Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Devon Doctors on 17,18 and 19 January 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. Lessons were shared across the organisation and with other out of hours providers.
• Risks to patients were assessed and well managed. There had been improvements made to environmental risk assessments since the last inspection.
• 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.

• The service employed a paediatric nurse during peak times to support child patients. The service worked with the Devon Partnership NHS Trust who supplied a community mental health specialist between 10am to 10pm every weekend in order to support patients with mental health problems.

• 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. All 60 comments and conversations with 14 patients were positive about the services provided.
• 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 and shared with other out of hours providers where appropriate.
• 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. Systems were in place to seek assurances and report issues about the facilities and estates used by Devon Doctors. 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.

We saw one area of outstanding practice:

The service had developed a dedicated end of life service which was led and coordinated by six designated staff. The team worked efficiently with local healthcare professionals to improve the care end of life patients received:

• The provider had developed a bespoke information screen which included a template which collected detailed information which was accessed by GPs, hospices, hospitals, ambulance service and the NHS 111 services. GPs were encouraged to update special notes which were then put on this screen.

• Devon Doctors promoted a direct dial telephone number for patients and carers to access without the need to telephone NHS 111. This improved access to clinical advice and support linked to their end of life needs. Targets for patients to be telephoned within 20 minutes or visited within an hour were consistently met. An audit of the direct line had resulted in further promotion and an increase in use following the lines promotion.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice