We carried out an announced comprehensive inspection on 24 July 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

This service was previously inspected in January 2016 and we identified breaches of regulation. We found these concerns had been addressed since the last inspection.

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

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We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC inspected the service in January 2016 and asked the provider to make improvements regarding the safety and effectiveness of their care and to review leadership and governance processes. The provider sent us an action plan following the inspection, setting out what they were going to do to improve their services. We checked these areas as part of this comprehensive inspection and found they had been resolved.

The service provides private GP services to patients including consultation, treatment (which may include long term care) and vaccinations.

The lead partner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received feedback from 52 patients including 35 comment cards and 17 patients reporting directly to CQC. All the feedback we received was highly positive regarding the care and access to the service.

Our key findings were:

• Patients received timely care when required and were able to easily access appointments.
• There were systems in place to monitor patient care and treatment.
• Incidents and complaints were reported and investigated openly and thoroughly.
• The premises were clean, safe and well maintained.
• Staff provided a caring environment for patients to receive care in.
• Medicines were stored safely and repeat prescribing was monitored.
• Staff received training and development to ensure they were safe and capable to provide care.

We carried out an announced comprehensive inspection on 19 January 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Background

Doctor Now is an independent GP service offering a range of general medical and specialist services including an out of hours service. Services provided include GP and nurse led consultations, health screening and pathology services. The service is an accredited MASTA travel clinic and yellow fever centre.

Services are provided between 8am and 8pm from Monday to Friday and from 9am to 4pm on Saturdays. Patients who hold relevant membership with Doctor Now are able to access services and care from a GP 24 hours a day. Other membership options provide patients with monthly home visit monitoring by a nurse and regular GP home visits throughout the year.

Services are provided by 11 GPs and three practice nurses. Three of the GPs are directors of the service and eight GPs work on a sessional basis. GPs and nurses are supported by a practice manager, an assistant practice manager and a team of reception, administration and support staff.

The Chief Medical Officer and Managing Director of Doctor Now is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection and we spoke to some patients on the day of our inspection. 20 patients provided feedback about the service. All of the comments were positive about the care they had received. Patients told us that staff acted in a professional manner and they felt they received good standards of care.

Our key findings were:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients and staff were not always assessed and well managed. The service had not undertaken regular fire drills. Risk of exposure to legionella bacteria had not been assessed. 
• There was a lack of formal arrangements to ensure infection control processes were fully implemented.
• There was a lack of systems and processes to ensure patients were protected from abuse.
• Travel vaccination services were well managed but medicines were not always stored securely.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had not always received training appropriate to their roles and further training needs had not always been identified and planned.
• Staff had not received regular supervision and appraisal of their performance.
• The practice worked closely with other organisations and with local community services in planning how care was provided to ensure that they met patients’ needs.
• There was a lack of systems in place for completing clinical audit cycles. The service was unable to demonstrate that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistently and strongly positive.
• The service offered highly flexible opening hours and access to appointments which met the needs of their patients.
• Information about services and how to complain was available and easy to understand.
• The provider was aware of, and complied with, the requirements of the Duty of Candour.

We identified regulations that were not being met and the provider must:

• Ensure all health and safety risk assessments are completed and action is taken as needed including for legionella bacteria and fire drills.
• Implement procedures to ensure medicines are stored securely at all times.
• Ensure effective systems for responding to identified fluctuations in medicines fridge temperatures.
• Ensure systems and processes are in place to protect patients from the risk of abuse, including the development of clear written policies and procedures and training in the safeguarding of children and vulnerable adults at an appropriate level for all staff.
• Ensure infection control processes are in place, including regular auditing and the safe management of sharps disposal.
• Ensure all staff receive regular supervision and appraisal as well as training for their role, including training in chaperoning, health and safety, fire safety, information governance, the Mental Capacity Act 2005 and infection control.
• Ensure clinical audits are used to promote continuous improvement.
• Review written policies and procedures to ensure their accuracy and currency.

There were areas where the provider could make improvements and should:

• Ensure regular calibration of the spirometer in line with manufacturer’s recommendations.
• Ensure the vaccination status of all appropriate staff is established and that staff receive booster immunisations where required. 
• Ensure clear information is provided for staff and patients about chaperoning arrangements.
• Establish a business continuity plan to manage emergencies that may impact on the daily operation of the service. 

We spoke with five people who had used the services of Doctor Now. People described the care as "good" or " excellent". They all said they were very happy with the information provided by Doctor Now. One person said there was a "comfort level in knowing they care".

Staff told us they felt well supported in their roles and had plenty of development opportunities.

The provider had effective systems in place to learn from incidents and complaints to improve the quality of the service.