Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the Out of Hours service at Albion Street Clinic on 5 March 2015, between the hours of 17.00 and 23.30 hrs. Overall the clinic is rated as good.

The provider also runs a satellite clinic in Haydock on Sunday’s. This clinic was not visited by CQC and is not included in our inspection.

Our key findings were as follows:

• The clinic had systems in place that supported staff and GPs in the delivery of safe treatment of patients, both at the clinic or when attending patients in their home.

  • The service provided by the clinic was effective in terms of urgent care and treatment delivery. This was evidenced by data, for example, in relation to reduced numbers of children attending the local accident and emergency unit to access primary medical care.
  • The GP led Acute Visiting Service for older patients, responded to calls from paramedics of the North West Ambulance Service, who could seek advice from the on-call GPs. The response rate from the Out of Hours service to these calls was typically 15 minutes and contributed to reduced hospital admissions for older patients.
  • The clinic was responsive to the demand for services, by patients unable to see their own GP. The management at the clinic produced ‘real time’ reports that highlighted future pressure points on the service. This information was shared with the 41 practices it served and with the local hospitals who could plan for anticipated surges in demand.
  • The service provided was highly valued by patients who used it. We received 97 CQC comment cards, where patients had expressed their views. All comments were positive and described how patients had been seen and treated by caring, compassionate and helpful staff.

We saw areas of outstanding practice including:

• Responsive and flexible services which included children’s clinics which delivered a 20% reduction in numbers of children from the St Helens area, attending A&E.
• A pilot scheme with the North West Ambulance service, where GPs from the Acute Visiting Service provided by the clinic, worked with paramedics to stabilise and treat older patients at home, reducing the need to transport and admit older patients to hospital. Figures showed that 91% of ambulance call outs to older patients were turned around in this way, meaning patients’ were safely treated at home.

However, there were also areas of practice where the provider should make improvements.

The provider should:

• Retain copies of staff checks conducted on GPs and nursing staff.
• Evidence checks on the working hours of GPs and keep records alongside evidence of indemnity insurance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The manager reported that the views of patients who used the service were sought through regular surveys. We looked at a recent patient experience survey which showed that most patients were very satisfied with the service they received. The service made adjustments to meet the needs of people, for example we saw procedures in place to support patients who required an interpreter service or who had a hearing impairment.

The service had electronic records in place to accurately describe the contact patients had with the ‘out of hours’ team and the actions taken to provide appropriate care and treatment. Telephone calls were recorded and stored securely and information was available to all staff regarding any previous contact the patient had with the service.

Staff we spoke with were knowledgeable about how to raise any safeguarding concerns however we found that the service did not have a policy or set of procedures to support vulnerable adults. Following discussion, the manager confirmed this would be addressed as a matter of urgency.

The service had systems in place to recruit skilled and experienced staff to meet the needs of patients using the service. New staff were supported through the service’s induction programme. We looked at a number of external audits which had been carried out recently. We saw a recent quality report from December 2012 which showed that the service met all the national quality requirements for ‘out of hours’ care.