This service is rated as Good overall. (Previous inspection September 2014 – No concerns)

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 an announced comprehensive inspection at Arrowe Park Hospital GP Out of Hours Service on 6 March 2018 as part of our inspection programme and in conjunction with the inspection carried out for Wirral Community NHS Foundation Trust.

At this inspection we found:

• The provider 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.

• There were systems in place to mitigate safety risks, including those associated with health and safety, infection control and dealing with safeguarding.

• The provider 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 had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• We saw that staff treated patients with compassion, kindness, dignity and respect.

• The service was underperforming in their targets for indicators relating to access and response time. However, patient feedback was positive in respect of them being able to access care and treatment from the service within appropriate timescales for their needs.

• The service facilities were accessible and well equipped to treat patients and meet their needs. The vehicles used for home visits were maintained and well equipped, however not all required checks on the vehicles were carried out on a daily basis.
• There were systems in place that enabled staff to access patient records and out of hours staff provided other services, such as the patient’s own GP and hospital, with the information they needed following contact.
• There was a clear leadership structure and staff felt supported by leaders and management. The provider sought patient views about improvements that could be made to the service; including through the Friends and Family Test, internal surveys and share your experience information. It acted, where possible, on feedback.

• Staff worked well together as a team and all felt supported to carry out their roles.

• There was a focus on continuous learning and improvement at all levels of the organisation.

• The provider was aware of the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Review the maintenance programme for the out of hours premises at Arrowe Park Hospitalto ensure an environment is maintained that enables good cleaning and infection, prevention and control measures. In particular the reception carpet and waiting room walls.

• Review protocols for the out of hours vehicles to ensure sharps bins carried in the vehicles are maintained safely and not overfilled and that daily safety and hygiene checks are carried out.

• Review the recruitment policy to include obtaining photographic identification being obtained prior to employment.

• Continue to review the staffing structure and model of care in order to improve access in a timely manner.

• Review audit planning to include a programme of audits that are based on local, national and service priorities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The Arrowe Park Hospital GP Out of Hours service is operated by the Wirral Community NHS Trust. The service provides emergency medical care to patients who are unable to wait for their GP practice to re-open. The service is run from five locations including the call centre, Arrow Park Hospital, Eastham, Riverside Park Call Centre, St Catherine’s Health Centre and Victoria Central. This inspection was undertaken at the location Arrowe Park Hospital and Riverside Call Centre.

The service is registered with the Care Quality Commission (CQC) to provide the regulated activities diagnostic and screening procedures, family planning, transport services, triage and medical advice provided remotely and treatment of disease, disorder or injury.

The out-of-hours service was safe at this location. Staff were encouraged by the leadership team to be proactive in learning from incidents and taking ownership when incidents occurred. They had a good understanding of safeguarding matters and were aware of what action they must take if these matters should arise.

The team were providing an effective service for their local population. Care and treatment was considered in line with current published guidelines and best practice, all of which were available to staff on their intranet.

Staff working at the service were caring. Patient's and their families told us staff treated them with compassion and dignity and they felt fully involved in their care.

The service was responsive to patients needs. Patient's views were sought and negative comments made were acted upon. Staffing levels were reviewed on a regular basis to ensure patient's needs and demands could be met.

The service was well led and staff told us they were well supported. There was an open culture where the leadership support was good. The leadership team were strong and visible and worked closely with staff throughout each shift. Staff told us they felt safe to report incidents and mistakes knowing this would be treated as a learning opportunity rather than there being a blame culture.

The patients we spoke with were complimentary of the care and treatment they had received. Patient's told us they were treated with dignity and respect and they were happy with the treatment they received from the GP in attendance.