The Care Quality Commission
  • Doctor
  • Out of hours GP service

Ashgate Manor

Overall: Outstanding read more about inspection ratings

Ashgate Road, Chesterfield, Derbyshire, S40 4AA

Provided and run by:
DHU Health Care C.I.C.

All Inspections

15-17 October 2023

During a routine inspection

This service is rated as Outstanding overall. (Previous inspection, 10 November 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Ashgate Manor between 15-17 October 2023. We inspected this service due to the length of time since our previous inspection, in line with the Care Quality Commission’s inspection priorities.

At this inspection we found:

  • The leadership, governance and culture within the service drove improvements to deliver high-quality person-centred care. This included collaborative partnerships, multidisciplinary and multiagency working which supported vulnerable patients and tackled health inequalities. The provider was able to demonstrate the positive impact this had on health outcomes for under-represented populations such as homeless people.
  • The provider had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the provider learned from them and improved their processes.
  • There was a comprehensive and effective system to safeguard children and vulnerable adults. The provider worked proactively and collaboratively with other providers and external agencies to ensure patients were safe.
  • The provider routinely and proactively reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment were delivered according to evidence-based guidelines and demonstrated this via a scheduled programme of rolling audits.
  • The service made improvements through the use of completed audits. Clinical audit had a positive impact on the quality of care and outcomes for patients. There was clear evidence of action to resolve concerns and improve quality.
  • Feedback from people who used the service, those who were close to them, and stakeholders, was continually positive about the way staff treated people. People thought that staff went the extra mile and their care and support exceeded their expectations. The provider proactively canvassed patient feedback and used this to adapt how services were delivered to enhance experience. We observed staff treated patients with compassion, kindness, dignity and respect during our inspection.
  • Patients were able to access out-of-hours care when they needed it at an accessible location, or in their own home when this was appropriate. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.
  • Leaders strove to deliver and motivate staff to succeed. Staff feedback was highly positive about their experience in working for the organisation and staff felt well-supported and were given opportunities to develop.
  • The provider supported staff welfare initiatives. There was a wide and well utilised range of schemes and services to promote and support staff physical and mental health wellbeing. This included access to occupational health, counselling and access to an independent health scheme.
  • Leaders promoted organisational values which we found were embedded into all aspects of how the organisation worked.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.
  • Leaders embraced innovations and proactively sought out and embedded new ways of working to provide care and treatment. We saw many examples of innovation and the development of services in response to patients’ needs. New evidence-based techniques and technologies were used to support the delivery of high-quality care. We saw how innovations had both positively impacted on the care of individual patients, and the wider health and social care system.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Healthcare

11 April 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced desk based review on 11 April 2017 to follow up concerns we found at Ashgate Manor Primary Care Centre on 10 November 2015. Overall the service is rated as good.

Our key findings across the areas we inspected were as follows:

  • There was a process in place to ensure the safe handling and security of blank prescription pads held at Ashgate Manor Primary Centre and when distributed to other locations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

9 & 10 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derbyshire Health United (DHU) evening and overnight district nursing service on 9 & 10 May 2016. As part of this inspection we visited Ashgate Manor where the north district nursing team were based. Overall the service is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff knew how to and understood the need to raise concerns and report incidents and near misses.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff had received extended training relevant to their role. For example, staff had undertaken training in varying aspects of end of life care, dementia awareness and domestic abuse awareness.
  • A care concern referral process had recently been introduced. This system enabled referrals to be made where the concerns for the patient did not relate to suspected abuse but related to care needs or welfare of the patient.
  • Through the comment cards patient completed for us, they said they were treated with compassion, dignity and respect. The also told us they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Patient information was available in different languages. Complaints were fully investigated and patients responded to with an apology and full explanation.
  • Vehicles used to visit patients in their own homes were clean and well equipped.
  • There was a clear leadership structure and staff felt supported by their team leaders and the senior management team.
  • The provider proactively sought feedback from staff and patients, which it acted on.
  • There were innovative approaches to providing integrated person-centred care. Rightcare plans were developed by the patient’s GP and shared with the evening and overnight district nursing service for clinically high demand patients including nearing end of life and those with complex health needs. Special notes were used to record relevant information about patients.
  • There were effective safeguarding systems in place for both adults and children at risk of harm or abuse. There was an effective system in place for adults to support people about whom there were care or welfare concerns.
  • There were clinical supervision and appraisal processes in place for all clinical roles and support was provided for those members of the nursing team who were required to revalidate.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice including:

  • A daily comfort call system was in place for patients referred into this service with palliative care needs and those patients who were at the end of their life. These patients received a telephone call on a daily basis to assess their care needs and received priority visits when required.

  • DHU worked towards achievement of a quality target to achieve a minimum of 95% of all requests for urgent visits to be achieved within a four hour time frame. During the period 1 April 2015 – 31 March 2016, a total of 18,361 patient contacts were recorded. The overall achievement of this target was 99.75% of urgent visits attended within a four hour timeframe. Data was monitored on a monthly basis and any reported breaches of this target were investigated on an individual basis to ascertain whether an actual breach had occurred.

  • DHU carried out an end of life care admission audit which involved a review of all hospital referral rates and emergency 999 calls for terminally ill/palliative care patients. This audit monitored reasons for admission to hospital and any further communication with or actions taken by DHU and identified whether a Rightcare plan was in place for these patients. This enabled DHU to continually monitor the appropriateness of unplanned admissions to hospital and use of emergency services. The results of this audit showed that 75% of either hospital admission or emergency 999 calls were appropriate or unavoidable. Results highlighted that 50% of cases did not have a Rightcare plan in place. Reasons for either admission or an emergency 999 call were recorded for those cases deemed inappropriate to enable DHU to monitor trends and action plans were implemented as a result of this audit.

