The Care Quality Commission has told Devon Doctors that it must make further improvements to its NHS 111 and GP Out of Hours service following an inspection in December.
CQC carried out an inspection of Devon Doctors’ NHS 111 and GP Out of Hours service, both of which are provided from two locations, 10 Manaton Court and Osprey House, in Exeter. This was to follow up on urgent conditions CQC had placed on the service following a previous inspection in July 2020. These urgent conditions required Devon Doctors to make rapid improvements within a set timescale.
This was originally supposed to be a focused inspection, but CQC found further concerns at this inspection which prompted it to be converted to a fully comprehensive inspection.
Overall the rating of this service moves from Good to Inadequate and it has been placed into special measures to ensure the provider gets the support it needs to make improvements and keep people safe. It was rated Inadequate for being effective and well-led, and Requires Improvement for being safe, caring and responsive to people’s needs.
CQC has also imposed two new conditions on the service, the details of which can be found in the report.
CQC’s deputy chief inspector for primary medical services, Dr Manir Hussain, said:
“NHS 111 and GP out of hours services are a vital part of the urgent care system which takes pressure away from accident and emergency and GP services by allowing people to have easy access to healthcare and advice.
“Devon Doctors was providing essential support during a time of unprecedented demand during the ongoing COVID-19 pandemic. Whilst we did see some improvements had been made since the previous inspection, these have been slower than they should have been, due to the provider managing significantly increased call and response demands and prioritising people’s needs.
“However, we found further areas of concern, and what was originally a focused inspection became a fully comprehensive one so we could fully understand where improvements needed to be made. We have imposed further conditions on Devon Doctors to focus the provider’s attention on these areas for improvement and to keep people safe.
“Although we saw committed staff who treated people with dignity and respect, the systems and governance structures that were the responsibility of leaders at the service, were not always there, or embedded enough to support staff to provide people with safe and effective care.
“Devon Doctors has assured us that it is aware of the issues we identified, and these will be addressed. We are working closely with NHS England & NHS Improvement and Devon and Somerset Clinical Commissioning Groups to ensure that Devon Doctors get the support needed to make these improvements. We will continue to monitor the service closely and return to check on their progress.”
Inspectors found:
- The provider did not consistently ensure that there were sufficient numbers of staff available to run the service to ensure risk was minimised and that they could respond quickly to an increase in demand.
- Risks to patients and service performance were not always adequately assessed, monitored or managed to maintain their safety.
- Performance levels had shown signs of improvement and were now in line with national performance levels but were below expected contracted targets.
- There had been improvements to prioritising safeguarding to minimise risk to patients. However, there continued to be shortfalls in the systems and processes to support staff to act on this. Not all staff had completed relevant safeguarding training as per their policy.
- Limited improvement had been made to ensure learning or actions taken from incidents were understood and acted on by all relevant staff.
- The provider had systems to keep clinicians up to date with current evidence-based practice. We saw evidence that clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols.
- Staff were kind and caring and responsive to the needs of patients, treating them with dignity and respect.