Archived: Devon Doctors - 10 Manaton Court

Updated 17 March 2021

Devon Doctors Limited is a social enterprise group which is run by healthcare professionals and reportable to a Board of directors. The organisation does not have any stakeholders and is a non-profit organisation. Any profits from the service are invested back into the service.

Devon Doctors Limited provide an Urgent Integrated Care Service (IUCS), comprising of an out of hours GP service and an NHS 111 service, for the counties of Somerset and Devon. The service covers an area of 6,707 km2 (2,590 square miles) of which a large percentage is rural. The service provides a primary medical service for approximately 1.1 million people. This figure increases substantially in the summer months. The IUCS functions as a whole service provision.

We focussed on the service provision for the Devon NHS 111 service and the Out of Hours service for Devon and Somerset.

Devon Doctors Limited registered locations are:

Suite 1, Osprey House

Osprey Road, Sowton Industrial Estate

Exeter

EX2 7WN

and

10 Manaton Court

Manaton Close

Matford Business Park

Exeter

EX2 8PF

The website is: www.devondoctors.co.uk

We visited the bases or clinical assessment services at Osprey House, Ashford Court, Honiton, Shepton Mallet, Taunton and Newton Abbot as part of this inspection.

The service has nine treatment centres in Devon, which are open at various times throughout the week and weekends to provide the out of hours GP service. There are five treatment centres in Somerset. Devon Doctors Limited is the main contract holder and is responsible for providing the NHS 111 service and out of hours service in Devon and Somerset. The NHS 111 service for Somerset is sub-contracted to another provider. Devon Doctors Limited remains responsible for any services which it sub-contracts out as the main contract holder.

The provider is registered for the following regulated activities:

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

Staff employed by Devon Doctors Limited include; call handlers, drivers, reception staff, GPs, nurse practitioners, call centre coordinators and supporting office staff holding lead roles such as clinical governance, recruitment, rotas and medicines. Supporting staff also include communication and information governance staff. These members of staff are led by a management team overseen by a Board of directors.

The out of hours service operates between 6pm and 8am Monday to Friday, and 24 hours on Saturdays, Sundays and bank holiday. The NHS 111 aspect of the service provision operates 24 hours a day, all year round.

Updated 17 March 2021

We are mindful of the impact of Covid-19 pandemic on our regulatory function. We therefore took account of the exceptional circumstances arising as a result of the Covid-19 pandemic when considering what type of inspection was necessary and proportionate.

This service is rated as Inadequate overall. (Previous inspection July 2020 – the overall rating of Good, was carried over form an inspection which took place in May 2017, as the July inspection was focused and therefore unrated.)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We carried out a focused inspection in July 2020, in response to concerns received. After this inspection we imposed urgent conditions on the provider’s registration with a timeframe to make urgent improvements in the service provided.

This inspection of Devon Doctors Limited, on 7, 8 and 9 December 2020 was a short notice announced focused inspection to follow up on the urgent conditions imposed on the provider and requirements made at our inspection in July 2020.

We looked at the following key questions: safe, effective, responsive and well-led. During the three-day inspection we found further information of concern. Therefore, we converted the inspection from focussed inspection to a full comprehensive inspection, to include the caring domain. We spoke with and interviewed a range of staff across the service, including call handlers, senior leaders, junior managers, clinicians, the chief executive officer and members of the Board. We also reviewed documents relating to the running of the service.

At this inspection we found:

• Staff were able to identify what constituted a safeguarding concern and knew what actions to take, however, not all staff had completed relevant training in line with the provider’s policy.
• The provider did not consistently ensure that there were sufficient numbers of staff available to run the service, to ensure risk was minimised and the service could respond quickly to an increase in demand.
• Risks to patients were not adequately assessed, monitored or managed to maintain patient safety.
• Overall service performance was not always consistently monitored in a way that ensured patient safety.
• Systems and processes to manage risk were applied inconsistently, whilst learning was not always shared effectively and acted upon. There was a lack of clarity on how significant events and risks were identified and managed. Improvement was still needed to ensure learning and actions taken from incidents were understood and acted on by all relevant staff.
• There were risks of patients not receiving effective care or treatment.
• There were shortfalls in systems and processes that did always not enable safe and effective care to be provided.
• There were still shortfalls in some of the personal development and support provision for staff. Staff did not have appraisals or supervision sessions, to enable them to develop their skills.
• There was a strategy, but it had not been implemented sufficiently to ensure that a high-quality sustainable and consistent care could be provided.
• There were shortfalls in communication between senior leaders and staff groups, staff did not consider they had been fully engaged in the running of the service.
• Governance arrangements were not consistent to support the delivery of a safe, effective and well led service in a consistent manner. Limited attention had been paid to achieving and maintaining compliance with the regulations of the Health and Social Care Act 2008.
• Performance levels had shown signs of improvement and were now in line with national performance levels remained below expected contracted targets. (Due to the pandemic commissioning bodies were accepting service level performance to be in line with national performance, rather than the defined national targets).
• Staff were kind and caring and responsive to patients‘ needs.

Following this inspection, we took regulatory action and varied the urgent conditions placed on the service after our inspection in July 2020.Conditions are a requirement of the providers registration with the Care Quality Commission. These conditions were imposed as there were significant shortfalls in systems, which led to delays to care and treatment; call answering targets were not consistently being met; there were often adequate numbers of staff; and governance processes were not effective.

We extended the timescales for the urgent conditions to be met, as evidence gathered during this inspection showed some improvement, but it was insufficient to deem that the urgent conditions had been met.

In addition, we imposed two new urgent conditions on the provider’s registration relating to taking calls from the NHS 111 national contingency service (National contingency is a systematic process available to all NHS 111 providers in England. This enables any other NHS 111 services nationally to route telephone calls of another provider during periods of high demand); and the second condition was for the provider to produce duty rotas which clearly showed which staff were scheduled to work across the service; which staff actually worked; and reasons for absence of staff.

We also made requirements related to meeting the fundamental standards; complaints handling; provision of staff training, appraisals and supervision; and health and safety.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care