Hants Doc provides urgent medical care from a primary care centre at the emergency department within Basingstoke Hospital. The service is run by North Hampshire Urgent Care (NHUC).

The service was mostly safe but we found some problems with the management of medicines. There was good monitoring of the clinical performance of doctors but limited audits of other activities. There were some gaps in recruitment procedures.

Patients were overwhelmingly positive about the care they received but some were unhappy about the waiting room being shared with the hospital’s emergency department.

The service co-operated with other organisations to improve the health care experience for patients in the area. The service responded to patients needs appropriately.

There was a good management team in place with a clear focus on patient needs but there were gaps in some audit processes which meant that issues of concern were not always identified or acted upon.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Hampshire Urgent Care Limited - Out of Hours GP Service (HantsDoc) on 21, 22 and 23 February 2017. Overall the service is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.
• Risks to patients were assessed and well managed.
• Patients’ care needs were assessed and delivered in a timely way according to need. The service met the National Quality Requirements.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• There was a system in place that enabled staff access to patient records, and the out of hours staff provided other services, for example the local GP and hospital, with information following contact with patients as was appropriate.
• The service managed patients’ care and treatment in a timely way.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience.
• The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Review the systems for monitoring individual medicines in order that there is a running total of all individual tablets and vials of medicines readily available.

We saw one area of outstanding service:

• The standard clinical system used by the majority of out of hours providers only categorises patients as urgent or routine, however the dispositions (recommended course of action) given by NHS 111 provide more options, for example, to be contacted within 30 minutes, one hour, two hours, six hours. The provider realised that patient prioritisation would be improved if the clinical system options matched the NHS 111 dispositions. The provider has developed in- house options within the clinical system so that the system shows patients in the same priorities as the dispositions that were assigned by NHS 111. We saw evidence that this had reduced the time patients were waiting for contact with the primary care centre, for example, the average time patients whose disposition was to be contacted within an hour had been reduced to under 30 minutes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice