Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Moorgate Primary Care Centre (part of Bury and Rochdale Doctors on Call Out of hours service – BARDOC) on 6 February 2016. Overall the provider is rated as good.

Our key findings across all the areas we inspected were as follows:

• The provider demonstrated an open and transparent approach to safety; and systems were in place for reporting, recording and providing feedback on significant events. Staff at ths site completed details on the BARDOC ‘hub’, staff at other sites were able to give details of incidents to shift leads, or were able to access the BARDOC ‘web’. Staff we spoke with were aware of their responsibilities to raise concerns and report incidents.
• The service was monitored against the National Quality Requirements (NQRs) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners about the level and quality of service being delivered. Where variations in performance were identified, the reasons for these were reviewed and action plans implemented to improve the service.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received appropriate training and updating which provided them with the skills, knowledge and experience to deliver effective care and treatment.
• Clinical supervision and appraisal processes were in place. Clinicians received regular audit of their clinical practice using the Royal College of General Practitioners urgent care tool the ‘Clinical Guardian’ system, and were provided with feedback, including areas for improvement. Call handling staff of all disciplines received regular call audits to monitor effectiveness and safety standards.
• Moorgate Primary Care Centre is the head office for BARDOC. Patients were not seen in house. Calls from patients were triaged by clinical staff. Appropriate arrangements were then made for their treatment, including home visits by a GP, in accordance with the disposition (outcome) of the assessment.
• Information about services and how to complain was available on the provider website. We saw that verbal complaints were recorded as ‘patient feedback’. Complaints were investigated and patients received an apology and explanation of actions taken following their complaint
• Staff had access to comprehensive safeguarding policies and procedures, and received training appropriate to their role. Staff demonstrated their awareness of their safeguarding responsibilities in relation to vulnerable children and adults; including frequent callers to the service.
• Vehicles used to transport GPs to home visits were clean, well maintained and appropriately equipped.
• There was strong and clear leadership from a clinical and senior management perspective. Staff felt supported by management who were visible on shifts on a daily basis to support the smooth running of the service.
• The provider proactively sought feedback from staff and patients, which it acted on.
• There were systems in place to provide integrated person-centred care. Special patient notes were used to record relevant information about patients who were nearing end of life or those with complex medical and/or social needs.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• Vulnerable citizens’ packs were in use, and carried in each of the cars in the fleet. These contained basic essential items such as water and a blanket; they also contained details of where out of hours treatment and dispensing centres were located. These were issued to members of the public who appeared to be vulnerable or in need, observed by the driver or visiting doctor en route to home visits.

• We saw evidence that inappropriate referrals to accident and emergency at Bolton hospital had been reduced between February 2016 and October 2016. This had been achieved by raising awareness amongst staff, training, and the additional clinical support provided by clinical floor walkers

The areas where the provider should make improvement are:

• Consider taking steps to standardise and streamline the incident reporting system by creating one system for all staff to use. At the time of our visit the method of reporting incidents varied according to level of connectivity with the main server.

• Review their arrangements for monitoring working hours for GPs and other staff working on a sessional basis.

• Maintain clear communication with facilities and premises management to ensure that premises’ risk assessments are appropriately updated and identified actions completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We inspected BARDOC – Moorgate Primary Care Centre during a Friday night. We saw that a group of call handlers, doctors, nurses and managers were at BARDOC during our inspection. They took calls from the Bury, Rochdale and Heywood areas. Patients who needed to be seen in person were given an appointment to visit a doctor at the centre. Doctors were also available to visit patients in their homes. We did not speak with any patients.

There was a passenger lift at Moorgate Primary Care Centre, and the patients’ waiting area was on the first floor. Consultation rooms were also on this floor. The centre was closed to the public after 10pm each night, and we saw CCTV was available to staff so they could allow entry to patients who had an appointment.

During our inspection we observed call handlers speaking with patients. We heard they always asked if they were speaking with the patient and asked for the patient’s consent, where possible, if they requested a third party to speak on their behalf. We heard call handlers ask for information about the patient’s illness and condition, then inform the patient of what would happen next and when they could expect a medical professional to call them back. We saw the quality assurance audits carried out by managers of the service. These were done on a monthly basis and they monitored the quality of the service provided so improvements could be made if necessary.