Lincolnshire Community Health Services NHS Trust provided out-of-hours General Practitioner (GP) services for patients living in Lincolnshire. The service was administered from the trust’s headquarters in Sleaford and patient care and treatment was provided from eight primary care centres at locations across the county. We visited the trust’s headquarters on 5 June 2014 where we looked at records and information and talked with staff about issues that related to all eight locations and the service a whole. On the 7 June 2014 we visited the primary care centre at Grantham and District Hospital and spoke with members of staff, patients and carers and reviewed documents and matters specific to that location.

Lincolnshire Community Health Services NHS Trust provides out-of-hours General Practitioner (GP) services for patients living across Lincolnshire. It is registered to provide the regulated activities of diagnostic and screening procedures and the treatment of disease, disorder or injury at Grantham and District Hospital.

Patients told us that they were happy with the care and treatment they received and felt safe. We spoke with representatives of three care homes, which provided care for older people some of whom lived with dementia. They told us the practice was helpful and responsive to their patients’ needs. We received one comment card from a patient, which said they had found the service to be excellent.

The provider conducted clinical audits that addressed specific areas of patient care. Individual clinician’s practice was assessed on a regular basis to help ensure that patients received safe and effective care and treatment.

We found the service was effective in meeting patients’ needs and the primary care centres were accessible to those who had mobility issues.

We saw that leaflets to inform patients about how they might raise a complaint were only available in English but we saw documentary evidence that the Clinical Commissioning Group had instructed that they should not be printed in other languages due to cost.

Staff were trained and supported to recognise the signs of abuse of children and vulnerable adults and were provided with training to heighten their awareness of domestic violence.

There were systems in place to help ensure patient safety through learning from incidents, and infection prevention and control.

The provider had not used effective recruitment processes to assess the suitability of staff to work in this sector. We have told the provider they must improve.

Patients experienced care that was delivered by dedicated and caring staff. Patients and carers we spoke with said staff displayed a kind and caring attitude. We observed patients being treated with respect and kindness whilst their dignity and confidentiality was maintained.

Some members of the staff team we spoke with felt well supported by management whilst others did not always hold positive views of the management team and their leadership. They told us there had been some recent improvements but they did not always feel well supported in their roles. They told us some managers did not listen and act on their concerns or suggestions to improve the level of service provided to patients.

We found the provider did not have reliable and safe medicine management systems in place. There were no formal procedures or audits for medicines received and held. Reliable checks would ensure safe administration of medicines, and minimise the potential for error. Following on our visit the provider took steps to improve the medicines management systems to keep patients safe.    

The provider had in place business continuity and contingency plans that would enable the service to continue to operate in the event of a failure of, for example, the information technology or telecommunication systems.