Care Quality Commission's investigation into GP out-of-hours provider Take Care Now
The Care Quality Commission has published its findings following an investigation into Take Care Now, the GP out-of-hours provider.
The report reveals that Take Care Now did not act on previous warnings about the use of diamorphine. The Care Quality Commission’s investigation was triggered by the death of David Gray, who died after being administered 100mg of diamorphine by Dr. Ubani, an out-of-hours doctor from Germany who was employed by Take Care Now at the time.
Report conclusions:
Diamorphine overdoses
- Two previous incidents at Take Care Now involving overdoses of diamorphine should have raised alarm bells. Concerns had been raised in Take Care Now however the more fundamental changes that might have helped prevent a further incident did not take place until after My Gray’s death.
Out-of-hours service
- Take Care Now struggled to recruit local GPs and relied heavily on doctors flying in from Europe to work weekends. Take Care Now was understaffed which put pressure on other staff.
- The out-of-hours provider failed to recognise the importance of learning lessons from complaints and incidents. Take Care Now failed to adequately report or investigate serious incidents. The provider failed to recognise problems in its own systems and was reluctant to admit its shortcomings.
- Take Care Now’s systems for medicines management were inadequate which led to controlled drugs being stored and administered inappropriately.
- The provider reported activity to Primary Care Trusts in a confusing and potentially misleading way which could have concealed poor performance.
- Take Care Now was focused on growth rather than providing high quality care.
- Commissioning and monitoring of out-of-hours contracts by the five Primary Care Trusts
- Out-of-hours services were low priority at the time and the Primary Care Trusts had limited understanding of these services.
- Out-of-hours was a relatively new area of commissioning and there was a lack of experience in the Primary Care Trusts in contracting with a commercial organisation. Staff responsible for routine monitoring of contracts didn’t fully understand the national quality requirements or Take Care Now's reports on activity or performance. The Primary Care Trusts did not scrutinise performance closely however the lack of transparency in the way Take Care Now reported its activity did not help this.
Report recommendations
- Out-of-hours services present a high risk to both patients and staff. All parties involved in the provision and purchase of out-of-hours services need to ensure that there are sufficient suitably trained and experienced clinical staff engaged in planning and delivering these services.
- Primary Care Trusts must consider out-of-hours services as a vital part of both primary care and of urgent care. Primary Care Trusts need to ensure they are procured and developed strategically.
- Primary Care Trusts need to be aware of the risks in out-of-hours services and actively commission services to reduce these risks. In particular, they need to ensure adequate staffing by GPs.
- Primary Care Trusts should scrutinise out-of-hours services more closely and that staff responsible for monitoring out-of-hours contracts should be sufficiently senior and understand the information being reported by providers.
- Primary Care Trusts should ensure that all serious incidents occurring in out-of-hours services are reported, thoroughly investigated and learning disseminated. Audits should be considered to identify under reporting.
- Primary Care Trusts need to seek and act on feedback from key stakeholders about out-of-hours services, and have clear governance structures in place for escalation of concerns.
- Providers of out-of-hours services need to have effective systems to record activity accurately and analyse data and performance.
- Providers of out-of-hours services must report all serious incidents, including those arising from complaints, and ensure these are thoroughly investigated, with analysis of underlying causes, high quality reports, and changes made at operational level.
- Providers of out-of-hours services need to ensure that clinical audit is used to identify the quality of clinical performance, that feedback is timely, that poor performance is identified and dealt with, and that information is shared appropriately with the relevant Primary Care Trust(s) and/or other authorities in a timely fashion.
- Providers of out-of-hours services need to have effective means to communicate with their frontline staff, particularly about clinical matters, and to listen to the views and concerns of staff.
Susan Brown, a leading medical negligence lawyer from Reading-based Boyes Turner comments: "It is very disappointing to note that Take Care Now, the company responsible for numerous out of hours services, failed to recognise the importance of learning lessons from complaints and incidents. If medical service providers and the NHS are to make improvements in the quality of care that is given to patients then it is essential that each and every serious incident is thoroughly and objectively investigated so that lessons really can be learnt and injuries avoided."
Consistent with our policy when giving comment and advice on a non-specific basis, we cannot assume legal responsibility for the accuracy of any particular statement. In the case of specific problems we recommend that professional advice be sought.
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