Devon Doctors - Osprey House Also known as Devon Doctor

Updated 11 January 2022

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 Integrated Urgent Care Service (IUCS), comprising of an out of hours(OOH) GP service and an NHS 111 service, for the counties of Somerset and Devon. The service covers an area of 10,878 km2 (4,200 square miles) of which a large percentage is rural. The service provides a primary medical service for approximately 1.8 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 OOH service for Devon and Somerset.

Devon Doctors Limited registered location is: Suite 1, Osprey House, Osprey Road, Sowton Industrial Estate, Exeter, EX2 7WN

The website is: www.devondoctors.co.uk

The service has two clinical assessment service centres at Osprey House in Exeter and Ashfords in Taunton. The service has nine treatment centres in Devon, which are open at various times throughout the week and weekends to provide the OOH 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 OOH 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 and Treatment of disease, disorder or injury.

Staff employed by Devon Doctors Limited include; call handlers, drivers, reception staff, GPs, nurse practitioners and call centre coordinators. There is a team of supporting office. These members of staff are led by a management team who hold lead roles. For example, clinical governance, recruitment, rotas, medicines, communication and information governance. All staff are overseen by the Board of directors.

The OOH service operates between 6pm and 8am Monday to Friday, and 24 hours on Saturdays, Sundays and bank holidays. The NHS 111 services operates 24 hours a day, all year round.

Updated 11 January 2022

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.

Background to this inspection in November 2021.

In July 2020 we carried out a focused inspection 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. We also made requirements related to meeting the fundamental standards: safeguarding service users from abuse and improper treatment; good governance; and staffing.

We carried out a focused inspection in December 2020 to follow up on the urgent conditions imposed and the requirements made. 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 focused inspection to a full comprehensive inspection, to include the caring domain.

Following the December 2020 inspection, we took regulatory action and varied the urgent conditions placed on the service. In addition, we imposed two new urgent conditions on the provider’s registration. We also made requirements related to meeting the fundamental standards; complaints handling; provision of staff training, appraisals and supervision; and health and safety. We also placed the service into special measures, as the key questions of effective and well led were rated as inadequate.

We carried out an announced focused desk-based review of Devon Doctors Limited, in May 2021 to check compliance with the conditions imposed on the provider’s registration. We judged that the conditions had been met and removed them from the provider’s registration. The requirement notices made at our inspection in December 2020 were still in place. We also made recommendations for the provider to consider:

• Implementing protected meeting times and time for learning from significant events to promote effective engagement with staff.
• Provide training as described in the action plans related to the inspection in December 2020.
• Review how significant events were documented, to enable decisions made on level of harm to be clear.
• Continue work on staffing needs and building resilience into service provision when possible.
• Provide clarity on how low harm incidents were used to drive improvements in the service provision.

This service is rated as requires improvement overall. (Previous inspection December 2020 – Inadequate)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Devon Doctors – Osprey House on 3, 4 and 5 November 2021, to follow up on breaches of regulations and to determine whether the service could be taken out of special measures.

At this inspection we found:

• There had been improvements to prioritising safeguarding to minimise risk to patients. All staff had received training appropriate to their role.
• Staff we spoke with were able to identify what constituted a safeguarding concern and knew what actions to take.
• Work was ongoing in the recruitment of sufficient staff numbers to provide the service. There were still issues with high staff turnover, but changes had been made to the recruitment process and there was a broader range of opportunities for allied health professionals.
• Regular monitoring of staffing levels and performance occurred. The service aimed to minimise risk to patient safety whenever possible, if there were insufficient staff to operate all of the sites.
• Risks to patients were assessed, monitored and managed to maintain patient safety.
• Improvements had been made to ensure learning or actions taken from incidents were understood and acted on by all relevant staff, but this needed time to be fully embedded.
• The provider had implemented a programme of appraisals and one to ones.
• Training records showed what training had been provided and what training was required- infection control and safeguarding training was up to date. Staff reported that professional development was discussed in supervision sessions and had started to be provided.
• Staff treated patients with kindness, respect and compassion.
• Staff understood patients’ personal, cultural, social and religious needs. They displayed an understanding and non-judgmental attitude to all patients.
• There were arrangements and systems to support staff to respond to people with specific health care needs such as end of life care and those who had mental health needs.
• Improvements had been made in monitoring service provision and performance to improve timely access and patients were informed of any delays to care and treatment. However, there were still shortfalls which the provider was regularly monitoring and taking action when they were able to.
• The whole of the board and governance structure had been reconfigured.
• There were systems and processes to support good governance and were starting to become embedded.
• Audits of clinicians were used to measure performance and address areas which required improvement.
• Systems had been implemented to monitor learning; further development was needed to ensure these were embedded in practice.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, including but not limited to infection control; sharing of learning from significant events and complaints; and monitoring of service performance in line with their action plan.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

The areas where the provider should make improvements are:

• Consider how policies and procedures are communicated to staff.
• Consider completing the two outstanding actions from the external health and safety inspection.
• Review processes to make sure medicines and equipment are stored securely when not in use.
• Review the significant event register to make sure any concerns identified from complaints received is included on the register.
• Continue to make sure staff received appraisals at regular intervals.
• Review how call handling data is displayed in clinical assessment service centres.
• Continue with their plan to make improvements using information from complaints.
• Continue to train staff to be Freedom to Speak Up Champions.

I am taking this service out of special measures, as the provider has made sufficient progress in complying with the regulations.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care