowing policies.
We saw that information was shared between providers such as the NHS 111 Out of Hours Service, Local Care Direct and the patients own GP. We also saw that the appropriate information sharing agreements were in place.
We looked at the recruitment records of four people, which included a GP and nurse. We saw appropriate checks were in place to ensure people employed had the necessary skills, experience, qualifications and were of good character.
We also looked at the quality monitoring arrangements and saw there were appropriate systems in place for monitoring the quality of the service. This included clinical meetings, serious incident and complaints sub group, information governance meetings and quality group meetings.