Practice Plus Group - Devon OOH/CAS

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