Lincoln County Hospital

Updated 10 July 2014

The GP out-of-hours service for Lincolnshire is provided by Lincolnshire Community Health Services NHS Trust. The service is commissioned by the four Lincolnshire Clinical Commissioning Groups (CCG’s), with the lead for out-of-hours services being Lincolnshire East CCG. The landlord for the out of hours location is United Lincolnshire Hospitals NHS Trust who runs Lincoln County Hospital.

The out-of-hours service provides care to patients who require urgent medical care from GPs and nurses outside of normal GP hours.102 GP practices are covered by the service. The provider employs the services of 100 GPs who are engaged on a sessional basis to deliver care to patients. The service operates county wide from 6.30pm until 8am Monday to Thursday, and 6.30pm Friday until 8am Monday, and all public holidays. During the day the location is an independent outpatient department of the hospital unconnected to the out-of-hours service.

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

The out-of-hours service is split into three ‘Business Units’, which comprised the North West, East and South business units. They are geographically aligned to Lincolnshire’s Clinical Commissioning Groups.  The out-of-hours service in each of these business units is managed by an Urgent Care Matron.

The service provides 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 are;

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.

Updated 10 July 2014

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.

The out-of-hours service conducted clinical audits that addressed specific areas of patient care. Individual clinicians’ 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 service was accessible to those who may have mobility issues.

We saw that leaflets to inform patients about how they might raise a complaint were only available in English, but we saw documentary evidence that the Clinical Commissioning Group had instructed that they should not be printed in other languages due to cost. The out-of-hours service had access to language line, which provided a telephone interpretation service. We were told that interpreters could be brought in if necessary. However this was very rare, as most patients either came with someone who could speak English or were able to make themselves understood.

There were systems in place to help ensure patient safety through learning from incidents, the safe management of medicines and infection prevention and control. Following our inspection we raised concerns with the provider with regard to the management of medicines. We received a swift response detailing what action would be taken to address the concerns.

Staff were trained and supported to help them recognise the signs of abuse of children and vulnerable adults and provided staff 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 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. However, staff did say that it was very rare to see a senior manager at the out-of-hours service due to the hours the service operated.