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

Archived: Leicester City, Leicestershire and Rutland Out of Hours Also known as Central Nottinghamshire Clinical Services

Overall: Good read more about inspection ratings

Fosse House, 6 Smith Way, Grove Park, Enderby, Leicester, Leicestershire, LE19 1SX (0116) 295 0091

Provided and run by:
Central Nottinghamshire Clinical Services Limited

Important: The provider of this service changed. See new profile

All Inspections

10 & 11 November 2015

During a routine inspection

We carried out an announced comprehensive inspection at Leicester City, Leicestershire and Rutland Out of Hours service on 10 and 11 November 2015.   Overall the service is rated as good.

This was following an inspection carried out in March 2015, where the service was rated as inadequate overall and placed into special measures. Issues identified at the previous inspection included: -

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example emergency and urgent patients were not being seen for face to face consultations in relation to their medical needs and in a timely manner 

  • Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

  • There was insufficient assurance to demonstrate people received effective care and treatment. For example we saw evidence of emergency patients waiting far too long to be seen by a clinician. Despite being aware of issues, the provider had not look at them in detail to identify the root cause.

Specifically, we found the service to be good for providing safe, effective, caring and responsive services. It required improvement for providing well led services.

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

  • Systems and processes had been established to protect patients from harm. Emergency and urgent patients were now being seen for face to face consultations in relation to their medical needs in a timely manner.

  • Staff were now clear about reporting incidents, near misses and concerns. We could see that the provider had implemented more robust mechanisms to enable learning and communication with staff.

  • The provider had implemented changes to ensure people received effective care and treatment. The provider had implemented patient lists for clinicians, with a person monitoring patient lists across all sites to identify potential breaches of waiting times enabling them to manage patient flow better.

  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

  • The provider had ensured that essential clinical equipment was available at all sites and in vehicles used. This was routinely monitored and equipment restocked where necessary.

  • Medication management was significantly improved following the previous inspection. The provider had employed a pharmacist three days per week who was responsible for implementing standard operating procedures and auditing medicines.

  • The provider had clearer leadership structures, however a large proportion of the executive team were either interim or acting staff.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must: -

  • Start recruitment to strengthen the permanent leadership with substantive posts.

In addition, the provider should: -

  • Have appropriate signage at the Loughborough site, so that patients can differentiate between the out of hours provision and the urgent care centre.

  • Have appropriate signage in different languages advertising interpretation services at each of the sites, rather than this being written in English.

On the basis of the ratings given to this service at this inspection, I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service .

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

17 & 18 March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leicester City, Leicestershire and Rutland Out of Hours Service on 17 March 2015 and 18 March 2015. Overall the service is rated as inadequate.

Specifically, we found the Out of Hours Service inadequate for providing safe, effective and responsive services and being well led. It required improvement for providing responsive services.

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example emergency and urgent patients were not being seen for face to face consultations in relation to their medical needs and in a timely manner.
  • Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
  • There was insufficient assurance to demonstrate people received effective care and treatment. For example we saw evidence of emergency patients waiting far too long to be seen by a clinician. Despite being aware of issues, the provider had not looked at them in detail to identify the root cause.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • Essential clinical equipment was found to be out of date in some areas or simply not available. This had caused inappropriate delays when treating some patients.
  • Medication management was poor. Medicines were found to be out of date or there were no systems in place to monitor the quantities or expiry dates.
  • The provider had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

  • Ensure that National Quality Requirement (NQR) key performance indicators are met each month in respect of definitive clinical assessments, face to face consultations in a primary care centre and face to face consultations for home visits.
  • Ensure that the patient queues for definitive clinical assessment, face to face consultations in a primary care centre and face to face consultations for home visits are robustly monitored and managed to ensure patient care does not suffer.
  • A supernumerary member of staff must be used on all shifts to monitor patient queues with the authority to intervene and allocate resources to ensure patients are being assessed and receive consultations within NQR timescales.
  • Review all incidents to identify serious incidents, then investigate and identify lessons to be learnt. The provider must also implement a new regime regarding serious incidents by communicating to staff and training them on identifying and reporting.
  • Staff must be trained appropriately in safeguarding and safeguarding policies must be implemented at all of the sites, rather than just centrally.
  • Medicines management policies and procedures need to be implemented across all sites. Responsible staff members must carry out audits of medication stock and whether it is in date.
  • Clinical equipment used and required by sites and vehicles must be in place.
  • Policies, procedures and checklists must be implemented for clinical equipment to ensure that important equipment is available and working correctly.
  • Appropriate and effective clinical audits need to be implemented to ensure that the service can identify areas of development and learning.
  • Clinical protocols need to be implemented for clinicians to follow.
  • Clinical supervision needs to take place for both doctors and nurses.
  • A performance regime for staff must be implemented to identify and investigate poor performance.
  • Implement and maintain an intervention type system to monitor waiting times for patients. A person or persons responsible for this must monitor the systems and direct clinicians to ensure patients are being seen appropriately and in line with their needs.
  • Information relating to incidents, complaints and lessons learnt must be shared with all staff.
  • Procedures relating to walk in patients must be shared with all site staff to ensure patients are not dealt with inappropriately.
  • A clear leadership structure must be implemented and staff made aware of their lines of management.
  • Communication must take place with all staff regarding changes that are taking place.

On the basis of the ratings given to this service at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the provider again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC. I have also served a notice on the provider placing conditions on their registration, which they must comply with. The conditions are the first three 'Must Improve' comments listed above.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

25 March 2013

During a routine inspection

We visited the out of hours central office and a treatment centre based at Hinckley and Bosworth hospital. We spoke with two people who used the service, a relative of a child who used the service and eight members of staff. We also reviewed the electronic documentation for three people who used the service and one staff file.

All the people we spoke with confirmed they had given consent to the care they had received. One person we spoke with told us: 'The care was explained and I agreed with it'.

Calls are monitored to ensure people are being supported by the appropriate staff and in a timely manner'. One person with spoke with told us:' I have used the service seven times, either for myself or my children and our needs were always met. We received good care on every occasion'.

We saw a safeguarding policy and a local operational procedure which detailed the process the staff should follow when a safeguarding concern was raised.

We saw evidence that all team leaders and managers received training in the recruitment process. The nurse manager and duty manager explained to us that all appropriate checks were undertaken before staff began their employment.

We saw a range of audits and checks were carried out to ensure systems and practices were working effectively. These included audits on the safeguarding process, the telephone assessment documentation, live telephone discussions, infection prevention and control and consent.