Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shropshire Doctors Co-operative Limited on 8th February 2017. Overall the service is rated as outstanding.

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 and staff were comprehensively 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 (NQRs).
• 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.
• 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. Staff training in the duty of candour had resulted in increased recording of significant events.

We saw areas of outstanding service:

• Risk management and complaints were comprehensively managed through an integrated system and every opportunity was used to learn from incidents and events. Learning was shared with other healthcare providers, Clinical Commissioning Groups (CCGs) as well as to all staff internally. Educational sessions were arranged internally to promote the safety of patients following a significant event.
• Comprehensive systems and processes were in place to promote the safe transport of medication and equipment. These included controlled drugs stored in boxes with fob access for GPs and temperature control measures within vehicles that carried medication and equipment.
• The provider consistently demonstrated that responsive actions were taken to safeguard patient safety as well as improve patient experience. This was supported by consistent and highly positive data from patients when asked questions relating to the responsiveness of the service. 

• Shropdoc demonstrated a proactive approach when responding to the needs of patients that could not be met by other health providers, commissioned to provide that service.

• There were examples of how an innovative approach had been used to improve the patient experience and support other healthcare providers particularly those in secondary care. These included an oncology service, clinical support to local GP practices and the implementation of a Patient Aligned Care team (PACT).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Shropshire Doctors Co-operative Ltd (Shropdoc) is a not for profit organisation established in 1996. Shropdoc has 279 local GP members who deliver out-of-hours care to a population of 600,000 patients within Shropshire,Telford &Wrekin and Powys.

The service opening times are from 18.30 until 08.00 Monday to Thursday and 18.30 Friday through to 08.00 Monday with 24 hour cover for all bank holidays.

Shropdoc provides care to approximately 140,000 patients per year.

Shropdoc currently has six centres in England. We visited the two largest centres during this inspection at Telford and Shrewsbury alongside the head office location where virtually all triage takes place.Shropdoc primary care centres are located within community or district hospital sites.

Shropdoc operates a ‘triage’ model where all patients have clinical telephone assessments. This prevents unnecessary journeys for patients and enables appropriate coordination of home visits and appointments according to clinical urgency and demand. Shropdoc does not use decision supporting software for assessing patients, all clinical decisions are based on evidence based knowledge and clinical guidelines for best practice.

We found patients accessing the service were kept safe and protected from harm. Care and support was delivered to patients by a caring team who were responsive to the changing needs of the patients.

We found policies and procedures to support staff whilst carrying out their roles were robust and up to date. Staff had all received appropriate training to carry out their roles.

We spoke with patients, parents attending with children, staff, the senior management team, looked at feedback from local healthwatch organisations and collected comments cards from the public at each of the locations visited. We also listened to call handlers and triage consultations with patients and observed consultations being carried out at the care centres.

Feedback from patients suggested they were happy with the care they had accessed, were treated with dignity and in a sensitive manner.

We found that the service was well-led and managed by an enthusiastic, experienced and knowledgeable senior management team, and their values and behaviours were shared by staff.