  • An out of hours coordinator was in place on a daily basis who was also supported by a clinical lead who provided clinical oversight and support in the community to the nursing teams. The out of hours coordinator continually monitored the location of all members of the nursing teams when working in the community via the ‘Adastra’ electronic system and ensured regular communication with staff throughout their shift. The coordinator continually monitored and re-allocated workloads across all nursing teams to ensure work was re-allocated to other teams should a nursing team require to spend more time with a patient dependent upon their care needs, whilst ensuring other patients received a home visit as soon as possible by the most appropriate team. This system also ensured achievement of the quality target to achieve a minimum of 95% of all requests for urgent visits within a four hour time frame

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

10 November 2015

During a routine inspection

We carried out an announced comprehensive inspection at Ashgate Manor primary care centre on 10 November 2015. We also visited Buxton Hospital and Chesterfield Royal Hospital primary care centres. Overall the service is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff knew how to and understood the need to raise concerns and report incidents and near misses.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Patient information was available in different languages.
  • Complaints were fully investigated and patients responded to with an apology and full explanation.
  • Patients said they found it easy to make an appointment and were offered a time and a place that suited them.
  • The primary care centres had excellent facilities and was well equipped to treat patients and meet their needs. Vehicles used for home visits were clean and well equipped.
  • There was a clear leadership structure and staff felt supported by the senior management team.
  • The provider proactively sought feedback from staff and patients, which it acted on.
  • There were innovative approaches to providing integrated person-centred care. Rightcare plans were developed by the patient’s GP and shared with the Out-of-Hours GP service for clinically high demand patients, including nearing end of life and those with complex health needs. Special notes were used to record relevant information about patients.
  • There was robust safeguarding systems in place for both children and adults at risk of harm or abuse.
  • There was excellent clinical supervision and appraisal processes in place for all clinical roles including regular audit of individual’s clinical practice and reflective feedback.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvement are:

  • The provider must ensure there are effective and robust systems in place across all locations for the control and security of blank prescriptions.

Professor Steve Field CBE FRCP FFPH FRCGP

10 November 2015

During a routine inspection

 We carried out an announced comprehensive inspection of Derbyshire Health United NHS 111 service at Ashgate Manor on 10 November 2015. Overall the provider is rated as good.

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording serious incidents. Staff knew how to and understood the need to raise concerns and report incidents and near misses. However, not all serious incidents identified through complaints were investigated through the serious incident procedure.
  • The provider was monitored against the Minimum Data Set (MDS) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners about the level of service being provided. Where variations in performance were identified, the reasons for this were reviewed and action plans implemented to improve the service.
  • Staff were trained and monitored to ensure they used NHS Pathways safely and effectively.
  • Information about services and how to complain was available and easy to understand. Complaints were fully investigated and patients responded to with an apology and full explanation.
  • There was strong and clear leadership from a clinical and senior management perspective. Staff felt supported by senior management and directors who were visible on shifts on a daily basis to support the smooth running of the service.
  • The provider proactively sought feedback from staff and patients, which it acted on.
  • There were robust safeguarding systems in place for both children and adults at risk of harm or abuse as well as frequent callers to the service.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • The provider had a clear vision and strategy to deliver high quality, safe and effective healthcare and promote good outcomes for patients. The provider was responsive to feedback received from patients and staff and used information available proactively to drive service improvements.

However there were areas of practice where the provider should make improvements:

  • Ensure that records of complaints include details of the outcome and/or the impact for the patient.
  • Ensure that when potential serious incidents are identified through complaints, these are investigated through the serious incident procedure.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

26 and 27 February 2014

During a routine inspection

Derbyshire Health United provides out-of-hours General Practitioner (GP) services for more than one million patients living across Derbyshire. It is registered with the Care Quality Commission to provide the regulated activities of transport services, triage and medical advice provided remotely and the treatment of disease, disorder and injury.

We carried out the inspection as part of our new inspection programme to test our approach going forward. It took place over two days with a team that included two CQC inspectors, a GP, a GP practice manager, a nurse and an expert-by-experience.

We found the service was effective in meeting patient needs and had taken positive steps to ensure people who may have difficulty in accessing services were enabled to do so. There was an effective system to ensure that patient information was promptly shared with each patient’s own GP to ensure continuity of care.

The provider had in place an innovative care planning system called ‘Rightcare’ that enabled seamless patient care during out-of-hours. The scheme was designed with patients with long term conditions and complex health needs including end of life patients in mind.

Patients told us that they were happy with the care and treatment they received and felt safe. There were robust systems in place to help ensure patient safety through learning from incidents, the safe management of medicines and good infection prevention and control.

The provider had taken robust steps to ensure that all staff underwent a thorough and rigorous recruitment and induction process to help ensure their suitability to care for patients.

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.

We found that the service was well-led and managed by an enthusiastic and knowledgeable senior management team and board of directors, and their values and behaviours were shared by staff. Members of the staff team we spoke with all held very positive views of the management and leadership and felt well supported in their roles. They told us the senior managers were approachable and listened to any concerns or suggestions they might have to improve the level of service provision.

The leadership was proactive is taking steps to help ensure that GP’s were supported in maintaining insurance indemnity at affordable levels and in promoting and facilitating career long learning for nurses.