Practice Plus Group - Devon OOH/CAS

Updated 23 October 2023

Practice Plus Group - Devon OOH/CAS is the registered location for services provided by Practice Plus Group Urgent Care Limited and provides out-of-hours primary medical services to patients in Devon when GP practices are closed.

The Devon out-of-hours service is contracted locally to take any patient calls made to GP practices after 6.30pm. The out of hours service is provided between 6.30pm and 8am on weekdays and 24 hours on weekends and bank holidays. The service is run from an administrative base and nine primary care centres. The service provides the clinical assessment service (CAS) for NHS 111, the ambulance service, care homes and health care professionals, which is delivered from a base in Exeter. Clinicians working at the bases carry out telephone triaging and face to face appointments, which are booked after a telephone triage call. There are also clinicians who work remotely and carry out telephone triage and when appropriate, offer advice and referrals to other service, such as pharmacies and minor injuries units.

The service is commissioned by Devon Integrated Care Board (ICB) and covers a population of approximately 814,500 people across the county of Devon. During the spring and summer months the population more than doubles due to tourism. Nearly 25% of the population of Devon is over 65 years old and 26% live in rural areas with limited access to public transport and out of hours pharmacy provision. Practice Plus Group (PPG) provides services in a number of rural locations.

The administrative base is located at:

Stratus House, Emperor Way, Exeter EX1 3QS

The out of hours service is provided from the administrative base and nine primary care centres. Patients are triaged according to clinical need and may be invited to attend a face-to-face appointment at one of the centres (during the hours listed):

Stratus House, Emperor Way, Exeter EX1 3QS (111, CAS & OOHs Hub) – open 6pm to 11pm weekdays and 8am to 11pm at weekends)

Practice Plus Group Hospital, 20 Brest Road, Plymouth PL6 5XP – open 6pm to 11pm weekdays and 8am to 11pm at weekends

Trelawny Surgery, 45 Ham Drive, Plymouth PL2 2NJ – open 8am to 6pm at weekends only*

St Leonard’s Practice, Athelstan Road, Exeter EX1 1SB– open 6.30pm to 11pm weekdays and 8am to 11pm at weekends

North Devon District Hospital, Raleigh Park, Barnstaple EX31 4JB – open from 7pm Monday to Friday and at weekends *

Tiverton Treatment Centre, Honiton Hospital, Marlpits Lane, Honiton EX14 2DE – open 9am to 6pm at weekends only*

Okehampton Treatment Centre, Okehampton Hospital, Cavell Way EX20 1PN – open 6.30pm to 11pm weekdays; 8am to 11pm at weekends *

Newton Abbot Treatment Centre, Newton Abbot Hospital, Jetty Marsh Road TQ12 2TS - open 6pm to 11pm weekdays and 8am to 11pm at weekends*

Totnes Treatment Centre, Totnes Hospital, Coronation Road, Totnes TQ9 5GH - open 6pm to 11pm weekdays and 8am to 11pm at weekends*

*Some of the primary care centres had flexible opening arrangements which was agreed with local commissioner, due to resource availability.

Patients access the service via the NHS 111 Service. Patients may be seen by a clinician at one of the primary care centres, receive a telephone consultation or a home visit depending on their assessed needs.

During the inspection we visited the Primary Care Centres at Exeter, Plymouth, Newton Abbot and Barnstaple. In the body of the report, we use the term ‘Bases’ when referring to the Primary Care Centres.

The provider is registered to provide the following regulated activities:

Transport service, triage and medical advice provided remotely

Treatment of disease, disorder or injury

Updated 23 October 2023

This practice is rated as Requires Improvement overall. This was the first inspection of this service.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Practice Plus Group - Devon OOH/CAS between 10 and 20 July 2023. We were onsite at the service on 17 and 18 July 2023. (OOH-Out of Hours and CAS-Clinical Assessment Service). This was the first inspection of this service since the provider, Practice Plus Group Urgent Care Limited, registered with the Care Quality Commission to provide a service from this location in September 2022.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing and face to face with staff members.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• Requesting the completion of a staff survey document.
• Conducting site visits.

At this inspection we found:

• Practice Plus Group (PPG) faced unique challenges in delivering this newly commissioned service. In response, we saw the provider demonstrated a willingness to constantly review and shape the service by ensuring it was agile and responsive to the needs of the expanding rural population of approximately 814,500 people (doubling in spring and summer).
• The provider had clear systems to manage risk so that safety incidents were less likely to happen. However, not all risks were adequately identified, limiting the facilitation of learning and improved patient safety processes.

• The provider reviewed the effectiveness and appropriateness of the care delivered. However, there was a theme of delayed responses for patients resulting from recruitment and staffing challenges, and inappropriate referrals for assessment. Whilst actions were taken or were in progress, sustained improvement in outcomes for patients had yet to be achieved.

• The service ensured care and treatment was delivered according to evidence- based guidelines.
• Staff always treated patients with compassion, kindness, dignity and respect.
• There was high levels of engagement with the public, staff and external partners to receive feedback and involve them in developing sustainable high quality care.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Overall governance arrangements still needed time to embed in this newly established out of hours service for Devon.
• Processes for managing risks, issues and performance did not provide assurance all risks had been identified and mitigated as far as reasonably practicable.

The areas where the provider must make improvements as they are in breach of regulations are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, specifically to:

• assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity.

The areas where the provider should make improvements are:

• Provide consistency in the standard outcome wording within response letters to complaints.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services