Croydon GP Collaborative Services Also known as Croydon UCC

Updated 7 January 2019

Croydon GP OOHs Service is commissioned to provide a GP out of hours service to the Croydon area. At the previous inspection in September 2017, the provider also provided an urgent care service, but they ceased to provide this from June 2018, although the provider still provides staff to the urgent care service. The service co-ordinates with two other providers who provide services which are linked to the out of hours service; one who provides walk in services at hubs linked to the service, and the hospital Trust who manage the accident and emergency and urgent treatment departments at the hospital. This report is focussed solely on the services for which the provider has responsibility. The service operates from Croydon University Hospital, 530 London Road, Thornton Heath, London, CR7 7YE. The service operates from temporary accommodation within the hospital while a new emergency wing comprising an emergency department, urgent care centre and resuscitation department is being built. This area was due to open the week following the inspection. The service is based on the ground floor of the hospital and is accessible to those with reduced mobility.

The provider provides centralised governance for its services and management locally is the responsibility of service managers and senior clinicians. On an annual basis approximately 30,000 patients are referred to the out of hours service (of which approximately 12,000 either attend the base or receive a home visit). The out of hours service provides a telephone advice service to determine the urgency of conditions and to determine whether or not a home visit is needed.

On site, the service is led by an operations manager, a deputy operations manager and a clinical lead. The majority of clinical staff at the service are either GPs based in the Croydon area or agency staff. Reception staff at the service were provided by the hospital trust.

The London borough of Croydon has 55 services providing GP services. There are a significantly larger number of residential homes (144) than other boroughs in South London. However, the population is generally younger than the national average, and there are a large number of patients who do not speak English as a first language. The borough has some areas of affluence but other areas of high deprivation.

The service is registered with the CQC to provide the regulated activity of diagnostic and screening procedures and treatment of disease, disorder and injury.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

Please note that when referring to information throughout this report this relates to the most recent information available to the Care Quality Commission at that time.

Updated 7 January 2019

This service is rated as Good overall.

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 this announced comprehensive inspection on 27 November 2018. We had previously carried out an announced comprehensive inspection on 26 September 2017. At that time the service was rated as requires improvement. It was rated as requires improvement for the safe, effective and well led domains and good for caring and responsive.

The areas where we said that the provider must make improvement were:

• Develop effective systems and processes to ensure safe care and treatment including, the storage and dispensing of medicines and ensuring that non-calibrated equipment is not stored where it might be used. The service should ensure that targets relating to the time taken to stream patients are met.
• Develop effective systems and processes to ensure good governance including ensuring streaming services are clear and understood by all staff. They should also ensure patient group directives are in place for nursing staff. The service should review that performance data meets national guidelines.

Since the last inspection the service no longer provided urgent care services, and was out of hours only.

At this inspection we found:

• The service had good systems to manage risk so that safety incidents were less likely to happen. The provider had taken steps to assure itself that incidents were not missed.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided.
• The service was below target levels for National Quality Reporting (NQR) standards in some areas, but not by a significant margin, and performance was improving since the last inspection.
• Audits were in place to monitor the performance of staff at the service.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• The service had a clear system for managing and learning from complaints.
• The service had an overarching governance framework in place, including policies and protocols which had been developed in conjunction with its partner organisations.
• 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.

The areas where the provider should make improvements are:

• Review which audits are undertaken to ensure that high risk, high cost and high dependency medicines are used in line with guidelines.
• Continue to review NQR standards to ensure that they are met.Inform all doctors that they should use only equipment provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice