Rutland and Leicestershire out-of-hours clinic placed in special measures

An out-of-hours GP clinic serving Rutland and Melton has been placed in special measures after an inspection.

The Care Quality Commission found Leicester City, Leicestershire and Rutland Out of Hours, run by Central Nottinghamshire Clinical Services Limited, was failing to for provide safe, effective and responsive services and was not well led. It also needed to improve the provision of responsive services.

It is important that the people who use Leicester City, Leicestershire and Rutland Out of Hours service rely on getting the high quality care which everyone is entitled to receive.

The clinic is based in Enderby and provides services to 996,000 patients in Leicester, Leicestershire and Rutland when GP practices are closed.

During a visit on March 17 and 18, inspectors found the following problems:

- Patients were at risk of harm because systems and processes were not in place to keep them safe. For example emergency and urgent patients were not being seen for face to face consultations in relation to their medical needs and in a timely manner.

- Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

- There was insufficient assurance to demonstrate people received effective care and treatment. For example we saw evidence of emergency patients waiting far too long to be seen by a clinician. Despite being aware of issues, the provider had not looked at them in detail to identify the root cause.

- Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

- Essential clinical equipment was found to be out of date in some areas or simply not available. This had caused inappropriate delays when treating some patients.

- Medication management was poor. Medicines were found to be out of date or there were no systems in place to monitor the quantities or expiry dates.

- The provider had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

Inspectors rated four out of five criteria as inadequate, and one as requiring improvement.

The service was given a 17-point checklist of areas where it needed to get better.

The commission’s deputy chief inspector of general practice and dentistry Janet Williamson said: “It is important that the people who use Leicester City, Leicestershire and Rutland Out of Hours service rely on getting the high quality care which everyone is entitled to receive.

“GP out of hours services face particular challenges in providing safe, compassionate care. Patients are often unfamiliar to staff, and staff do not always have access to their medical records. Often these services have a large workforce where staff may not know each other well. Cases can be complex and urgent and must be handled effectively in order to ensure the best patient care is delivered.

“Although the patients we met told us they were treated with dignity and respect, we also found that care and treatment was not always delivered in line with best practice.

“We know that Leicester City, Leicestershire and Rutland Out of Hours has acknowledged the areas where action must be taken. We have found significant areas of concern, which is why we are placing the service into special measures - so opening the way to support from NHS England among others.

“We will continue to monitor this service and we will inspect again in six months to check whether improvements have been made. I am hopeful that the service will do what is required for the sake of its patients, but if we find that the service remains inadequate, we will consider taking further action.”

The commission said it was working closely with NHS England and the three Leicester, Leicestershire and Rutland Clinical Commissioning Groups to support the service, while it addresses the issues identified by the inspection.

The full report can be seen at www.cqc.org.uk.