The Care Quality Commission (CQC) has rated Gloucestershire Out of Hours requires improvement, following an inspection in November.
The service provides care to 637,000 people in Gloucestershire when their usual GP practice is closed. It is run by Practice Plus Group Urgent Care Limited.
This inspection was undertaken to check whether the service had made improvements following its previous rating of requires improvement last year. It has been rated requires improvement at the last three inspections it has had since 2018.
In addition, the rating remains as requires improvement overall, the ratings for safe, effective, responsive to people’s needs and well-led remain rated requires improvement. The rating also remains unchanged as good for being caring.
Neil Cox, CQC’s deputy director of operations in the south, said:
“Gloucestershire Out of Hours has made some improvements since our previous inspection, including how it reviewed significant incidents and complaints. However, we were still concerned with aspects of the leadership and the lack of effective processes to keep people safe.
“Due to a lack of consistent monitoring from the service’s leaders, we found people experienced delays when using the service because of how staff were scheduled to work. There was also a lack of consistent monitoring to ensure that staff had completed mandatory training to provide quality care and treatment to people.
“However, we saw staff treat people with kindness and compassion, especially those receiving end-of-life care. Staff also helped people understand their conditions and involved them in decisions about their care.
“We’ve reported our findings to Practice Plus Group Urgent Care Limited, so its leaders know what they must do to improve the service. We will continue to monitor the service closely, including through future inspections.”
Inspectors found the following during this inspection:
- Improvements had been made to how staff review and report significant events and complaints, but further development and embedding were required
- Leaders hadn’t ensured all staff completed mandatory training. Although action had been taken since CQC’s last inspection to complete sepsis training
- Inconsistent management of rotas continued to contribute to delays in people’s care and treatment
- Risks to staff and people weren’t always aligned with policy and guidance
- Risk assessments and actions plans weren’t always completed in a timely manner
- There was mixed feedback regarding senior leaders. Staff reported not always feeling heard or consulted.
However:
- Staff treated people with respect and had access to appropriate guidance when needed
- Improvements had been made to audits to drive improvement at the service
- Care and treatment were delivered in a coordinated way which considered the needs of those whose circumstances may make them vulnerable
- Staff could access people’s records and previous clinical encounters with the out-of-hours service.
CQC has told Practice Plus Group Urgent Care Limited it must make several improvements in Gloucestershire Out of Hours to meet its legal obligations. These include:
- Establishing effective systems and processes to ensure good governance
- Ensuring staff receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties
- Ensuring enough suitable, qualified, competent, skilled and experienced staff are deployed
- Safely providing care and treatment to people.