Care Quality Commission
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CQC publishes report on out of hours GP services in Cornwall
The Care Quality Commission has told Serco Ltd that it must take action to improve its out of hours GP services in Cornwall and the Isles of Scilly.
In a report published recently CQC says that Serco was not meeting four of the essential standards of quality and safety. Providers have a legal responsibility to make sure they are meeting all the essential standards.
Serco has been given 14 days to provide a report setting out how it will achieve compliance. CQC inspectors will revisit the service at a future date without giving any notice to check that the required improvements have been made.
The recent report follows inspections conducted during April and May. A team of inspectors, joined by professional advisors, made unannounced visits to the company’s call centre in Truro and five clinics where they met patients, GPs, support staff and others. They also spoke to current and former members of staff who asked to pass on information in confidence.
CQC had decided to carry out this review because concerns were identified in relation to eight outcomes, including respecting and involving people who use services, the care and welfare of people, safeguarding, levels of staffing and staffing issues, arrangements for assessing and monitoring the service, and their complaints procedures.
The inspectors found that Serco was meeting four of the essential standards which were reviewed. They were not meeting the four other standards:
Safeguarding people from abuse
Inspectors concluded that people who use the service were not protected from the risk of abuse, because not all staff were trained in the safeguarding of vulnerable adults and children.
Inspectors found that there were not enough qualified, skilled and experienced staff to meet people’s needs. While the service was currently in the process of recruiting more GPs, there was a shortage of clinical staff at times. Inspectors found that on one particular weekend, some doctors were working double shifts which consisted of 13-hours through the night, and others were working 11-hour daytime shifts. Serco acknowledged that it had underestimated demand over the Easter weekend, and that it was unable to cover some GP shifts over the May Bank Holiday, meaning that people received a slower service.
Among complaints from patients, one person complained of waiting at a clinic for 90 minutes; another gave up waiting for a home visit and dialled 999.
The report concludes that not all staff received appropriate training and professional development. A quarter of staff had not completed mandatory training. Although Serco said that all their GPs received formal clinical supervision, not all staff had received regular appraisals.
Assessing and monitoring the quality of service provision
Inspectors found that the provider did not have an effective system to assess and monitor the quality of service that people receive.
Serco demonstrated how it routinely altered daily performance reports which showed if the service was meeting its targets for responding to calls from patients on time. A manager would go through the performance figures and correct individual records which suggested the service was failing if the entry was known to be incorrect for any reason.
But the company said it would take too long to check whether calls reported as achieved might also be wrongly categorised and should be changed.
A further concern with the accuracy of the data was raised when inspectors examined a small sample of data and found two examples of failed calls which had been wrongly classified as achieved.
The inspectors did not find evidence that the figures had been deliberately altered to enhance performance. ut it was clear that problems with the computer system had been known about for several years, but there was no strong evidence of attempts to resolve this.
Serco had a whistleblowing policy in place – but some staff told inspectors that they would be anxious about raising concerns with their manager, because of possible repercussions.
Ian Biggs, deputy director of CQC in the South said:
“At least half a million people depend on this service, so it is vital that it is properly staffed with properly qualified GPs who are available when people need them.
“At times, Serco has not had enough doctors on duty and it is hardly surprising that people have complained. sking GPs and their drivers to work such long hours should be a last resort.
“However we note that the service has already recruited more GPs and has introduced a new triage system to cope more effectively with calls.
“We haven’t found that the company have been deliberately misleading the people of Cornwall about their performance, although quite clearly the system of monitoring performance is unreliable.
“When the managers correct the data, only the calls that would improve the overall daily performance are subject to checking and reclassification, so that must raise questions about the accuracy of the data. It is possible that the performance of the provider may be overstated in their reports.
“We have been told that the problems of wrong classifications have been known to Serco for about four years – so it is puzzling that this has not been resolved before now.
“We now expect Serco to address these issues. The company has 14 days to tell us what they will do to ensure compliance. My inspectors will return at some time in the near future to check that the required improvements have been made and we will report back on our findings.
“We are grateful to former and current members of staff who, quite rightly, drew their concerns to our attention. While we have not found evidence that the data has been falsified - they did lead us to information which helped us to arrive at our overall findings.”
For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.
Notes to editors
About the Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of health and social care in England. We make sure that care in hospitals, dental practices, ambulances, care homes, people’s own homes and elsewhere meets government standards of quality and safety – the standards anyone should expect whenever or wherever they receive care. We also protect the interests of vulnerable people, including those whose rights are restricted under the Mental Health Act.
We register services if they meet government standards, we make unannounced inspections of services – both on a regular basis and in response to concerns – and we carry out investigations into why care fails to improve. We continually monitor information from our inspections, from information we collect nationally and locally, and from the public, local groups, care workers and whistleblowers. We put the views, experiences, health and wellbeing of people who use services at the centre of our work and we have a range of powers we can use to take action if people are getting poor care.