Health bosses urge improvement in Somerset's out-of-hours GP and NHS 111 services

  Posted: 18.11.20 at 11:13 by Daniel Mumby - Local Democracy Reporter

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Health bosses have called for rapid improvements in Somerset’s out-of-hours services to ensure patients are treated quickly and safely.

Devon Doctors Ltd provides Somerset’s urgent integrated care service, comprising the out-of-hours GP and NHS 111 systems, which can diagnose and direct patients to the appropriate NHS services.

The Care Quality Commission (CQC) inspected Devon Doctors in July after “concerns were raised” about how will it was delivering these services.

Its investigation found that patients were not being treated or triaged quickly enough, with response times being below the England average.

The Somerset Clinical Commissioning Group (CCG) said the NHS 111 service had suffered because of the coronavirus, and that steps were being taken to address wider problems with Devon Doctors’ performance.

Devon Doctors took over the running of Somerset’s out-of-hours GP service from Vocare in April 2018, and was awarded a new £7 million contract for both this and the NHS 111 service by the Somerset Clinical Commissioning Group (CCG) in February 2019.

While Devon Doctors runs the out-of-hours GP service directly, the NHS 111 operation is sub-contracted to Practice Plus Group, formerly known as Care UK.

The CQC carried out a three-day inspection of Devon Doctors’ operations, and despite giving it an overall ‘good’ rating, it noted the following shortcomings which needed to be urgently addressed:

* Staff did not always follow procedures to keep patients safe and safeguarded from abuse
* Not all staff had received sufficient training in safeguarding or health and safety
* Staff did not feel properly supported by the leadership team
* Staff were working with out-of-date information to deliver safe care and treatment to patients
*The NHS 111 service was not meeting targets – the number of calls answered within 60 seconds "regularly fell below the national average”

Janet Ortega, the 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 the Devon and Somerset CCGs 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.”

A further report on Devon Doctors’ performance was published before a virtual meeting of Somerset County Council’s adults and health scrutiny committee on Thursday (November 12).

Hugh Archibald, the CCG’s quality lead officer for urgent care and risk management, said a number of changes had been put in place following the July inspection – namely:

* Introduction of “comfort calling” (where patients whose callback overruns are given an additional call by clinicians to ensure their condition hasn’t worsened)
* Introduction of a new lead clinician to monitor calls and ensure callers are correctly prioritised and directly to the appropriate resources
* Recruitment of further clinicians, including GPs, into the service
* Changes in how emergencies are categorised to ensure the most urgent patients are properly prioritised
* A plan to improve performance, based on keeping patients safe
* Changes in the internal management and governance structure

Mr Archibald admitted the NHS 111 service was still underperforming as a result of additional pressures from the coronavirus, but said more capacity would soon be made available.

In the week ending October 4 (the most recent figures available), 79.6 per cent of calls to NHS 111 in Somerset were answered within 60 seconds – lower than the England average of 81.2 per cent.

The call abandonment rate (the number of callers who hung up before they were answered) was similar to the England average, at five per cent.

Mr Archibald said: “The national Covid Response Service had a soft relaunch on October 12, and so improvements in performance both for Somerset and nationally is expected as this additional resource comes online.”

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