Oxfordshire’s GP Out of Hours Service was categorised as ‘good’ in two quality measurements and ‘requires improvement’ in three, in a report by the Care Quality Commission (CQC).
This gives the GP Out of Hours Service an over-all rating of ‘requires improvement’ and the trust has responded to those remarks in the six months since the inspection last November.
As the body that assesses the quality of NHS services in England the CQC found the GP Out of Hours Service was caring and commented that: “Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment”.
Patient response cards showed:
- 92% of patients said they were likely or very likely to recommend the service to others.
- 96% of patients had confidence and trust in the doctor or nurse they saw during their visit
- 96% said they were treated with dignity and respect
Inspectors also found the service was responsive to people’s needs. The service responded to the needs of the local population and engaged with commissioners to bring improvements where needed. The service had systems in place to ensure patients received care and treatment according to the urgency of need, had good facilities, was well-equipped and patients and staff knew how to raise concerns and there was good learning from incidents and complaints.
Improvements were required in safety with inspectors noting the challenges of GP recruitment but noting the effectiveness of additional assessment and pre-consultation screening tools to ensure patients were kept safe. Another area of work was the trust’s ability to demonstrate the completion of DBS checks and training in safeguarding children for all GPs and inspectors also recommended drivers and receptionists undertake resuscitation and chaperone training.
The effectiveness of the service could be improved with data showing the service was not meeting the National Quality Requirements (performance standards) for GP Out of Hours services. It was recognised this was reflective of recruitment challenges in the region. In the six months prior to inspection 82% of face-to-face consultations took place within two hours of assessment for urgent patients against a national target of 95%. In the same period 97% of face-to-face consultations took place within six hours for less urgent patients, exceeding the target of 95%. Inspectors found staff assessed needs and delivered care in line with current evidence based guidance, had the skills, knowledge and experience to deliver effective care and treatment.
There was an overarching governance framework to support the delivery of the strategy and good quality care within the service however inspectors made recommendations on the way the service was led finding this was inconsistent in monitoring arrangements to improve quality, identify, assess and manage. Staff were able to identify communications relating to safe and effective delivery of services. There were some inconsistencies in how this communication was received and in how the service monitored the effectiveness of the communication.
We have responded by:
- Recruiting more GPs to the team increasing numbers from 136 to 143.
- Filling 38.98 of our aim of 40 full time equivalent GP posts. We are currently considering applications from potential candidates.
- Achieving 91% shift coverage against a target of 95%.
- Prioritising keeping a record of DBS and safeguarding checks where we had not done so previously as all practising GPs already have DBS checks.
- All our drivers and receptionists now undertake resuscitation training and chaperone training options are being considered.
We continue to:
- Prioritise patient care and safety by implementing processes to ensure those in most urgent need of assessment are seen first.
- Undertake clinical prioritisation which inspectors noted resulted in slower assessment but incorporated appropriate prioritisation of need to ensure patient safety.
Dominic Hardisty, Chief Operating Officer and Deputy Chief Executive, said:
“It always feels disappointing to receive a rating of ‘requires improvement’ but we know that Out-of-Hours is a very challenging service to run well. We have taken on board all of the CQC’s recommendations and acted on them. Everyone involved in the running of the service can be proud of the fact that the service was rated well for ‘caring’ and ‘responsive’. Once our action plan has been completed we are confident that we will be able to score well in other domains as well. I would also like to take this opportunity to thank the staff and GPs who work in the service, all of whom I know work incredibly hard to do the right thing for patients – it is gratifying to see this represented in patients’ feedback.”