Stamford and Rutland Hospital

Updated 10 July 2014

Lincolnshire Community Health Services NHS Trust provides the GP out-of-hours service for Lincolnshire. The service is commissioned by the four Lincolnshire Clinical Commissioning Groups (CCGs), with the lead for out-of-hours services being Lincolnshire East CCG.

The out-of-hours service provides care to patients who required urgent medical care from a GP outside of normal GP hours.102 GP practices were covered by the service. The provider employed the services of 100 GPs who were engaged on a sessional basis to deliver care to patients. The service operated from 7pm to11pm Monday to Friday and 8am to 11pm at weekends.

Initial telephone contact with the out-of-hours service is through the NHS 111 telephone system, a service provided by another healthcare provider.

The out-of-hours service was split into three ‘Business Units’, serving the North West, East and South of the area geographically aligned to Lincolnshire’s Clinical Commissioning Groups.  The out-of-hours service in each was managed by an Urgent Care Matron.

The service provided care to a population of 723,000 residing in an area of 2,350 square miles from eight primary care centres geographically spread across the county. The eight locations were;

• The County Hospital, Lincoln                                      
• John Coupland Community Hospital, Gainsborough  
• Grantham and District Hospital                                   
• Stamford and Rutland Hospital, Stamford                  
• Johnson Community Hospital, Spalding                     
• The Pilgrim Hospital, Boston                                      
• Skegness and District Hospital                                   
• County Hospital, Louth                                                

In the year, 2013/14 in excess of 100,000 patients accessed the out-of-hours service.

This inspection focused on the out-of-hours service at Stamford and Rutland Hospital.

Updated 10 July 2014

Lincolnshire Community Health Services NHS Trust provided out-of-hours General Practitioner (GP) services for patients living in Lincolnshire. The service was administered from the trust’s headquarters in Sleaford and patient care and treatment was provided from eight primary care centres at locations across the county. We visited the trust’s headquarters on 5 June 2014 where we looked at records and information and talked with staff about issues that related to all eight locations and the service a whole. On the 6 or 7 June 2014 we visited the primary care centre at Stamford and Rutland Hospital and spoke with members of staff, patients and carers and reviewed documents and matters specific to that location.

Lincolnshire Community Health Services NHS Trust provides out-of-hours General Practitioner (GP) services for patients living across Lincolnshire. It is registered to provide the regulated activities of diagnostic and screening procedures and the treatment of disease, disorder or injury at Stamford and Rutland Hospital.

The provider conducted clinical audits that addressed specific areas of patient care. Individual clinician’s practice was assessed on a regular basis to help ensure that patients received safe and effective care and treatment.

We found the service was effective in meeting patients’ needs and the primary care centres were accessible to those who may have mobility issues.

Staff were trained and supported to recognise the signs of abuse of children and vulnerable adults and were provided with training to heighten their awareness of domestic violence.

The provider had not used effective recruitment processes to assess the suitability of staff to work in this sector. We have told the provider they must improve.

Patients experienced care that was delivered by dedicated and caring staff. Patients and carers we spoke with said staff displayed a kind and caring attitude. We observed patients being treated with respect and kindness whilst their dignity and confidentiality was maintained.

The provider had in place business continuity and contingency plans that would enable the service to continue to operate in the event of a failure of, for example, the information technology or telecommunication systems.

We found that the service was well-led and managed by a knowledgeable senior management team and board of directors. They had taken action to help ensure their values and behaviours were shared by staff through regular engagement.

Members of the staff team we spoke with held positive views of management and their leadership and felt well supported in their roles. They told us the senior managers were approachable and listened to any concerns or suggestions they might have to improve the level of service provided to patients.

We found the provider did not have reliable and safe medicine management systems in place. There were no formal procedures or audits for medicines received and held. Reliable checks would ensure safe administration of medicines, and minimise the potential for error. We saw four medicine reference books, including those in the vehicle, which were out of date. This meant the GPs and other clinicians did not have the most up to date resource for prescribing although this was available on line. However, these could not be used on home visits because staff did not have access to remote electronic recording systems. Following on our visit the provider took steps to improve the medicines management systems to keep patients safe.