CQC places Peterborough Out-of-Hours service into Special Measures

CQC inspectors found the out-of-hours service provided by Cambridgeshire Community Services NHS Trust in Peterborough to be Inadequate following the inspection in November.

The out-of-hours service provides urgent medical care outside of normal GP hours.

Inspectors found the service inadequate for being safe, effective and well led. It was rated Good for providing caring services.

The report identifies a number of areas where improvements must be made including:

The service used nurses to triage patients by telephone before referring patients to a GP, advanced nurse practitioner or emergency care practitioner. But the nurses did not have access to adequate guidance and there was no evidence that they had been properly trained to deal with these calls.

Staff files and recruitment procedures were not documented or governed thoroughly. A review of staff files demonstrated that staff were not always recruited in accordance with the trust policy and various information was either incomplete or missing.

Inspectors were concerned that patients did not always receive effective and timely care and treatment. Response times for calls back to patients varied. Even though the service was not always meeting national requirements, there was no clear vision for improvement.

CQC shared its concerns with key stakeholders including Trust Development Authority, NHS England and Cambridgeshire and Peterborough CCG and the trust submitted an action plan which seeks to address the issues raised by the inspection team.

Janet Williamson, Deputy Chief Inspector of General Practice and Dentistry in CQC’s Central region said:“We found that patients were at risk because systems were not always in place to keep them safe. The provider must ensure that all staff who triage patients have been adequately trained to make clinical decisions by telephone and have been assessed.

“The service must ensure that the time patients wait for thorough clinical assessment is properly monitored to ensure patient care does not suffer. There must be enough staff on site to keep people safe.

“Clear arrangements must be put in place to ensure that managers have effective oversight of the performance of the out-of-hours service at all times so that they can take appropriate action to minimise the risks to patients.

“It is important that the people who use the GP out-of-hours service for Peterborough and surrounding area can rely on getting the high quality care which everyone is entitled to.

“We will continue to monitor this service and we will inspect again in six months to check whether improvements have been made. I hope that the service will take the necessary steps, but if we find that the service remains inadequate, we will consider taking further action.”

Dr Neil Modha, Chief Clinical Officer, Cambridgeshire and Peterborough CCG said: “The CCG has worked closely with CCS since the inspection to ensure implementation of their recovery plan and we have been pleased with the progress and improvements in areas where quality of care were of concern. We will continue to monitor this progress so we can be assured that patients are receiving the high standard of out-of-hours care that we expect.”

Matthew Winn, Chief Executive, Cambridgeshire Community Services NHS Trust said staff were working to ensure the service received a better grade at the next inspection. He said: “We accept the findings set out in the Care Quality Commission’s report following its inspection in November 2015. It is pleasing that the CQC rated the service as ‘Good’ in relation to the provision of ‘caring’ services.

“We are disappointed that the service has been rated ‘inadequate’ overall which means the service - not the overall Trust – will be placed in

to special measures whilst it continues to implement an improvement programme.

“We took immediate actions to respond to the concerns identified by the CQC relating to evidencing safe practice including; the introduction of new clinical protocols for nurse consultations undertaken via the telephone; an audit to ensure that all personal files contain evidence of professional registrations • re-establishing monthly clinical supervision for every employed nurse; implementing a new system of routine audit and monitoring; ensuring robust processes are in place to evidence and monitor GP mandatory training and appraisals.

“Additional actions continue to be taken forward and the vast majority of these will be fully implemented by the end of February 2016.

“We have every intention of ensuring the service achieves a ‘Good’ rating from the CQC at its re-inspection of the GP Out of Hours Service in six months.

“This service-specific rating does not change the Trust’s overall CQC rating of ‘Good’.”