Out of hours GP services across Merseyside are so understaffed some patients have been left waiting up to two days for a phone consultation.
According to a report produced by the Care Quality Commission (CQC) following an inspection carried out in May, Primary Care 24 (Merseyside) Ltd, which provides NHS 111 and other out of hours services across Merseyside “did not ensure people's safety was always protected” due to a lack of staff.
A “significant shortfall” of clinicians saw eight clinical staffing shifts left empty during one bank holiday leading to delays in patients receiving treatment.
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Some patients have at times been left waiting all weekend until Monday for an ‘out of hours’ call back with non medical staff being left instead to contact patients periodically and “check their condition had not deteriorated.”
According to the CQC report, problems began after the company, based in Wavertree, took on a significantly expanded contract covering Halton, Knowsley, Liverpool, Sefton, St Helens and Warrington in April 2021, which resulted in a huge increase in the number of people it served.
Primary Care 24 (Merseyside) told inspectors the first year of operation of the expanded service had been “challenging” due to the impact of covid and additional demand “significantly impacting upon the delivery model and performance”.
Commissioned by NHS Liverpool Clinical Commissioning Group, the company had been awarded the expanded contract in February 2020 and were due to take over the service in October of that year, although this was later delayed until April 2021 due to covid.
Primary Care 24 (Merseyside) Ltd is a not for profit social enterprise with directors drawn from across the public and third sectors , providing a range of services across wider Merseyside. Specifically, the company provides out of hours and clinical assessment provision for the NHS 111 service across Halton, Knowsley, Liverpool, Sefton, St Helens and Warrington.
In addition, Primary Care 24 (Merseyside) provides an “extended access appointment service” with GPs and clinicians, covering patients in Knowsley, St Helens and Liverpool. The company also arranges out of hours GP and clinician appointments for people who present at Aintree and Royal Liverpool Accident and Emergency departments but do not to require emergency treatment, as well as a clinician “call answering and advice service.”
Primary Care 24 (Merseyside Ltd) also runs a number of surgeries across Sefton and provides health care to asylum seekers across Merseyside. Finding the company in breach of two Health and Social Care Act regulations in relation to its out of hours provision, the CQC report said key problem areas included “considerable delays” across weekend services and for telephone consultation waiting times.
The report added: “Key performance indicators for integrated urgent care demonstrated poor performance consistently” in relation to timescales for urgent call backs.
In addition, inadequate monitoring of mandatory safeguarding training was identified.
The company was also criticised for the systems it had in place to ensure good governance, with measures to deal with staffing shortages and surges in demand inadequate and “not effective.”
The report added that management weaknesses left staff reporting they felt managers were not “visible” and communications systems were ineffective.
Following the report, which was published on July 22, Primary Care 24 (Merseyside) Ltd must now submit a report to the CQC detailing how it will tackle the breaches and bring about service improvements.
Responding to the report, a spokesperson for Primary Care 24 (Merseyside) Ltd said: “Our colleagues have worked extremely hard and continue to do as we strive for excellence against a backdrop of significant challenges posed by the pandemic.
“We believe that this rating was largely because of the impact of the clinical workforce challenges all providers are currently facing and the levels of patient demand and pressure brought on by the covid-19 pandemic.
“ However, the overall rating also masks much of the very positive feedback we received from the inspectors following their visit, not all of which are specifically articulated in the report.”
The spokesperson pointed to elements of the report, including having been rated ‘good’ for caring, which show positive aspects of the service, adding: “Our continuous focus as an organisation remains doing everything we can to ensure our patients receive high quality care.
“We’re committed to working together with our patients, colleagues, and communities to improve our services.
“We recognise that there is still much for us to do, and this independent review provides invaluable insights and we’re working to ensure that the areas identified for improvement are completed as soon as possible.”
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