Devon’s out-of-hours and 111 GP service put in special measures

A shocking re-inspection of Devon’s NHS 111 and out of hours GP service has found that patients are still not all receiving safe care or treatment – six months after major failings were exposed.

[Owl would feel more confident if less use was made of stock buzz phrases such as: “build back better”]

Anita Merritt www.devonlive.com

Devon Doctors Limited, which is based in Exeter and 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 2020, after concerns were raised about the service, including safety fears and insufficient staffing to meet expected demand.

Following the focused inspection, the CQC imposed a timeframe to make urgent improvements after ‘deep rooted issues’ were identified.

‘Significant’ shortfalls in systems were uncovered which led to delays to care and treatment; call answering targets were not consistently being met; there were often adequate numbers of staff; and governance processes were not effective.

A further focused inspection was conducted between December 7 to 9, to follow up on the urgent conditions imposed.

However, due to further concerns found during the visit, a full comprehensive inspection was instead carried out and it has since been rated inadequate and placed in special measures.

The report from that inspection has been published today, March 17. Key findings include:

  • Sufficient numbers of staff available to run the service were inconsistent to ensure risk was minimised and the service could respond quickly to an increase in demand.
  • Risks to patients were not adequately assessed, monitored or managed to maintain patient safety.
  • Overall service performance was not always consistently monitored in a way that ensured patient safety.
  • There was a lack of clarity on how significant events and risks were identified and managed. Improvement was still needed to ensure learning and actions taken from incidents were understood and acted on by all relevant staff.
  • There were risks of patients not receiving effective care or treatment.
  • There were shortfalls in systems and processes that did always not enable safe and effective care to be provided.
  • There were still shortfalls in some of the personal development and support provision for staff.
  • There were shortfalls in communication between senior leaders and staff groups, and staff did not consider they had been fully engaged in the running of the service.
  • Governance arrangements were not consistent to support the delivery of a safe, effective and well-led service in a consistent manner.

Devon Doctors received an overall rating of ‘inadequate’. It was deemed as requiring improvements for its services to be safe, caring and responsive, and inadequate for being effective and well-led.

However, inspectors highlighted how staff were kind and caring, and responsive to patients‘ needs. It was also noted that performance levels had shown signs of improvement and were now in line with national performance levels.

Dr Rosie Benneyworth, chief inspector of Primary Medical Services and Integrated Care, said: “We extended the timescales for the urgent conditions to be met, as evidence gathered during this inspection showed some improvement, but it was insufficient to deem that the urgent conditions had been met.

“In addition, we imposed two new urgent conditions on the provider’s registration relating to taking calls from the NHS 111 national contingency service.

“National contingency is a systematic process available to all NHS 111 providers in England. This enables any other NHS 111 services nationally to route telephone calls of another provider during periods of high demand.

“The second condition was for the provider to produce duty rotas which clearly showed which staff were scheduled to work across the service; which staff actually worked; and reasons for absence of staff.

“We also made requirements related to meeting the fundamental standards; complaints handling; provision of staff training, appraisals and supervision; and health and safety.”

The service has now been put in special measures which means it will be inspected again within six months.

If insufficient improvements have been made, the CQC can begin the process of preventing the provider from operating the service.

The service will be kept under review and if needed could be escalated to urgent enforcement action.

Dr Rosie Benneyworth concluded: “Special measures will give people who use the service the reassurance that the care they get should improve.”

Devon Doctors has nine treatment centres in Devon, which are open at various times throughout the week and weekends to provide the out of hours GP service. It also has five treatment centres in Somerset.

Devon Doctors is responsible for providing the NHS 111 service and out of hours service in Devon and Somerset.

The NHS 111 service for Somerset is subcontracted to another provider. Devon Doctors Limited remains responsible for any services which it subcontracts out as the main contract holder.

Staff employed by Devon Doctors Limited include; call handlers, drivers, reception staff, GPs, nurse practitioners, call centre coordinators and supporting office staff holding lead roles such as clinical governance, recruitment, rotas and medicines.

Supporting staff also include communication and information governance staff. These members of staff are led by a management team overseen by a board of directors.

The out of hours service operates between 6pm and 8am Monday to Friday, and 24 hours on Saturdays, Sundays and bank holiday. The NHS 111 aspect of the service provision operates 24 hours a day, all year round.

A spokesperson for Devon Doctors said: “We recognise that we have fallen short of the high standards which characterised Devon Doctors Group services over more than two decades.

“We can only apologise that of late the care received by users of our integrated urgent care services in Devon and Somerset has not been as good as it should have been, while our staff and clinicians haven’t always enjoyed the level of support they might reasonably have expected.

“While putting patients first has always been our overriding objective, it has become apparent that, as Devon Doctors Group has grown and its responsibilities have swelled, some parts of the organisation have struggled to keep pace.

“Remedying this has not been easy and it has taken us longer than we would have hoped to resolve all the concerns raised by the CQC.

“However, after a year of unprecedented challenges, progress is being made. For instance, we have already: recruited significantly more staff; implemented heightened safeguarding measures; improved infection control procedures; and introduced enhanced governance processes.

“In addition, we acted swiftly to affect significant changes in personnel. A number of senior employees have left the organisation, which has been boosted by the recruitment of a number of new directors, and senior managers, with proven track records in the delivery of healthcare.

“Over the coming months, working in tandem with the CQC, National Health Service England (NHSE), our commissioners, and other healthcare partners, Devon Doctors Group will do whatever it takes to build back better and restore the confidence of service users, and other stakeholders, in our integrated urgent care services.

“In the meantime, patients in Devon and Somerset should continue to ‘Think 111 First’ when they need to swiftly and directly access urgent health services in Devon and Somerset. “