Urgent improvements have been demanded at Devon’s NHS 111 and out of hours GP service after inspectors found ‘deep rooted issues’ and that not all patients are receiving safe care or treatment.
It was also criticised for not treating patients promptly enough, with national performance targets failing to be met, and some patients having been put at risk, including deaths which have since been the subject of serious incident investigations.
Shocking examples included a patient who died some time after a fall and had not being properly assessed due to the clinician’s heavy workload, and a patient who had sustained an injury, but no call back was made and they subsequently died.
Devon Doctors Limited, which provides an Urgent Integrated Care Service (UICS) across Devon and Somerset, was inspected by independent health and social care regulator the Care Quality Commission (CQC) in July, after concerns were raised about the service including safety fears and insufficient staffing to meet expected demand.
They included that prior to lockdown in March 2020, up to 300 call backs were reallocated back to patients’ own in hours GPs on Monday mornings as they had not been addressed by the service over the weekend.
It resulted in considerable delays for some patients in accessing advice or treatment, with some patients having waited up to 17 hours for contact from the service.
The inspection looked specifically at Devon NHS 111 and out of hours service, and some areas of the Somerset out of hours provision.
Devon Doctors, which is based at Manaton Court in Exeter, provides a primary medical service to approximately 1.1 million people, a figure which increases substantially in the summer months due to the area’s tourism industry.
Janet Ortega, CQC’s head of inspection for Primary Medical Services in the south, said: “People who call the NHS 111 service are entitled to quick and easy access to healthcare advice and information, or access to urgent attention when that’s appropriate.
“This should never impede on patient care. Our inspectors visited Devon Doctors in July and were not assured that patients were being treated promptly enough and, in some cases, they had not received safe care or treatment.
“It is clear there are deep rooted issues and the provider needs to address these. We have shared our findings with the leadership team at Devon Doctors and they know what they must do to improve.
“The provider recognised the concerns highlighted by our inspection team and is working very closely with Devon CCG and Somerset CCG through an improvement programme.
“We will continue to monitor Devon Doctors extremely closely and will return to inspect services again on an unannounced basis in the near future.”
The service was last inspected in January 2017 when it was rated as good overall.
However, during the latest visit, CQC inspectors found the systems in place to keep patients safe and safeguarded from abuse were not always followed. This meant the risk to patients was not always minimised.
Not all staff had received up-to-date safeguarding and health and safety training appropriate to their role. Records showed there were gaps in staff completing training and records that had been completed did not show what level of training had been undertaken.
Some staff said they were not always confident that the training they had received was sufficient to enable them to carry out their roles.
The leadership team was unable to show that actions to address any challenges to the quality of service had been effectively put into place or monitored. Not all staff felt supported by leaders to perform their role effectively.
Information to enable staff to deliver safe care and treatment to patients was not always up to date.
The data relating to performance for the NHS 111 service was consistently considerably below England averages. The service was not achieving the required national targets.
Performance targets for answering calls within 60 seconds were not always met and regularly fell below the national average.
There were a lack of systems to ensure risks were reduced and the safety of patients’ health and welfare was protected.
The service was not rated at the latest inspection due to it being a focused inspection.
A spokesman for Devon Doctors said: “We were inspected by the CQC in July 2020 and some areas for improvement were identified.
“An improvement plan has been developed and agreed with the CQC and commissioners in Devon and Somerset.
“We are working very closely with all three of these organisations to address specific areas for improvement and this work has already begun.
“We are confident that we can resume the high-quality service that we have successfully provided to patients for the last 20 years.”
To read the full report click here.