Updated 30 June 2017
Our inspection team
The inspection took place over two days. On both days the inspection team was led by a CQC lead inspector.
On 24 May 2017 we visited the head office and one of the primary care centres (at Hereford County Hospital). The team consisted of GP specialist advisor, a practice manager specialist advisor, and four CQC inspectors.
On 27 May 2017 we visited two of the three further primary care centres (at Leominster Community Hospital and Kington Court Community Care Centre). These visits were carried out by the CQC lead inspector.
We did not visit the primary care centre at Ross-On-Wye Community Hospital as part of this inspection.
Background to Primecare – Primary Care – Hereford
Primecare – Primary Care – Hereford provides primary care medical services outside usual GP practice working hours (out of hours or OOH). The provider holds a contract to provide out of hours services with the NHS Herefordshire Clinical Commissioning Group (CCG) within the county of Herefordshire. The population covered by this CCG is approximately 190,000.
Patients access the OOH provision by calling the NHS 111 telephone service. Call handling for the service is carried out by Care UK. The service sees ‘walk-in’ patients wherever possible especially if they were judged to be vulnerable. Reception staff are trained to assess patients and report concerns to clinical staff. Where this is not possible to see these patients they were directed to telephone NHS 111 to book an appointment. Reception staff told us they would assist patients in calling NHS 111 if this was necessary.
The service’s headquarters are located at the Rural Enterprise Centre in Hereford, which is used for administrative and governance purposes. There are no clinical facilities at this site, and no patients are seen.
There are either two or three vehicles (weekends/bank holidays and weekdays respectively) used by the service. These vehicles are based at the Rural Enterprise Centre.
Patients who need to be seen by a clinician are visited at home or are referred by appointment to one of the four primary care centres located in Herefordshire. These are:
- Hereford County Hospital, Stonebow Road, Hereford HR1 2BN (provides OOH services Monday to Friday, 7pm to 8am);
- Leominster Community Hospital, South Street, Leominster HR6 8JH (provides OOH services at weekends and bank holidays, 9am to 1pm);
- Ross-On-Wye Community Hospital, Alton Street, Ross-On-Wye HR9 5AD (provides OOH services at weekends and bank holidays, 9am to 1pm), and;
- Kington Court Community Care Centre, Victoria Road, Kington HR5 3BX (provides OOH services at weekends and bank holidays, 1.30pm to 3pm).
Home visits can take place throughout the out of hours period.
Staffing at each primary care centre typically consists of two GPs (or one GP plus one Advanced Nurse Practitioner), a receptionist, a shift leader, and a driver. Home visits are carried out by one of the clinicians plus the driver.
There are 40 clinicians who provide the OOH service. These are either employed by Primecare, or contract with Primecare on a sessional basis or through an agency. The majority of these clinicians (35) are GPs, with the remainder being Advanced Nurse Practitioners.
Management, administration, policy and procedure, and governance functions for the organisation are performed by Primecare staff. This includes the Head of Quality and Governance, the Contract Manager, the Head of Governance and Assurance, the Clinical Manager, and the Office Manager.
Why we carried out this inspection
We carried out a comprehensive inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
How we carried out this inspection
Before visiting, we reviewed a range of information we hold about the service and asked other organisations to share what they knew. We carried out an announced visit on 24 May 2017 and 27 May 2017. During our visit we:
- Spoke with a range of clinical and non-clinical staff (including GPs, clinical and operational managers, administrative staff, shift leaders, receptionists, and drivers) and spoke with patients who used the service.
- Inspected three of the four out of hours premises, looked at cleanliness and the arrangements to manage the risks associated with healthcare related infections.
- Looked at the vehicles used to take clinicians to consultations in patients’ homes.
- Reviewed the arrangements for the safe storage and management of medicines and emergency medical equipment.
- Reviewed comment cards where patients and members of the public shared their views and experiences of the service.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:
- Is it safe?
- Is it effective?
- Is it caring?
- Is it responsive to people’s needs?
- Is it well-led?
Please note that when referring to information throughout this report, for example any reference to the National Quality Requirements data, this relates to the most recent information available to the CQC at that time.