Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Ives House (East Lancashire Medical Services Limited) on 6 March 2017. The overall rating for the practice was good, although the key question of safe was rated as requires improvement. A requirement notice was issued in relation to safe care and treatment, as the provider was found to be in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report on the March 2017 inspection can be found by selecting the ‘all reports’ link for St Ives House on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 6 September 2017 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 6 March 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the service is rated as good, with the previous rating of requires improvement for the key question of safe updated to a rating of good.

Our key findings were as follows:

• The service had made improvements to how it documented mandatory training undertaken by sessional staff.

• All staff had been reminded who could undertake chaperone responsibilities, and the service’s chaperone policy had been updated to make this more explicit.

• Staff who drove as part of their role had been reminded that relevant health checks were available to them as part of their employment with the service.

• The service’s incident reporting policy had been updated to ensure it incorporated incidents being investigated following complaints.

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 East Lancashire Medical Services Limited on 6 March 2017. Overall the service is rated 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.
• Patients’ care requirements were assessed and delivered in a timely way according to needs.
• 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.
• There was a system in place that enabled staff access to patient records, and the out of hours staff provided other services, for example the local GPs and hospital, with information following contact with patients as was appropriate.
• 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.
• The service had good facilities and was well resourced 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.

The areas where the provider must make improvement are:

• Ensure that driver safety and fitness checks are in place and drivers who act as chaperones are trained for the role.
• Ensure appropriate recruitment and training checks are undertaken for all staff not directly employed by the service such as ensuring clinical staff have been trained to the appropriate level in safeguarding and resuscitation.

The areas where the provider should make improvement are

• Consider improving privacy in the reception area at the Burnley Urgent Care Centre.
• Consider the ease with which staff can access policies during the evening shifts.
• Consider the mechanisms for ensuring all staff are aware of who the fire marshals on duty are training for staff who work in the out of hours teams.

• Consider site specific patient experience surveys.
• Consider raising incidents from complaints in order to maximise learning opportunities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients accessed this service by dialling the National 111 number for non emergency care. Following a telephone assessment of their medical condition they were either given advice from a doctor, given an appointment to attend an out of hours medical centre or received a doctors visit dependent upon their needs.

We looked at records held at the main office and spoke with members of the management team and three staff members. The records we viewed were up to date and accurate.

Patients were given the support they needed to make a comment or complaint. Records were clear and showed that patient's concerns or complaints had been responded to appropriately and the information was used to improve the service. We also saw a numberof 'compliments' made about the service.

We spoke with patients who used the service at one of the out of hours centres. Patients said the advice and direction they received was appropriate to their needs.