Archived: Gloucestershire Out of Hours

Updated 14 July 2023

Gloucestershire Out of Hours is the registered location for services provided by Practice Plus Group Urgent Care Limited and provides out-of-hours primary medical services to patients in Gloucestershire when GP practices are closed.

The administrative base is located at:

Unit 10
Highnam Business Centre,
Highnam,
Gloucestershire
GL2 8DN

Gloucestershire is mainly rural with two major urban centres, Gloucester and Cheltenham.

The service is commissioned by Gloucestershire Integrated Care Board and covers a population of approximately 637,000 people across the county of Gloucestershire. Patients access the service via the NHS 111 telephone service. Patients may be seen by a clinician at one of the primary care centres, receive a telephone consultation or a home visit from a clinician being driven by a driver in one of their fleet of 4x4 liveried vehicles, depending on their needs. The majority of patients access the service via NHS 111.

The service provides the clinical assessment service (CAS) for NHS 111, which was delivered from the administrative base, with some clinicians working remotely and other clinicians working at the primary care centres.

The out of hours service is provided from the administrative base and the primary care centres are located at:

Gloucester Royal Hospital, Great Western Road, GL1 3NN (6.30pm to 8am weekdays and a 24-hour service over weekends and bank holidays)

Cheltenham General Hospital, Sandford Road, GL53 7AN (6.30pm to 11pm weekdays and 8am to 11pm over weekends and bank holidays)

Dilke Hospital, Cinderford GL14 3HX (6.30pm to 11pm weekdays and 8am to 11pm over weekends and bank holidays)

Cirencester Community Hospital, Tetbury Road, GL7 1UY (6.30pm to 11pm weekdays and 8am to 11pm over weekends and bank holidays)

There are two further primary care centres not currently in use in agreement with the commissioner.

During the inspection we visited the Gloucester and Cheltenham sites.

The provider is registered to provide the following regulated activities:

Transport service, triage and medical advice provided remotely

Treatment of disease, disorder or injury.

Updated 14 July 2023

This service is rated as Requires improvement overall. (Previous inspection November 2021 – Requires improvement)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Gloucestershire Out of hours on 22-23 November 2022. This was a follow up inspection due to the rating of Requires improvement and breaches of regulations at the previous inspection in November 2021.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• Requesting the completion of a staff survey document
• Conducting site visits.

At this inspection, we found:

• Since the last inspection, improvements had been made to some processes including the reporting and reviewing of significant events and complaints. However, further embedding and development was required.
• Action had been taken to address shortfalls in sepsis training, however we found new issues with the lack of staff mandatory training oversight.
• Rota fill and staffing continued to contribute to delays in patient care and satisfaction. Patients experiencing delays were not always monitored effectively.
• Shortfalls in systems and processes had led to the service being unable to assure themselves of safe and effective care for patients.
• Risks to staff and patients were not always effectively managed in line with policy and guidance.
• Staff treated patients with respect and had access to appropriate guidance and support where needed.
• Improvements had been made to audits carried out on staff.
• There was mixed feedback regarding senior leaders, including communication. Staff did not always feel heard or consulted.
• The service promoted values, which staff were aware of, however leaders did not monitor this with a vision or strategy.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure sufficient numbers of suitable qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

• Complete risk assessments & any associated action plans in a timely manner.
• Develop a strategy for the service to be monitored in line with their values.

.Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services