Letter from the Chief Inspector of General Practice

This service is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Isle of Wight NHS Trust Urgent Care Service (Out of Hours service) on 24 and 25 January 2018. This inspection looked at the GP led Out of Hours service of the urgent care service. We also looked at the GP led walk in service offered at weekends and bank holidays.

We carried out a comprehensive inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There had been changes to the GP out of hours and walk in service since our last inspections. There was a revised leadership structure since October 2016 however staff felt that they were not always supported by the management arrangements.
• The Trust now employs all the GPs either as salaried or bank and has responsibility therefore for the management and supervision of all the GPs.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and managed, with some exceptions such as in relation to infection prevention and control and staffing. We found that there were gaps in staffing levels and rotas. On some occasions there was not a GP to see patients.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• The majority of patients said they were treated with compassion, dignity and respect.
• The service had a number of policies and procedures to govern activity, but some were overdue a review.
• 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.
• GP care was delivered in line with current evidence based guidance.
• The Trust sought some limited feedback from staff and patients.
• The Trust was aware of and complied with the requirements of the duty of candour.

• The service had systems to manage risk so that safety incidents were less likely to happen.
• The service reviewed the effectiveness and appropriateness of the care it provided through governance meetings. It checked that care and treatment was delivered according to evidence- based guidelines. However there was not an overarching governance of the Out of Hours service to include clear quality improvement strategies.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service generally within an appropriate timescale for their needs.

The areas where the provider must make improvements as they are in breach of regulations are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Persons employed must receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improvements are:

The Trust should actively encourage feedback about the quality of care.

The Trust should actively seek the views of a wide range of stakeholders, including people who use the service, staff, visiting professionals, professional bodies, commissioners, local groups, members of the public and other bodies, about their experience of, and the quality of care and treatment delivered by the service.

The Trust should have effective communication systems to ensure that people who use the service, those who need to know within the service and, where appropriate, those external to the service know the results of reviews about the quality and safety of the service and any actions required following the review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice