Tower Hamlets Out of Hours GP Service

Updated 18 October 2023

Tower Hamlets Out of Hours GP Service is a registered location that consists of two services based at the Royal London Hospital, Whitechapel Road, London E1 1BB.

The first service is a 24 hour, 7 days per week urgent treatment centre (UTC), which is co-located with an emergency department operated by a hospital Trust. This service provides treatment of minor injuries and illnesses to patients across a number of boroughs in North-East London, as well as workers and tourists based in the central London area. All patients attending the UTC are directed from either the local 111 provider, or from the hospital’s emergency department where patients receive an initial clinical assessment.

The second service is an out of hours service which provides care to Tower Hamlets residents only. This service is available at all except 8am to 6:30pm Mondays to Fridays. This service is appointment only, and is bookable through the local 111 service.

Both services are provided by Tower Hamlets GP Care Group CIC. The provider also provides an extended access hub service for NHS GP patients in Tower Hamlets, as well as a range of community services in Tower Hamlets and Waltham Forest. These services are separately registered with CQC and were not inspected at this time.

Both services are staffed by some clinical staff employed directly by the provider, though most are employed on either a zero-hours “bank” basis, or are agency staff. Non-clinical staff at the site are mostly employed by the service, but some are also bank staff. The out of hours drivers and car were provided by a subcontractor.

The UTC service is currently commissioned to see 130 patients per day, although on average had been providing care for more than double this number of patients across the last year, at approximately 270 per day. The out of hours service saw 30 patients per day, with an average of 3% requiring a home visit.

CQC registered the provider to carry out the following regulated services at the service:

• Treatment of disease, disorder or injury
• Diagnostic and screening procedures
• Transport services, triage and medical advice provided remotely
• Family planning

The service’s website address is www.gpcaregroup.org.uk

Updated 18 October 2023

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection of Tower Hamlets Out of Hours GP Service on 28 September and 2 October 2023. The service had previously been inspected in October 2018, at which point the location was an out of hours service only. The inspection in October 2018 had rated the service as good overall, and in all five key questions.

The registered manager for the service had been the Director of Clinical Governance. The manager had recently departed the organisation and the service was in the process of appointing a new manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found:

• The service had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved their processes. However, we saw in one incident reviewed that a report did not comment on the insufficient follow up arrangements for a patient.
• The service was not meeting key performance indicators as required by its commissioners for the number of patients categorised as urgent seen in two hours in the out of hours service.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the service easy to access and reported that they were able to access care when they needed it. The service was not ensuring a throughput of patients in line with its four-hour target.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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

• Ensure that care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Review how two separate databases are used to record patient information, and to store policies and procedures.
• Review monitoring procedures to ensure that expired equipment is removed from areas where it might be used.
• Review systems to ensure that all clinical staff are aware of learning from incidents.
• Review DBS security checking protocols so that the provider may be assured that they are up to date.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care