Case study: Northdoc
By Dr Mel Bates, Medical Director
There is a famous scene in the movie, Jaws, where Roy Scheider eyeballs the shark for the first time. He walks backwards with a shocked look on his face and says “You’re going to need a bigger boat.” We, in Northdoc, felt a bit like this after the clinical risk assessment we commissioned the MPS to do on D-Doc in 2011. We felt afterwards that we were going to need a bigger team, a bigger Board, and a bigger partnership.
D-Doc is the GP OOHs service covering the majority of the population of north Dublin city and county. It started on 26 November 2006. The quality of the service to patients who attend D-Doc depends on the participation of experienced local GPs. There are three strands to the service, with Northdoc providing doctors and medical governance, CareDoc providing nurse triage, and the HSE providing the infrastructure (centres, cars, computers) and other staff (nurses, drivers, call takers and receptionists).
We developed protocols and guidelines and by 2011 we felt we were ready to measure ourselves against international standards and invited MPS to carry out the audit
We operate from five centres, with up to three cars at the weekends. Ninety five per cent of the shifts up to midnight are covered by local general practitioners. In 2012 we had 97,000 contacts to the service. The first few years were challenging. Our main focus was on change management and simply filling the roster. We developed protocols and guidelines and by 2011 we felt we were ready to measure ourselves against international standards and invited MPS to carry out the audit.
On the day
The MPS assessors were both charming and thorough. They were obvious fans of the 1970s detective series, Columbo, starring Peter Falk: “That’s great, but there’s just one more thing that bothers me.” In the face of this approach, Liam Quinn (manager) and I confessed to crimes we had never committed. Over two and a half days, every contribution to the service, from Northdoc, the HSE and CareDoc, was scrutinised in forensic detail.
In-depth face-to-face interviews with drivers and on call doctors and managers were achieved in a finely choreographed schedule. The data from 164 questionnaires returned by doctors and nurses working in the service were collated and measured against similar audits in mainly UK-based GP co-ops. All documentation relating to any policies or protocols in Northdoc was examined, including the Doctor’s Handbook (our GP guide to practical medical issues met in out of hours).
The MPS team found the staff throughout D-Doc to be very dedicated and ambitious to further develop the service. They were impressed by the medication protocols, the Doctor’s Handbook, the robust complaints handling procedures, and the quality of the leadership and management in Northdoc. The fact that we volunteered for the risk audit demonstrated our drive for quality and our wish to meet best standards.
Having one person doing all the duties of the Medical Director was not sustainable and restricted development of the service
They made many observations:
- Having one person doing all the duties of the Medical Director was not sustainable and restricted development of the service.
- Upskilling the Board would pay dividends.
- The complaints handling service needed to be upgraded and delegated.
- Recruitment protocols needed to be upgraded and delegated.
- More monitoring of the quality of the service including clinical performance auditing, meeting target response times, and promoting a culture of feedback within the organisation to promote quality was recommended.
- More robust capacity planning.
- Regular patient satisfaction surveys.
- Computers in the cars to allow contemporaneous note taking.
- Internet access in the centres to allow ready availability of up-to-date guidelines.
A risk assessment begins as a single event and quickly becomes an ongoing process of assessment and review. Out of this process, we have discovered this paradigm: Patient’s safety = doctor’s safety = corporate safety. Anything we do to promote patient safety benefits our GP members and protects the company which is responsible for managing their out of hours service. Fifteen months on, we have implemented almost all of the MPS recommendations. We will, in all probability, look into the jaws of another audit in the future – but next time, we will have more confidence in our boat.
If you are interested in booking a risk assessment for an OOHs service provider, please contact [email protected] or contact +44 113 241 0624.