Letter from the Chief Inspector of General Practice

Following our comprehensive inspection of the service on 11-16 March 2017, the service was rated as requires improvement for safe, good for effective, caring, and well-led, and outstanding for responsive services. We rated the service as good overall. We issued a requirement notice with regards to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment in respect of medicines management.

This focused follow up inspection was undertaken on the 26 October 2017 to confirm that the service had carried out their plan to meet the legal requirements in relation to those that we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The service is now rated as good for providing safe services.

Our key findings were as follows:

• Systems and processes such as for the storing and security of medicines were now in place to keep patients safe. The organisation had invested in additional staff hours to ensure the stock checking of medicines was consistently accurate across all sites.
• Safety and security procedures had been reinforced through staff training and /or guidance provided to the site host staff.
• The service had replaced their blood glucose monitors so that the same unit was available at all sites.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at BrisDoc Healthcare Services - Osprey Court on 11-16 March 2017. Overall the service is rated overall as good.

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

• There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.
• Risks to patients were assessed and well managed. The service used the National Early Warning Score (NEWS) report, which was a standardised assessment tool used in telephone consultations and when patients presented at the service. The NEWS system assessed the degree of illness of a patient and thereby helped define where the patient needed to be seen.
• Patients’ care needs were assessed and delivered in a timely way according to need. The service mostly met the National Quality Requirements and fully met the contract commissioner’s targets.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. The service had developed a ‘Clinical Toolkit’ available to all staff on the intranet. The home page had the latest updates and NICE guidance that clinicians should be aware of, and a list of available resources.
• The service had policies and protocols in place to keep patients safe however, systems to manage medicines, emergency situations and base security were not always operated consistently. This potentially put staff and patients at risk.
• There was a system in place that enabled staff access to patient records. The Out of Hours staff provided information to other services, for example the local GP and hospital, following their contact with patients. This was undertaken in a timely and appropriate manner.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience such as the ‘Professional Line’. This is a dedicated phone line to which GPs, advanced nurse practitioners, paramedics (30% of calls) and nursing home staff could use. Clinicians such as paramedics or nursing home staff used this phone line to discuss treatment of patients at risk of admission to hospital.
• The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding service:

• The service had developed a governance system. Called the Clinical Guardian, this was developed in partnership with Applied Healthcare Solutions and it uses the Royal college of General Practitioner criteria for urgent and emergency care against which to audit clinical practice. We saw working examples of how 'Clinical Guardian' was a key mechanism by which clinical practice and standards were reviewed, monitored and maintained. The service had invested in clinician time to conduct the Clinical Guardian reviews to improve the consistency and quality of care.

The areas where the service must make improvement are:

• The service must ensure that the medicines management policy is fully implemented and regularly evaluated for effectiveness across all the bases.

The areas where the service should make improvement are

• Ensuring the implementation of the protocols for staff in respect of emergency situations such as fire, and base security.
• Ensuring the calibration and checking of blood glucose meters is carried out in accordance with the manufacturer’s specification at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP)Chief Inspector of General Practice

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice