· Web view35 – Cover email and letter re patient being sent to A&E (supplied in PDF and word) 35 – email and attachment re UHL ED Handbook 35 – SELDOC Weekly Bulletin

Strictly Private and Confidential

Independent Investigation for SELDOC Doctors Cooperative Ltd

Whistleblowing Concern March 2018

FINAL REPORT

Produced by: Howbeck Healthcare LtdJuly 2018

Lead Author: Tina Cookson

1Howbeck Healthcare – SELDOC Final Report


CONTENTS PAGE

Page No.

1. Background 3

2. Outline of Concerns Raised 3

3. Investigation Methodology Outline 4

4. Communications to Staff 4 - 5

5. Investigation Findings 6

5.1 Examples of Findings by Allegation Theme 7 - 155.2 Final Investigation Findings 16 - 18

6. Recommendations 19 - 25

7. Conclusion 26

Appendices:

Appendix 1 Terms of Reference for the Review 27 - 29

Appendix 2 Investigation Methodology 30

Appendix 3 Communications sent to staff from the Chief Executive 31 - 33

Appendix 4 Matrix of Staff Interviews 34 - 35

Appendix 5 Improvement Ideas from Staff Interviews 36 - 38

Appendix 6 Schedule of Information Received 39 - 54



1. Background

SELDOC Doctors Cooperative Ltd received a Whistleblowing Concern in March 2018 and commissioned Howbeck Healthcare to undertake an independent investigation. The full terms of reference for this investigation can be found at Appendix 1, however in summary Howbeck Healthcare aimed to seek to:

Determine whether the allegations made were wholly or in part correct, If Howbeck Healthcare found that any of the allegations were founded we would look

to determine whether the ‘harm’ was potential, actual, or neither. Review any actions taken as a result of the internal investigation into a previous and

very similar whistleblowing allegation (Previously received by SELDOC in Summer 2017).

The project brief and investigation approach were themed into the following areas: Raising concerns / whistleblowing Shortage of staff and impact on staff Service delays and impact on patients Advice to patients Management practice and operational policies and processes Safe clinical practice.

We have not included the whistleblowing letter in this report as it names SELDOC staff.

2. Outline of Concerns Raised

Following analysis of the Whistleblowing Concern received, 6 areas were identified to form the main focus of the investigation.

1) Whistleblowing. It was alleged that staff had been victimised for raising concerns.

2) Shortages of staff. It was alleged that staffing levels were insufficient to cover the workload.

3) Service Delays. It was alleged that the impact of the staff shortages had meant that there had been excessive delays in both the call back to patients and in the response to patients.

4) Advice to Patients. It was alleged that patients were encouraged to use the service inappropriately.

5) Management Practice. There were a number of allegations relating to the way the service is managed (in addition to the allegation of victimisation of Whistle-blowers) these include:

a) Failure to ensure staff safety including the lack of panic buttons and a failure to protect staff from verbal and racial abuse.

b) Poor monitoring of activity, adherence to SOPs.c) Poor training.d) Falsification of rota information.e) Management and Leadership of the organisation

6) Safe Clinical Practice. There was a specific allegation that one Doctor had inappropriately prescribed controlled drugs.



3. Investigation Methodology Outline

The investigation formally commenced on the 16th May 2018, for an anticipated period of approximately 4 weeks.

Due to delays in receiving some information and arrangements to speak to key staff the timeline for completion of the draft report was extended to Tuesday 2nd July 2018 and was agreed between Howbeck Healthcare and the Chief Executive of SELDOC Doctors Cooperative.

The full investigation methodology can be found at Appendix 2.

During the interviews with staff they suggested a number of service improvement ideas, these can be found at Appendix 5.

In the terms of reference, we said we would send out a confidential staff questionnaire and speak to some patients about the experience of the service. We did not progress either of these as our site visit and early information received indicated there would be little value in doing these as we gained sufficient evidence from other information and speaking to staff.

4. Communications to Staff

During or after the previous 2017 whistleblowing allegation no communication went out to staff. It was agreed between Howbeck Healthcare Investigation Lead and SELDOC Chief Executive that communication with staff was essential especially as the allegations had come in anonymously and as this Whistleblowing letter was very similar to the concern received in 2017.

Communications were agreed jointly between the investigating team and the Chief Executive, Steven Pink and circulated from the SELDOC CEO Office. A summary of the communications is detailed below, and full copy of communications circulated to staff are included at Appendix 3.

Three communications were circulated to staff during the investigation as follows:

21st May 2018: To advise staff: - That SELDOC had received a Whistleblow covering a number of concerns in relation

to the South East London GPOOH service. That Howbeck Healthcare had been appointed to investigate and to encourage staff

to be open and honest in speaking with the investigation team, whether asked to speak to the team or if staff wished to make contact directly to share concerns.

30th May 2018: To advise staff: - Of the broad themes of the concerns. Of the two-day site visit scheduled for the 30th and 31st May 2018. Of how to contact the investigation team should they wish to share any information

whilst on site or at any point during the investigation timeframe.

6th June 2018: To advise staff: - Of progress with the investigation. That the investigation period was drawing to a close. That the latest opportunity to contribute information / speak to the investigation team

would be the 11th June 2018.



Communications to staff covered a three-week time period to ensure all staff across the organisation had an opportunity to contribute to the investigation should they wish, allowing for individuals who may have been on annual leave for a two week leave period to be aware of the investigation on their return.

It is worthy of note that the communications from the Chief Executive positively encouraged staff to engage with the investigation and he also offered open access to himself to discuss any concerns at any time via the new confidential email [email protected] .


mailto:[email protected]


5. Investigation Findings

Howbeck Healthcare undertook the independent investigation within the following scope: To determine whether the allegations made were wholly or in part correct, If Howbeck Healthcare found that any of the allegations were founded we would look to determine whether the ‘harm’ was potential,

actual, or neither. Review any actions taken as a result of the internal investigation into the original whistleblowing allegation (Previously received in

Summer 2017).

We reviewed 156 pieces of information and spoke to 43 staff which gave us a good range of information to assess the whistleblowing allegations and also as agreed with the Chief Executive, how SELDOC is doing with the wider associated management and leadership of the organisation.

We recognise that 43 staff members is relatively small, but many staff talked about other staff examples and the points we picked up especially from front line staff, were consistent.

We also reviewed the 2017 investigation findings, the allegations of which were very similar to the 2018 concern. The 2017 investigation did not uphold any of the allegations that were made. There were some improvement actions identified but it was not easy in this investigation to track the positive impact or learning from the 2017 whistleblowing report.

As part of this investigation report we felt it was important to include some of the examples that helped reached the conclusions rather than just share the final decision. The main reason for this is that where we have not upheld the allegation, there is clearly an improvement opportunity for SELDOC that the wider information gathered, especially from staff that can inform SELDOCs improvement journey.

We have given narrative examples from our analysis of the information and interviews in section 5.1 to provide rationale for our decisions and recommendations.



5.1 Examples of Findings by Allegation Theme

1 Staff victimised for raising concerns From evidence we reviewed

We found no direct evidence of this from the information shared with us and from the managers and leaders we spoke to.

From clinical staff interviews

We were not given any evidence of this. Some staff did say that they had heard some examples of this from colleagues, but they hadn’t experienced it directly. Some staff said they were pleased that this investigation was taking place, as it was difficult to raise concerns internally

and for anything to change. Some staff told us they found SELDOC a very supportive place to work.

From non-clinical staff interviews

Some staff did give us some examples, but they asked us not to share the specifics as they would then be identified. Staff felt they didn’t get work, especially extra shifts, after they had raised concerns about processes or managers. It was difficult to track evidence of this due to the way Rotamaster is set up. (See more information in section 5d). Some staff said they were pleased this investigation was taking place as it was difficult to raise concerns internally and

for anything to change. Some staff told us they were very happy working at SELDOC There was a very strong loyalty to SELDOC even from the staff that shared concerns.

2 Shortages of staff Staffing levels insufficient to cover workload

From evidence we reviewed

There is some evidence of this. It is difficult to determine if SELDOC is worse than other similar providers as most NHS services have struggled to

meet the demand over winter, and peak pressure periods like bank holidays or outbreaks. The evidence suggests SELDOC could have done more to address staffing levels especially during predictable peak

periods.


Staff gave us some evidence of this. Staff were very supportive of the team leaders / supervisors – they felt they had very difficult jobs and didn’t always get

the support they needed, especially when the shift was starting with less staff than was needed or activity was higher than predicated.

Some staff spoke positively about the Senior Rota Manager saying that he worked hard on building relationships which


Strictly Private and Confidential helped when staff were asked to do extra shifts.

Staff told us that when the service was under pressure the criteria for some dispositions was changed, especially for home visits, which they felt uncomfortable about as it was done due to inadequate staffing and wasn’t the right outcome for patients.

Staff did say that everywhere was struggling with staff but that SELDOC could do more to recruit and retain staff which would help.


Staff gave us some evidence of this. Staff said it was the lack of GPs that was the main pressure. There had been new SOPs regarding managing the workload better, but there was a need for more clinical staff

especially on home visits. It was easier to fill non-clinical rotas as there was a lot of staff who were keen and willing to do extra hours and be

flexible with their roles. However, staff said the late issuing of the rota caused problems and sometimes this affected goodwill.

From manager and leader interviews

It was acknowledged that rotas could not be fully populated all the time and managers and leaders were working to improve this.

SELDOC had successfully introduced Pharmacists into the service and started a pilot of using Advanced Nurse Practitioners earlier this year. They had also put in new SOPs to better manage the different “queues”.

There is a senior clinical and non-clinical on call rota for staff to escalate to, and the team leader / supervisors can make local decisions on bringing in extra staff or extending shifts to manage the demand on any particular shift.

3 Service Delays Staff shortages led to excessive delays in call back and response to patients.


There is some evidence of this (note: although we mainly looked at evidence from the dates referred to in the letter we did get access to wider set of performance data).


Staff gave us evidence of this and shared how difficult it is to know that the staffing isn’t meeting the demand. Some staff said they had highlighted risks and possible solutions, but these had not always been addressed. They did

also say that great effort was made to fill the rotas but often quite late which then put pressure on extending shifts of those who had already committed to work.

From non-clinical staff

Staff gave us evidence of this and shared how difficult it is to not meet the patient need in a timelier way, and to then keep re-contacting patients about further delays to the agreed plan.


Strictly Private and Confidential interviews The introduction of the Comfort Calls Policy and the Failed Contact Policy had created extra work, but staff did

acknowledge that these were there to ensure patients were safe. Strong view from staff that more staff were needed to staff the service properly and this would then reduce the

additional work from comfort calls – i.e. patients would get the service they needed within the standards and clinical prioritisation times that were set.


SELDOC leaders and managers acknowledged that at times the service isn’t able to meet the patient demand. The have introduced new senior meetings on Mondays to review the weeks performance data and any concerns that

have arisen, so they can be responded to in a timely way. CCG staff member we spoke to advised that all activity and performance is monitored through the contract monitoring

process and that the CCG worked closely with SELDOC on monitoring and improving performance

4 Advice to Patients Patients are encouraged to use the service inappropriately


We found no evidence that SELDOC were advising patients inappropriately.


Staff told us that patients often said they couldn’t get an appointment with their GP and had been told to ring SELDOC.

This is a historic and national issue which is often difficult to prove or disprove especially when the priority is resolving the patients’ medical concern.


Staff told us that patients often said they couldn’t get an appointment with their GP and had been told to ring SELDOC.

Staff felt patients kept the SELDOC number and used it directly. This is a historic and national issue which is often difficult to prove or disprove especially when the priority is resolving

the patients’ medical concern.


This issue was well known and SELDOC had been trying to address it for many years but there was often little evidence to go back to practices with and it was recognised that it is likely that some patients had not contacted their practice on the day.

5a Failure to ensure staff safety –


Strictly Private and Confidential i) lack of panic buttons in rooms ii) failure to protect staff from verbal and racial abuse


i) There are panic buttons in the clinical rooms. We were sent photographs and saw them when on the site visit.There is no panic button in reception but there is a camera which is monitored by the team leader /supervisor.

ii) We were sent the Zero Tolerance Policy and examples of when it had been used. Staff told us about 1 incident, but this was not recorded in the incidents we saw.


i) Staff told us the panic buttons were not ideally located in some of the rooms and this had been fed back. A GP told us about an incident, but this was not in SELDOCs incident log.

ii) Staff told us they reported incidents or patients they had concerns about, and they were told they were followed up.Staff we spoke to were aware of the Zero Tolerance Policy.


i) Staff told us that the panic buttons were not all ideally located in the clinical rooms and this had been fed back. They also told us they had asked for a panic button to be put in reception and this was being considered by managers. There is a camera in place and it is monitored by the team leader / supervisor, but they are not always at their desk.

ii) Staff told us they reported incidents or patients they had concerns about and they were told they were followed up. Some had seen evidence of this.

Staff we spoke to were aware of the Zero Tolerance Policy.Staff did say it was difficult dealing with patients who were very frustrated if there were long waits for services.


i) It was confirmed that as part of the estates review the location of the panic buttons was being reviewed. We were told staff have mobile panic buttons, but we didn’t see these during our site visit nor were told about them by front line staff ii) The Zero Tolerance Policy was used when staff raised concerns about patients and we were given examples.


Strictly Private and Confidential 5b Poor monitoring of activity and adherence to SOPs From evidence we reviewed

We looked at this and it was difficult to make the link via the evidence review as the formal reporting didn’t connect the two.

The internal operational performance reviews and meetings did look for any escalation activities. We did find evidence of new policies and SOPs that had come out of learning and recognition of improvement

needed.From clinical staff interviews

Staff told us that activity is monitored closely on the shift to ensure performance measures are met. Staff can be moved between activities to manage different “queues” and to ensure that patient needs are met in a timely way.

Some staff found the Failed Contact Policy and process frustrating as whilst they fully recognise that the patient may have become seriously unwell, often they have left the house, so there are many wasted home visits that compromises the patients who need a home visit. Staff felt if the staffing were better the Failed Contact and Comfort Call Policies would be needed less and patients’ needs would be met in a timelier way.

Some staff told us that the SOPs were changed depending on operational pressures, especially the changing of the home visit category. They didn’t agree with this as it wasn’t in the best interests of patients. They felt if staffing was better the escalation SOPs would be needed less.

Staff said they knew where to find policies and SOPs and that the team leaders / supervisors often led use of them.From non-clinical staff interviews

Staff told us that activity is monitored closely on the shift to ensure performance measures are met. The team leader / supervisor is responsible for this.

Some, not all staff we spoke to, said feedback on poor performance can be negative and demoralising. When we were observing a shift, we saw other team members flagging risks to the team leader which was positive. Some staff told us that the SOPs were changed depending on operational pressures, especially the changing of the

home visit category. They felt if staffing was better the escalation SOPs would be needed less. Staff said they knew where to find policies and SOPs and that the team leaders / supervisors often led use of them on

each shift. Staff also told us there were printed copies in the base although they were not always up to date.


Operational activity is reviewed daily and as part of a weekly management and leadership group. Monitoring activity and performance against the national and contracted standards is taken very seriously. We were sent additional information after the interviews that shows how activity is monitored. We were also sent some

staff communications that showed feedback to staff and reminding them about SOPs, and other support available to them if they needed it on shift. On the whole the written communications were clear and did have some acknowledgement of how difficult busy shifts can be and thanking staff for their efforts.

5c Poor Training




SELDOC introduced an on-line induction and training programme to make it more accessible to staff as face to face sessions are more difficult to deliver to very part time staff who often have other jobs.

We asked for a breakdown of what was in it, but staff couldn’t tell us the detail. We were sent the link, but it required us to complete the programme sections before moving through it which wasn’t

appropriate to complete


Staff who had completed the online induction said it was very “clunky” but worked for some as getting in for a face to face would be difficult.

They felt funding some of the training time would be valued by staff, as whilst it is part of their required CPD, it was for the benefit of the service not just for them as a registered professional.


Most staff we spoke to had done the face to face induction. Some told us new colleagues didn’t like the new online programme. One we spoke to said it was fine.

Staff said most training was “on the job”. Some said they would value more time for training and staff meetings. Overall staff we spoke to seemed satisfied with training but would value more.


The Medical Director described the bi-monthly educational sessions in place although acknowledged that attendance was low, and attendance was largely from those GPs engaged in SELDOC and not the GPs that would benefit the most from attendance. This time for training was not funded.

Some managers said they feel there should be a mix of face to face and on line, as they said staff fed back that they didn’t like the on-line programme and not all new staff had access to computers.

New staff are given a brief face to face “service and building” induction on site on their first shift.



5d Management Practice falsification of rota information


We did not find evidence of this. We have signed statements from the Senior Rota Manager and the Director of Operations that falsification of the

rotas has not and does not take place and that as far as they are aware all staff knew they were rostered to work. As we had expanded this question wider than falsification of the rotas we captured a lot of views on rotas. The

summary of this is that non-clinical staff were unhappy with rotas for 2 main reasons; lateness of the final published rota and inequity on how the shifts were allocated.


Although not contracted many did regular days / shifts. There were always extra shifts if you wanted them. They often felt pressured to do more than they wanted to due to operational pressures and often found it difficult to

say no - but that SELDOC operational staff did seem to value the commitment. They felt SELDOC needed to recruit and retain more doctors to fill the rotas. Some said there was a risk to SELDOC losing more doctors when the national indemnity offer came in especially as

SELDOC paid at the lower end of local pay rates and this would have a negative impact on the rotas and safe care. Many said they worked for SELDOC as when on shift there was a good team spirit and when things were difficult it

was the shift team effort that kept patients and staff as safe.


Staff told us that final rotas came out very late which made it difficult to plan home life and other work commitments. Some staff told us that SELDOC was unfair in how shifts were allocated, and that preference was given to staff who

were relatives or friends of senior managers. Some staff told us that that SELDOC did not apply rota allocation for contracted and bank shift policies consistently -

some staff were prevented from working extra if they had been off sick for core shift and others were not. A few staff told us that some staff who had worked for and been loyal to SELDOC for many years were no longer

getting much work as SELDOC was bringing in new staff (often family and friends of senior staff) and they were getting the work.

Some staff who shared this said those who were getting less shifts had previously complained, and they felt this was the reason for not now getting work. One staff member shared personal experience of this and was very angry and upset about this and felt raising concerns had further compromised shift allocations.




The Senior Rota Manager explained how SELDOC use Rotamaster and assured us the staff allocations cannot be falsified.

The manager felt staff rotas were put up in good time although acknowledged that final rotas were sometimes later than ideal.

All the relevant senior managers we spoke to refuted falsification of the rotas and felt confident staff were allocated shifts in an equitable way.

The HR Manager said family and friends may be signposted to SELDOC by existing staff but that all staff went through the same recruitment and interview process so there was an equitable process.

5e Management and Leadership of the Organisation As part of this allegation theme we looked at:

ii) organisational and operational policies / protocols and SOPs iii) leadership and management of the organisation


i) We requested and reviewed many policies, SOPs and information. (See Appendix 6). A lot of the information we requested was received late. We also needed to go back for a lot of further information to enable us to make a judgement on the allegations to ensure the investigation was comprehensive. We acknowledge that this put pressure on some SELDOC staff. Some of the policies were out of date which included the initial Whistleblowing Policy we saw. We were then sent an in-date version, but staff were not able to tell us what had changed and who had changed it. (This is one of the outstanding pieces of information in Appendix 6).There have been some vacancies and staff sickness in some corporate departments which may have impacted on compliance with the governance of policies, other corporate documents and processes. There was a disconnect between the clinical and corporate / operations departments. Not on a personal level, but each part of the organisation said often “that’s not us you need to ask xxx”.

ii) SELDOC does not have a large management and leadership structure. Many of the managers connected to the South East London GPOOH have been in post for many years. The Board structure and governance had been reviewed and changed in 2017.A new Chief Executive was appointed in November 2017. A new Medical Director was appointed in February 2017. SELDOC took on West London in partnership with Vocare in September 2016.There have been a lot of changes for SELDOC over the past couple of years and whilst there have been some


Strictly Private and Confidential positive leadership and governance changes the management /office move away from Dulwich was quite a significant move for the operational staff who remain based there. SELDOC staff survey gives clear indication of improvement areas that should be addressed.


i) Staff knew where to gain access to policies if needed. Some but not all recalled seeing reference to them in communications that were sent out. Agency staff did not get the regular communications and updates.

ii) All staff we spoke to value the new approach and culture that the new Chief Executive had introduced. Some staff spoke very positively about the strengthened quality improvement approach that was being led by the

Medical Director.


i) Staff knew where to gain access to policies if needed. Some but not all recalled seeing reference to them in communications that were sent out.

ii) All staff we spoke to value the new approach and culture that the new Chief Executive had introduced.


i) Polices: We were given conflicting information about how policies were governed. There were different processes for operational and clinical policies. There was also different access to different policies for staff. Some policies are on the public facing website and some on the “V” drive. There were different versions of some policies in place and staff couldn’t explain why.

ii) SELDOC CEO is keen to increase the focus on the leadership style and culture of the organisation and is personally leading much of this. We were given examples of improvements that we will recommend in this report that had already started.



5.2 Final Investigation Findings

Theme of Allegation Outcome(Upheld / Not

Upheld)

Summary of findings

1 Whistleblowing. It was alleged that staff had been victimised for raising concerns.

NOTUPHELD

We found no direct evidence of this but note information in section 5.1 point 1.

2 Shortages of staff. It was alleged that staffing levels were insufficient to cover the workload.

PARTIALLY UPHELD

SELDOC like many other NHS services struggle to meet the activity levels in line with patient need especially at peak times of the year or week. It is partially upheld as there were gaps in rotas and examples of rotas that had not been reviewed in light of known predictable excess activity, plus staff gave us specific examples. SELDOC work hard to fill the rotas but there is evidence this is often quite late and some of the new ideas with skill mix could have been introduced earlier in line with many other OOH providers.

3 Service Delays. It was alleged that the impact of the staff shortages had meant that there had been excessive delays in both the call back to patients and in the response to patients.

PARTIALLY UPHELD

There was evidence of delays against the clinical prioritisation standards and operational performance measures in the contract and staff expanded on these during the interviews. These are all monitored via the contract monitoring route and the CCG that we spoke to did not have any concerns that were not being managed via the contracting route. SELDOC senior managers and leaders fully acknowledged that there are times when the service response is delayed longer than is needed and specified. There was some evidence of new SOPs and policies designed to safeguard patients and avoid unnecessary harm from delay. Where there has been an SI it had been robustly and appropriately managed and improvements identified had happened or were in progress of being designed to be implemented. Patient satisfaction surveys showed that overall, they were happy with the service they received from SELDOC.

4 Advice to Patients. It was alleged that NOT There was no clear evidence of this but staff at all levels told us that


Strictly Private and Confidential patients were encouraged to use the service inappropriately.

UPHELD patients told them that practices regularly told patients to contact the GPOOH service if they couldn’t give them an appointment at the practice. As patients are given a dedicated number to ring it is likely that patients will keep this and may not contact their practice first. We found no evidence that SELDOC were advising patients to abuse the service.

5 Management Practice. There were a number of allegations relating to the way the service is managed (in addition to the allegation of victimisation of Whistle-blowers) these include:a) Failure to ensure staff safety including

the lack of panic buttons and a failure to protect staff from verbal and racial abuse.

b) Poor monitoring of activity, adherence to SOPs.

c) Poor training.

d) Falsification of rota information.

e) Management and Leadership of the organisation.

NOTUPHELD

PARTIALLY UPHELD

NOT UPHELD

NOT UPHELD

There are some panic buttons in place. Some of the locations are not ideal and staff have asked for one in reception and these are being considered. There is strong evidence of a SELDOC having and using a Zero Tolerance Policy.

There is some evidence of inconsistent application of policies and SOPs. There are also out of date policies and an inconsistent way of developing, updating and governing polices between corporate and clinical departments. SELDOC has changed the way it delivers induction training to an online system. Many staff don’t like it. For general training / updates, SELDOC do provide it but many staff do not find it easy to access and for many, time is not funded. There are areas of improvement needed but induction and training are available.

We have signed statements from the Rota Manager and the Director of Operations that this is not true. We also reviewed the way the rota system works, and it would be extremely difficult to falsify the information.



i) Organisational and operational policies / protocols and SOPs

ii) Leadership and management of the organisation

PARTIALLY UPHELD

NOT UPHELD

This was not specifically part of the allegations, but we needed to review these as part of the investigation. The governance of policies gave us concern. New policies and protocols introduced under the leadership of the Medical Director are very positive.

There was no evidence to suggest senior staff and leaders were not competent.These examples are not directly linked to the allegations but some positive examples:

There is a relatively new board and governance structure in place which was working well.

There was full support from staff for the new CEOs approach to improvement.

The majority of clinical staff we spoke to were supportive of the Medical Director’s approach to quality improvements.

Evidence we reviewed suggested that the new SELDOC CEO had already identified a need to improve culture, communications and the service delivery.

The Medical Director is continuing to focus on quality improvements which we viewed as very positive.

The Senior Operations Team are experienced managers and like all staff need to adapt to changes in organisational form and culture. Those we spoke to spoke positively about recent changes. There are many improvements to be made but we do not uphold the allegations in the letter.

6 Clinical Practice. There was a specific allegation that one Doctor had inappropriately prescribed controlled drugs.

NOT UPHELD

SELDOC have completed and shared an enhanced audit of all prescribing activity of the GP and it identified no concerns. We viewed the audits and enhanced audits as good practice.



6) Recommendations

The table below sets out the recommendations from the investigation and suggested timescales.Please also see Appendix 5 as not all the staff generated ideas are covered in the recommendations below

Howbeck Healthcare recommend That SELDOC Chief Executive ensures the development of an improvement action plan to respond to these recommendations with

responsible named staff and clear timescales. That the action plan is overseen, and delivery monitored via the SELDOC Board. That the recommendations and action plan are independently audited in 9-12 months’ time to evidence positive improvement.

Theme No Recommendations Suggested Timescale

A Culture and Organisational Development.

1 The CEO should ensure there is an Organisational Development Strategy and Delivery Plan in place. This could include:

The culture and behaviour expected of all staff in the organisation Clarity on an open and transparent communication structure with a

move away from a perceived hierarchical approach. Practical support for staff who may find a change in culture difficult. Mini staff surveys through the year to keep a regular check on how staff

are feeling and what improvements may be needed. Needs to be aligned to the organisations Clinical and Business strategy.

Strategy to be developed and agreed within 3 months

B Leadership and Management capacity and capability

1 The CEO should review the leadership and management capacity and capability of the organisation to ensure it is fit for purpose for the current service needs and for the next 12 months.This should be reviewed when there are any organisational or senior leadership changes.

Review to be completed within 3 months

2 Review the staff vacancies and progress recruitment or temporary cover where practical

Within 1 month




C Communication

1 SELDOC should include staff communications in its strategic and operational planning. Specifically:

Align communications across the organisation – there are currently too many separate communications from operations and clinical governance departments and if streamlined would reduce work and improve consistency of communications.

Give consideration to clinical governance bulletins and operational newsletters being combined as one communication. There will still be a need for some more focussed clinical communications.

Consider how to improve communications with regular agency staff Consideration of technology supported communications E.g. podcasts,

blogs.

Within 3 months

2 The CEO should ensure there should be regular planned and ad hoc site visits by the senior leadership team. Staff value face to face communication opportunities. This could include medical leaders doing clinical shifts at the service base.

Planned within one month then ongoing

3 Deterring staff from using the available WiFi should be reviewed especially considering the national move to extend availability of WiFi to NHS staff and patients in all NHS buildings.

Note ;- Most staff use their personal phones to access work information and communications

Review within one month.

4 The CEO should ensure that all staff are aware of the polices and processes that are available to support them. E.g. the Zero Tolerance policy, the wider suite of HR policies, the “askSteven” email.

Within one month and ongoing

5 The CEO should ensure SELDOC regularly communicate with and feedback to its member practices about advising their registered patients on appropriate use of the GPOOH service (this may be covered in local communications).

Ongoing




D Governance 1 The CEO should review the governance processes including responsibilities for policies and Standard Operating Procedures (SOPs). Specifically, this should include:

How policies and SOPs are created, approved, communicated and reviewed.

Replacement of the Whistleblowing Policy using the NHSE guidance for primary care providers.

Update all out of date policies using best practice. (Prioritise Grievance Policy).

How staff access policies. Currently some are on a public facing website and some on the V drive. E.g. Whistleblowing Policy is on the public facing website and Grievance is on V drive. They are policies that staff may wish to easily access at the same time. Both are out of date and need updating.

Review within 1 month Replace within 1 month (guidance link already sent) Within 2 months

Within 1 month

2 The CEO should ensure that the Medical Director is supported to continue the improvement work on Quality and Safety. Specifically, this should include:

Continue to develop and extend the coverage of the GP audits. Review and develop the balanced scorecard with the Operations Director. Continue to develop policies and processes that promote the quality of

care and safety of patients and staff.

Review of capacity in the clinical governance team within 1 month. Ongoing support




E Improved alignment between Medical /Clinical and operational departments

1 A number of the recommendations in all sections require much closer working between the Medical /Clinical Directorate and the Operations Directorate.

Specifically, the CEO should ensure that the focus of this closer working should be to ensure that service priorities, workforce rotas and any operational decision-making give primacy to the quality and safety of the patient / family and the workforce. The evidence showed that on too many occasions too many patients waited too long for a service response and that SELDOC could have done more to reduce some of the long waits.

To agree how this will be done within one month and then ongoing oversight by the CEO.

2 The CEO and Executive Team should review all policies and communications to ensure that as many as possible include all staff rather than separating clinical and operational staff communications.

Within two months

3 All distribution lists should be reviewed to ensure that All staff on them still work for SELDOC That all emails and contacts for staff are correct That if appropriate, the number of distribution lists are reduced.

Within 2 months


Strictly Private and Confidential Theme No Recommendations Suggested

TimescaleF Workforce, Recruitment

and Retention (including leadership, support and skill mix) and safe staffing

1 The Director of Operations and Medical Director should review the recruitment and retention of clinical staff. Specifically:

Create a recruitment campaign for medical staff and possibly wider clinical workforce that shows the wide range of services and flexible working opportunities that SELDOC has available.

Review pay rates and overall package for Doctors due to changes in role from October and the need to remain competitive with local pay rates, the current proposed 2019 national offer for indemnity may adversely affect SELDOCs overall package.

Review use of Advanced Nurse Practitioners and consider recruiting them as part of either employed or self-employed sessional SELDOC staff. (needs robust governance)

Consideration should be given to more home working technology especially for periods of escalation.

Within 1 month Within 1 month Within 1 month

Within 1 month

2 The CEO should ensure that there is an improvement action plan for the most recent staff survey in place. If there is already a plan, then ensure that it is reviewed considering this report.

Within 1 month.

3 The Medical Director should review the Clinical Training / CPD offer due to poor attendance. Specifically, this could include:

Seek views of GPs Review the programme that is offered Review the time of the day / day of the week this is offered especially

for GPs who work in the daytime. The location of the training to increase access. Payment for some of the training time.

Within 3 months




F Workforce, Recruitment and Retention (including leadership, support and skill mix) and safe staffing Continued ….

4

The Director of Operations should ensure: That all staff understand how Rotamaster works and how important

staff participation in providing availability is to enable the built in fair allocation of work.

Contact all non-contracted staff on the rota to confirm if still wish to work for SELDOC and ask for feedback on satisfaction with the amount of work they are allocated. (Noting that many of the workforce will be affected by the 111 integration).

Review the criteria and adherence to the criteria for preventing staff doing extra shifts.

There is an open and equitable recruitment process in place for all jobs.

Within 1 month

5The Director of Operations should:

Review the capacity needed overnight especially during periods of high escalation.

Review the Business Continuity Plan with a particular focus on managing escalation.

Within 1 month Within 2 months

6The CEO should oversee review of the Recruitment Policy and ensure compliance against it:

It contains a section on flexible working. Consideration should be given to having a separate Flexible Working Policy that includes support for carers.

Consideration should also be given to why some groups are excluded and if one Recruitment Policy for all permanent, self-employed and casual staff would be more appropriate.

Within 1 month

7The Director of Operations should ensure staff are given a timeframe for a decision about the panic buttons.

Within one month


Strictly Private and Confidential Theme No Recommendations Suggested

TimescaleWorkforce, Recruitment and Retention (including leadership, support and skill mix) and safe staffing Continued ….

8

SELDOC may find the recent CQC report on urgent care services useful: https://www.cqc.org.uk/sites/default/files/20180619%20State%20of%20care%20in%20urgent%20primary%20care%20services.pdfand the Workforce governance guide (link below) as whilst it is not specific to GPOOH it contains a lot of useful relevant information on workforce: https://www.england.nhs.uk/wp-content/uploads/2018/03/workforce-governance-guide.pdf

N/A


https://www.england.nhs.uk/wp-content/uploads/2018/03/workforce-governance-guide.pdf

https://www.cqc.org.uk/sites/default/files/20180619%20State%20of%20care%20in%20urgent%20primary%20care%20services.pdf

https://www.cqc.org.uk/sites/default/files/20180619%20State%20of%20care%20in%20urgent%20primary%20care%20services.pdf


7) Conclusion

We received and reviewed 156 pieces of information and spoke to 43 members of staff, which whilst a small number compared to overall staff numbers, it does represent most front-line roles in the organisation. Overall, we found limited evidence to fully uphold the allegations made in the whistleblowing letter. We met and spoke to lot of dedicated and loyal staff at SELDOC and it was clear that the CEO had already set out several areas for improvement which the majority of staff welcomed.

However, interviews and telephone conversations with staff, especially front-line staff plus the analysis of the information we received, suggest that there is a need for SELDOC to set out a realistic but ambitious improvement plan to address the findings from the investigation, plus other challenges and opportunities that sit outside the scope of this investigation.

We appreciated the professional and open approach that staff at SELDOC took in response to this investigation. Anonymous whistleblowing allegations are particularly challenging as the concerned staff member/s are not available to clarify detail.


Strictly Private and Confidential APPENDIX 1

TERMS OF REFERENCE

Independent Review of anonymous complaints – SELDOC

Proposed mandate and approach to delivering the mandate.

The Mandate

Seldoc Doctors co-operative are to commission Howbeck Healthcare ltd to undertake an independent investigation to determine the veracity of allegations made in two anonymous complaints.

Our Aim

Howbeck Healthcare will be seeking to determine;

Whether the allegations made in the complaints are wholly or in part correct, If we find that any of the allegations are founded we will also be looking to determine

whether the ‘harm’ is potential, actual, or neither. We will review any actions taken as a result of the internal investigation. We will report all findings and make recommendations for action.

Our Analysis of the allegations – the areas our investigation will cover.

We have analysed the anonymous complaint that has been shared with us and we have identified the following 6 areas on which our investigation will focus, for each area we will follow the approach set out below in seeking to identify the veracity of the allegations, and the impact of any shortfalls in service or management.The five facets of the complaints that we will investigate:

1) Whistleblowing. It is alleged that staff have been victimised for raising concerns.We will seek to identify specific cases by requesting all staff to complete a totally confidential questionnaire. We will then follow up any allegations made, with the individual without breaching their confidence.

2) Shortages of staff. It is alleged that staffing levels are insufficient to cover the workload. We will firstly examine the staffing levels on the days identified and compare these to the staffing levels contained with the SOPs. We will then sample other dates at random, comparing staffing levels with the SOPs. We will confirm (randomly) that the information contained on the rotas reflects individual staff diaries and time sheets. In addition to comparing actual levels with planned levels, we will consider whether we believe that the planned levels are sufficient to meet demand.

3) Service Delays. It is alleged that the impact of the staff shortages has meant that there have been excessive delays in both the call back to patients and in the response to patients. We will examine all the patient call and response data for the dates identified a in particular for the Christmas 2017 period. We will assess all complaints made during this period either to the provider, 111, or the CCG. We will assess all feedback received from patients.

4) Advice to Patients. It is alleged that patients are encouraged to use the service

inappropriately. We will ask staff to identify any concerns in this area, we will also review this with our sample patients.



5) Management Practice. There are a number of allegations relating to the way the service is managed (in addition to the allegation of victimisation of Whistle-blowers) these include:

a) Failure to ensure staff safety including the lack of panic buttons and a failure to protect staff from verbal and racial abuse.

b) Poor monitoring of activity, adherence to SOPs.c) Poor training.d) Falsification of rota information.e) Management and Leadership of the Organisation

We will review all policies and procedures relating to this list and will include questions on our confidential staff questionnaire to cover each allegation. We will be seeking to interview a number of staff during the on-site phase of the investigation.

6) Clinical Practice. There is a specific allegation that one Doctor has inappropriately prescribed controlled drugs. Our Clinical Director will review the internal audit previously undertaken to determine how best this allegation should be addressed.

Our Planned Approach – Timeline

The timeline for the elements of the work are set out below. We can commence on the 14th May, subject to contractual agreement – our aim would be to conclude the project by the 15th June.

Prior to the commencement of the work we will ensure a contract is in place and we have appropriate arrangements in place to maintain confidentiality and to ensure we fully adhere to the GDPR requirements. This can be completed by the 11/05/18

We will create a list of what is needed to be supplied, including:o Policies and SOPs etc, o Rotas, o Call volume and waiting time information etc,o Contract /performance notices, or concerns from CCG, o Relevant complaintso The internal investigationo A full staffing list with E Mail contacts (we will need to agree the appropriate

way of contacting staff in line with GDPR)We will aim to produce the list within 3 working days of the agreement to proceed

We will then do the office-based ground work in order to determine any further information needed and the questions to be addressed. This can proceed as soon as the information is received

We will undertake a series of initial calls including:o The manager responsible for the internal investigation,o The Seldoc Medical Director

These calls can be undertaken concurrently with the ground work.

We will then spend around two days ‘on site’, having previously arranged to meet with key individuals. We aim to be on site during May.


Strictly Private and Confidential We will seek to contact a number of patients (identified during the on-site visit) by

phone in late May/ early June.

The work will be overseen by our Clinical Director Dr Neil Paul. Biography for Dr Neil Paul will be provided.

We will issue a confidential questionnaire to all staff prior to the on-site visit. We will to offer the opportunity for staff to speak to the team, in confidence, as part of the work.

We would produce a formal report. The report will document the findings and make any appropriate recommendations. Our aim is to produce the draft report by the 15th June.

About Howbeck Healthcare.

http://www.howbeckhealthcare.co.uk/

Howbeck Healthcare is a company specialising in providing support to GP Federations across a range of areas. We currently support GP Federations across 6 CCG areas, covering over 120 practices.One of the services we provide is the provision of the Freedom to Speak Up Guardian Role. Over 100 GP practices have signed up to receive this service.

Howbeck Healthcare has a team of experienced Managers and Clinicians, the members of the team that we propose to use for this project are set out below – short biographies are on our website, full CVs will be sent prior to the commencement of the work. Dr Neil Paul will be the Clinical Lead, and Tina Cookson the Operational lead for this work.

Dr Neil Paul – Director. Neil is an experienced practicing GP partner in a large practice in the North West. Dr Paul has experience of leading OOHs services as both a commissioner and a provider.

Mike Pyrah – Director. Mike is a former NHS Chief Executive (17 years).

Tina Cookson – Director of Nursing and Service Redesign. Tina is a former Trust Director of Nursing and registered as a FTSU Guardian, and has experience of GPOOHs services as a Commissioner and a Provider.

Lisa Taylor – Business Manager. Lisa is a former CCG Quality and Governance Manager


http://www.howbeckhealthcare.co.uk/


INVESTIGATION METHODOLOGY

In undertaking this investigation, Howbeck Healthcare undertook the following methodology:

Desktop review exercise – requesting a range of information and evidence relating to each point detailed within the Whistleblowing Concern letter. This review continued throughout the whole timeframe, with further information and supplementary evidence requested at various points as a result of evidence reviewed, interviews undertaken etc.

Two-day site visit:- Day 1: the investigation team spent approximately 8 hours on site at Dulwich

Community Hospital with the operational team, where a range of interviews were undertaken with staff on duty, a tour of the operational site facilities, and observational time of the service in operation.

- Day 2: the investigation team spent approximately 6hours at the Headquarters site at Hanover Site interviewing the corporate team including, Chief Executive, Medical Director and Director of Operations.

Contact with the CCGTo discuss this current whistleblowing concern and the whistleblowing concern received during 2017.

Interviews with Staff- During the timeframe of the investigation, the investigating team undertook a range of

formal interviews with staff at all levels. The team requested interviews with key senior individuals and operational staff named in the concern or responsible for areas detailed within the concern e.g. rotas, HR etc.

- The investigating team also interviewed key staff on duty at the Dulwich Community Site on the day of the site visit.

- Whilst on site at Dulwich Community Hospital it became clear that interviews with clinicians would not be possible due to the need to respond to the demands of the service, and the level of calls that evening. Therefore, calls were arranged for the following week with clinicians from all staff groups, SELDOC GPs, agency / locum, homeworker GP and nurse.

In addition, all staff, whether employees, sessional, bank, agency or locums, clinical or non-clinical were given the opportunity to speak to Tina Cookson, Lead Investigator via telephone. This offer was made to all staff confirming that discussions would be confidential, and staff did not wish to disclose their name if they did not wish to, requesting only their role title and approximately length of service with SELDOC but that was not essential. The telephone calls lasted approximately 30 minutes. It is pleasing to note that a number of staff contacted the investigating team as a result and their views and investigation team findings are included in this report.

In total, 43 members of staff were spoken to as part of this investigation. The investigating team has made every effort to speak to staff at all levels of the organisation, including clinical and non-clinical covering the range of roles undertaken at the operational Dulwich Site as possible.

A full matrix of staff we interviewed, and the high-level questions can be found at Appendix 4. The interviews with staff in managerial or leadership roles were approximately 60 minutes and most of the interviews with clinical and front line operational staff were approximately 30 minutes long.



Communications to Staff from the Chief Executive

COMMUNICATION 1: Dated 21st May 2018

Dear South East London Colleagues I wanted to let you know that we have received a Whistleblow which covers a number of concerns in relation to our South East London service. This is important and, under our Whistleblow policy, we have a duty to investigate it properly with a transparent and impartial approach. With this in mind, I have engaged an external organisation to conduct the investigation. The company is called Howbeck Healthcare and I would encourage you to be open and honest with them if they ask to speak with you or if you would like to speak with them. Details of how this can be arranged anonymously will follow. Under our Whistleblow policy, we also have a duty to keep confidential the identity of any Whistleblower. I take this seriously and we will respect this. The following folks make up the Howbeck team: Director (Lead Accountability): Mr Mike Pyrah, Howbeck HealthcareManagement Lead: Tina Cookson, Director of Nursing and Service RedesignClinical Lead: Dr Neil Paul, GP and Clinical LeadManagement Support: Lisa Taylor, Business Manager. Tina Cookson is leading the work from Howbeck. She is a Registered Nurse, a Primary Care Freedom to Speak up Guardian and very easy to speak with. As part of her role in this investigation Tina can be contacted in confidence by you if you feel you want any concerns. Her contact details are: [email protected] . All conversations will be in confidence. I will update you again as this progresses and I will share the outcomes with you. I know we all want to focus on looking after our patients and providing the very best service we can. If you ever want to contact me, about anything at all, at any time, please remember we have set up the following email address which you can use: [email protected] Speak soon and thank you all for your hard work. I appreciate it. Best wishes Steven Pink - Chief Executive





COMMUNICATION 2 – Dated 30th May 2018

Dear South East London Colleagues

Further to my note to you of 21 May, I wanted to share an update.

Our independent investigators have been gathering lots of documentary evidence and reviewing it. They will be on site in Dulwich on Wednesday 30 May and then in Norbiton on 31 May. If you would like to speak with them confidentially, you can see them on one of these days. If you are not available at these times, a private telephone call can be arranged.

The broad themes of the investigation are: Our culture Support for staff and whether we need to do more Adherence to policies and processes – how we are doing and where we can make

improvements, and Any potential patient safety concerns.

You will remember from my earlier note that Tina Cookson from Howbeck Healthcare is leading this work. As a Registered Nurse and a Primary Care Freedom to Speak up Guardian, Tina wanted to offer you a personal invitation to speak to her in confidence. I have included this below.

Message from Tina Cookson – Independent Whistleblowing investigation lead

“Hello,

I thought it may be useful to send a direct communication to you all which Steven has agreed to incorporate into his update message to you.

Steven has already informed you about the investigation and encouraged you to contact me in confidence if there are any concerns you wish to share.

I know from experience that staff can be cautious about “speaking up” and any negative impact this could have on them in an organisation. You can be assured that if you speak to me in confidence, your anonymity will be preserved. I am giving you my personal commitment to this and Steven has also given you this commitment.

I am an experienced Registered Nurse and an existing Primary Care Freedom to Speak Up Guardian and have worked with the CQC as a specialist advisor on inspections since 2012. So I have a lot of experience in speaking with and supporting staff who have concerns.

If you want to contact me my email address is [email protected] - No one but me has access to my email and if you prefer to contact me by phone my mobile telephone number is XX (phone number removed for the report but was put on the email).

Lisa Taylor, management support for the investigation and I are planning to be on site at Dulwich on Wednesday 30th May and in Norbiton Thursday 31st to speak to staff. I have asked to meet with a wide range of staff at the Dulwich site and I hope you will be supportive of this as it is important we get as much information as possible to ensure the investigation makes a positive difference, benefiting staff and patients.

You may have positive experiences to share with us as well as any concerns.




If you want to book to see Lisa and me, please email me if you wish to do this in confidence or you can book an appointment via Jacqueline O’Meara on j.o'[email protected]

I look forward to meeting some of you on Wednesday and Thursday

Regards Tina “

Guys, this is really important so let’s support the process to maximise any learning and further improve the service we provide to our patients.

Looking forward to seeing you soon. With best wishes

Steven Pink - Chief Executive

--------------------------------------------

COMMUNICATION 3 – Dated 6th June 2018

Dear Colleagues

Our Whistle Blow investigation is drawing to a close and I wanted to update you.

We have provided a lot of documentation and policy detail to the investigation team and they have spoken with a number of you. The final report will be written up and shared with me shortly.

Before the report is concluded Tina, who is leading the work, and I wanted to let you know that there is still an opportunity to talk in confidence to the investigation team if you haven't yet done so. To organise this, please contact Tina on XXX (phone number removed for the report but was put on the email) or email: [email protected] by 11th June 2018.

Tina and I would like to thank you for your openness and support through this process. As an organisation we are keen to learn and improve and your contribution to this is invaluable.

Please remember that you can contact me at any time about anything at all. I will listen. The best way to do this is through the "ask Steven "email address: [email protected]

Many thanks.

Steven Pink - Chief Executive





MATRIX OF STAFF INTERVIEWS

JOB ROLE NUMBER OF INDIVIDUALS SPOKEN TO

TYPE OF INTERVIEW HELDFACE TO FACE

INTERVIEWTELEPHONE

CALLChief Executive 1 Medical Director 1 Director of Operations 1 Pharmacist Lead 1 Regional Manager for South East London

1

CCG 1 Quality Manager 1 HR Manager 1 Operations Support 1 Rota and Transport Manager

1

Team Leader/Supervisor 3 Dispatcher 2 Call Handler 3 Driver 3 Receptionist 2 SELDOC sessional GPs 11 Homeworking GP 1 Agency Nurse 1 Agency GPs 2 Anonymous 4 SELDOC staff but not from SEL GPOOH

2 (not included in evidence)

Staff no longer working for SELDOC

1

TOTAL 43

Many staff especially more junior and front-line staff were anxious about the confidentiality of the interview and some said they were concerned they may say the wrong thing. The concern about confidentiality was particularly from staff who responded to the emails from the Chief Executive saying they could contact me in confidence to discuss concerns. Staff seemed less anxious about the confidentiality of the planned interviews albeit the majority of this group of staff were in a managerial or leadership role.

To help settle staff who phoned, to apply some consistency and to avoid using examples from the whistleblowing letter a set of high level questions were asked that linked to the allegations or themes.

Not all the questions were asked of all staff as the tone was more of a conversation and went in whatever direction staff wanted to discuss, especially those who phoned with specific concerns.



These questions are listed below:

Themed Questions for SELDOC Clinical staff interviews 1. Operational pressures – do you feel safe and supported when demand is above the

ability to respond in a timely way? 2. What is the culture of the organisation like? E.g. can you be open and honest about

any concerns you have? Have you ever raised a concern? if yes was it dealt with appropriately and in a positive manner?

3. What is the communication like? Do you feel it’s the right balance of emails and face to face?

4. If you need to access policies / protocols or pathways how easy is it to do this?5. We have been told Lots of doctors have left / won’t work for SELDOC in last couple

of years. Are you aware of this? If yes, any reasons you are aware of? 6. Impact of 111 and how SELDOC have managed it. 7. Pay / Terms and Conditions – actual and comparative – any views?8. Ideas for increasing number of sessional doctors / nurses9. There have been many changes in the organisation in the last couple of years (West

London, new Medical Director, new Chief Executive), how do you feel this has impacted on the SEL GPOOH service?

10. If the organisation / Steven could improve anything, what 3 things would they be?

Themed Questions for Non-clinical front line Operational Staff1. What is it like working for SELDOC? What is your role and how many years’

experience do you have with SELDOC?2. Do you feel safe and supported when at work?3. What is the communication like? Do you feel it’s the right balance of emails and face

to face?4. What is the culture of the organisation like? E.g. can you be open and honest about

any concerns you have? 5. If you have raised a concern was it resolved?6. There have been many changes in the organisation in the last couple of years (West

London, new Medical Director, new Chief Executive), how do you feel this has impacted on the SEL GPOOH service?

7. Do you get your rotas in good time and do you feel the shift allocation is fair?8. If you need to access policies, how easy is it to do this?9. If the organisation / Steven could improve anything, what 3 things would they be?

During the interviews with clinical and front line operational staff the ideas suggested by staff were captured and can be found at Appendix 5.



APPENDIX 5

IMPROVEMENT IDEAS FROM STAFF INTERVIEWS

During staff interviews the lead investigator asked the majority of staff, and in particular the front line clinical and operational staff “if Steven / SELDOC could improve 3 things what would they be?”

The responses are below came out of the conversations – some were suggestions from staff and some from the lead investigator to test out some specifics that were coming out of the investigation.

These are valuable ideas and overall, they were suggested with enthusiasm and a wish to see SELDOC improve from the current position

Improve communication – specific ideas were o Improve the visibility of managers and leaders on the Dulwich site – “Dulwich Wednesday” is a necessity from an IT perspective

but managers think that’s their visibility sorted, when in fact staff are there OOH and unless staff work Wednesday then they wont see senior staff

o The CEO has been to Dulwich a few times and this has been unplanned and very welcome by staff. Staff feel the CEO can restore the confidence of the staff but he needs to ensure other managers and leaders change their approach to engaging and involving staff in the organisation.

o There was specific mention of the Medical Director needing to do shifts at Dulwicho Join up the communications to all staff. Clinical Staff said they often hear things from operational staff before if at all they get the

same communication o Staff who new about the October 111 changes were concerned that communications and local team working could deteriorate

after operational staff are moved to another organisation. SELDOC should do as much as possible to prevent this happening as the local team per shift worked well

Marketing to improve recruitment and retention of staff. Specific ideas wereo Some GPs said SELDOC doesn’t market the full offer well enough. They felt the pay rate is low but its not always about that and

SELDOC should also highlight the flexible working options including home working and emphasise how the local team worked so GPs knew they had strong operational support during a shift

o Some staff talked about the personal learning from SELDOC that they had taken to other jobs or practices. o Some agency staff may consider moving to SELDOC to get better shift options but are not clear on the whole offer o Many staff spoke positively about SELDOC and could be used as part of the job adverts /recruitment campaigns.



Improve staff morale and feeling of being valued. Specific ideas were o Improve communication including with those who are not currently getting shifts o Hold more team meetings (staff recognised how difficult this is but could technology be used to aid this) o Giving staff access to wifi rather than discouraging it. Most staff use personal phones and data to receive work related emails

and calls so this is all a personal expense and is not recognised. o For the CEO to explain better why the “ask Steven” email will lead to a different outcome and no compromise to them. Most staff

felt very positive about the concept but had little confidence in it (appointing a Freedom to Speak Up Guardian in line with national policy may help this)

o Make better use of the staff you have registered with you and you are not using – re-engae them by more than asking them to complete Rota master.

o Put a fixed break in the shift recognising that breaks are needed and whilst staff are given drinks and can take a comfort break its not easy to take a break as all activity is monitored.

Review service activity and demand. Specific ideas/solutions could be o Strengthen communications with practices about advice given to patients about use of GPOOH services to reduce inappropriate

demand o Give SELDOC the ability to say “NO” to some other providers and patients. eg Nursing Homes and parents of children who

wanted paracetamol or other simple self-care, or patients demanding repeat prescription. o More protocols for safe care without seeing them – eg use of pharmacists or community pharmacies, self care o Get access to patients own records as this would shorten consultation time by having access to the most upto date information o Have a GP screening for calls where outcome will be easily predictable, eg frail elderly esp in care home likely to need visit or

a&e, pregnant lady with pv bleed etc. The rationale for this idea was that whilst patients should be seen in turn /clinical priority ranking there are some patient categories where

Review the rotas to put staff where needed. Specific ideas were o Review staffing on the overnight shifts as clinical and operational staff felt the nurses made a positive difference to the service

staffing and we were told they have now been removed due to funding. o The home visit staffing was not adequate and should be urgently reviewed. o Many staff said “more staff” but they also offered that the skill mix and shift times could be reviewed so its not just more of the

same as now. o For the small number who knew about the October 2018 111 changes they said they felt the staffing review was urgent as was

engaging with the clinical staff more than had been done to date.



Review the staff skill mix and pay and terms and conditions. Specific ideas were

o Review pay rates for Doctors – some said the indemnity offer that SELDOC offered may not be so attractive when the new national offer came in and the core rate offered by SELDOC was the lowest in the area.

o Review and progress using Nurses as well as GPs o Review and possibly expand the use of pharmacists o Increase the availability and use of Home Working Doctors by increasing the computers and reviewing the use of technology

including for home visits.



APPENDIX 6

SCHEDULE OF INFORMATION RECEIVED

Note :- Information we did not receive is highlighted in the table.

Document Required Date Requested

Deadline for Receipt

Date Received

Comments

1 SELDOC Investigation Template Documentation 16.05.18 21.05.1812 noon

N/A we do not have one

2 First Whistleblowing Concern (Summer 2017) 16.05.18 21.05.1812 noon

16.05.18 Complete

3 SELDOC Response to first Whistleblowing Concern (Summer 2017) (including action plans / recommendations)

16.05.18 21.05.1812 noon

16.05.18 Letter and response provided including appendices.

4 Copy of any communication circulated to staff regarding first Whistleblowing Concern

Supplementary 03.16.18Please provide a written statement to confirm that no communication was undertaken with staff about the 2017 Whistleblowing Concern, either; In telling staff SELDOC had received a whistleblowing

concern, or By involving staff in the investigation, or By communicating changes as a result of the

whistleblowing investigation.

17.05.18

3.6.18

21.05.1812 noon

4.6.18 8.6.18

No evidence provided (supplementary question then asked).

4 – Whistleblowing communication statement

5 Copy of appendices referred to in Whistleblowing Letter (March 2018) Screenshot on 13/12/17 Email from Derek Witt 7/3/18 acknowledging

poor performance Unfilled rota over 9th, 10th, 11th, March 2018

17.05.18 21.05.1812 noon

16.05.18

16.05.18

16.05.18

5 - Screenshot on 13/12/175 - Email from Derek Witt 7/3/18 acknowledging poor performance5 - Unfilled rota over 9th, 10th, 11th, March 20185 - Email from Derek Witt re


Strictly Private and Confidential Document Required Date

RequestedDeadline

for ReceiptDate

ReceivedComments

Email from Derek Witt re Mothering Sunday Weekend Briefing.

16.05.18 Mothering Sunday Weekend Briefing.

6 Copy of any communication circulated to staff regarding second Whistleblowing Concern (16th March 2018)

16.05.18 21.05.1812 noon

20.5.18 6 - Copy of communication6a – Copy of communication 30.5.18

7 Any information that relates to staff suspensions, disciplinaries or terminations in last 12 months where the staff member has made a complaint or raised a concern. (Note – please anonymise staff names and implement a reference code for each staff member to enable this to be tracked back to your records if required).

Supplementary 3.6.18Can you confirm that there have been no staff suspensions disciplinaries or terminations due to a staff member raising concerns or making a complaint.

Can you confirm this same for sessional / non-contracted staff?

17.05.18

3.6.18

21.05.1812 noon

4.6.18

Revised to 20.6.18

21.6.18

Supplementary question following interviews.

7 – Staff Suspensions Statement (provided by Sandra Ketter)

8 Reasons for leaving for all staff in last 12 months from exit interviews (Note – please anonymise staff names and implement a reference code for each staff member to enable this to be tracked back to your records if required).

Supplementary QuestionsDo you have any information about reasons for staff leaving? Do you know if any staff left after raising concerns?

17.05.18

28.05.18

21.05.1812 noon

29.05.18

Revised to 20.6.18

21.6.18

No exit interviews take place. Supplementary question therefore asked.

8 – Exit Interviews Statement (provided by Sandra Ketter)



RequestedDeadline

for ReceiptDate

ReceivedComments

9 Planned and actual Rotas for the last 6 months from the date the Whistleblowing concern (March 2018) was received.

17.05.18 21.05.1812 noon

29.05.18 9 and 10 – Ops Staff Rota

10 Planned and actual Rotas for last 6 months from the date the Whistleblowing concern (March 2018) was received, that show stand-by GPs (if not included in rotas above).

17.05.18 21.05.1812 noon

29.05.18 9 and 10 – Ops Staff Rota

11 Extract of Whistleblowing Concern (March 2018) letter – ‘Contrary to SELDOC’s policy Nurses were only used on Mothering Sunday 2018.’

Please provide policy referred to in the above statement.

Supplementary QuestionsCould SELDOC advise what policy the WB may be referring to? Could SELDOC please advise if Nurses were on rota for Mother’s Day and if there was anything unusual / untypical about the rotas for that day?

Supplementary 3.6.18Can you confirm that nurses were used for the first time on Mother’s Day 2018?

Can you advise if any communication was done with staff regarding the introduction of non-medical staff - i.e. nurses and pharmacists – and if yes please provide copy of the communication.

17.05.18

28.05.18

3.6.18

21.05.1812 noon

29.05.18

4.6.18

29.05.18

7.6.18

Policy does not exist. Supplementary question asked.

11c – Statement re supplementary questions re policy.

11a – Statement to confirm ANP used for the first time on Mothers Day

11 – SEL Briefing 10-11 March (Intro of Nurses included)

11b – Email from DW / Steph



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Supplementary 7.6.18 Does the weekend briefing (eg provided) go to all staff including doctors or just the team leader / supervisors?

If the latter, then did the doctors get any communication before they turned up for shift that nurses were being introduced and they would need to support them?

7.6.18 8.6.18 8.6.18confirming nurses not mentioned in Clinical Governance weekly bulletins during March.

12 All Staffing policies related to stand by / on call and escalation policies.

Supplementary 3.6.181. The title of a policy detailed in your SI policy is ‘Business

Continuity, Escalation and Epidemic Policy’.Can you confirm if there is a different policy to the one supplied?

2. For the Business Continuity Policy May 2016 supplied, please provide evidence that the policy was reviewed before 2018 bank holidays and if any changes were made, what these were.

3. Please provide your On-Call Policy (clinical and non-clinical if they are separate)

4. If these do not cover the “stand by” process, please provide that policy

17.05.18

3.6.18

21.05.1812 noon

4.6.18

20.5.18

22.6.18

12 - Business Continuity Policy supplied (May 2016)

12 – Escalation policy statement for supplementary questions.

13 Extract from Whistleblowing Concern (March 2018):On the 23.12.18-over 250 advise calls 24/12/18 over 200 advise calls waiting to speak to a GP, on the 31/12/18 over 200 advise calls and 50 home visits waiting to be visited.

17.05.18 21.05.1812 noon

20.5.18



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These are a few dates that the provider had been extremely short-staffed.

-November 12th, 20th 2017-December 13th, 22nd, 24th, 25th, 31st 2017-January 6th, 21st 2018-February 24th 2018-March 6th, 9th, 10th and 11th 2018

Please provide: Any incident reports or escalations for the dates

referred to above. Evidence of actual calls and home visits waiting

for the dates above. Evidence of the ‘norm’ for the respective days of

the week / and bank holidays. Evidence of any escalation and mitigation

undertaken on the above dates. Evidence of number of failed calls for the above

dates Evidence of what decisions were made for each

failed call.

28.05.18 29.05.18 15.6.18

13 - Incidents provided from relevant dates13 – Word doc explaining spreadsheets etc13 – Nov 17 April 18 Call Volumes13 – Contact reports Oct 17- March 13 – Shift SEL Sept - Feb

14 Extract from Whistleblowing Concern (March 2018):The rotas are routinely filled with names of staff not scheduled to work or names made up by the SELDOC on those days in order for the service to appear well staffed.

Please provide evidence and / or staff names including length of employment to match to rotas.

Supplementary

17.05.18 21.05.1812 noon

Not received

No evidence provided. Supplementary question therefore asked.



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Please provide a self-declaration signed by the SEL Rota Manager and signed off by Derek Witt or Steven Pink that no names have been put on the rotas that are not genuine SELDOC staff or known agency or sessional GPs.

Supplementary 3.6.18Please confirm in a written statement that all staff on the rotas knew they were scheduled to work.

28.05.18

3.6.18

29.05.18

4.6.18

29.05.18

7.6.18

14 – Self Declaration provided

14 – Rota Statement provided.

15 Standard Operating Procedure and Policies for Call Handlers / Call Handling and Call Back Policy

17.05.18 21.05.1812 noon

29.05.18 15 – Call Handler Information

16 Policy that relates to escalating concerns about failed calls or no patient contact.

SupplementaryPlease provide copy of a Failed Calls Policy / Protocol.

17.05.18

28.05.18

21.05.1812 noon

29.05.18

20.5.18

29.05.18

16 – Business Continuity Plan (May 2016)

16 - Weekly Bulletin 26 June 201716 - SELDOC Newsletter Aug 201716 - Weekly Bulletin April 2018

17 Confirmation / evidence of whether there are panic buttons fitted on screens and in clinicians’ rooms. Supplementary 3.6.18Please confirm when these panic buttons were fitted

Please confirm there is no panic button in the reception area.

17.05.18

3.6.18

21.05.1812 noon

4.6.18

20.5.18

22.6.18

17 - Room 1, 2, 3 and 4 photos

17 – Statement provided - confirmed panic buttons were fitted over 10 years ago. There are no panic buttons in the reception area but all staff have access to mobile panic buttons.

18 Lone Worker Policy 17.05.18 21.05.1812 noon

20.5.18 18 – Lone Working Policy July 2016

19 Evidence / incidents relating to staff shouting for help or being in an unsafe situation.

Supplementary 3.6.18

17.05.18 21.05.1812 noon

23.05.18 19 – File Note (no incidents reported, not aware of incident referred to in supplementary)



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We have been told about an incident where the doctor was felt very compromised and went to “escape” to the disabled toilet. Can you confirm this was reported as an

incident? Can you advise if any action was taken after

this event to safeguard staff and provide any supporting evidence?

3.6.18 4.6.18 8.6.18

20 Any evidence showing whether the patient having a fit (referred to in Whistleblowing Letter March 2018) was reported as an incident and whether there was any poor outcome or negative consequence of the alleged unsafe situation.

17.05.18 21.05.1812 noon

8.6.18 20 – File Note

21 Evidence of staff being exposed to verbal, and in some cases racial abuse from patients due to the alleged inordinately long waiting times e.g. incident forms, emails to senior team, complaints etc.

17.05.18 21.05.1812 noon

20.5.18 21 – Concerning GP/Case/Topic Board Report (Feb 2018)

22 Evidence of call from 111 to SELDOC regarding concerns about the patient call back times e.g. call logged, actions taken, response.

Supplementary 3.6.18Can you clarify why a 111 call from Stafford would be dealt with by Dulwich GPOOH?

17.05.18

3.6.18

21.05.1812 noon

4.6.18 5.6.18

22 – File Note

23 Escalation Policy for inability to meet demand. 17.05.18 21.05.1812 noon

20.5.18 23 – Business Continuity Policy May 2016

24 Zero Tolerance Policy 17.05.18 21.05.1812 noon

23.05.18 24 – Zero Tolerance Policy

25 Evidence of whether Zero Tolerance Policy has been applied.

17.05.18 21.05.1812 noon

20.5.18 Attachments 25 – plus file note25 – Screenshot of files re complaint 25 – examples from incident log25 – GP call to CG to report incident



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25 – Email re abusive unregistered patient25 – Response letter zero tolerance policy applied25 – Response letter zero tolerance policy redacted25 – Screenshot of email re zero tolerance applied25 – Screenshot to show when incident raised etc25 – Screenshot to show when SPN added25 – Screenshot from SPN inc complaint25 – Email showing weekly bulletin June 2017

26 Documentation in respect of any other whistleblowing concerns (with the exception of Summer 2017) from anonymous or named individuals.

Supplementary question Have you had staff raise concerns about staff or patient safety, or victimisation via incident forms or verbal escalation to senior team?

If yes what, and when, and what action was taken?

17.05.18

28.05.18

21.05.1812 noon

29.05.18 8.6.18

None

26 – File Note

27 Evidence of action taken as a result of any other Whistleblowing concerns, and application of the Whistleblowing Policy.

17.05.18 21.05.1812 noon

- None

28 Policy or Standard Operating Procedure for Waking / Sleeping Shifts

17.05.18 21.05.1812 noon

No policy for this



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Supplementary question Is it acceptable and agreed for staff to sleep when on duty?Need a statement to confirm.

28.05.18 29.05.18 22.6.18 28 - Statement provided – not acceptable to sleep on duty.

29 Policy / Procedure in respect of whether personal devices are allowed when on shift.

17.05.18 21.05.1812 noon

29.05.18

29.05.18

29 – Policy for electronic devices (May 2016)29- SELDOC Handbook (page 17 section 8.5 refers to personal mobile phones)

30 Confirmation of shift times, including agreed staffing levels, including overnight South-East Region.

17.05.18 21.05.1812 noon

18.6.18 Information included in item no. 13

31 Clarification on agreed appointment slot times including whether these are different for different appointment types.

17.05.18 21.05.1812 noon

29.05.18 31 – Appointment slot file note

32 Confirmation of staff activity / monitoring in place for shifts, including what action is taken if there are concerns.

Supplementary 3.6.18Do you have an on-call record log including when there has been no response from the on call manager or clinician? Please provide copy as example.

17.05.18

3.6.18

21.05.1812 noon

4.6.18

29.05.18 32 - This is the responsibility of Supervisors to monitor staff and activity levels with ability to contact on-call managers if there are any concerns.

32 – Supplementary – answer not provided.

33 Evidence of induction and training for all staff, including nurses.

17.05.18 21.05.1812 noon

26.5.18 33 -Induction procedures checklist33 – SELDOC Agency GP Pack33 – SELDOC Nurse Practitioner Checklist

34 Evidence of staff raising concerns in respect of Dr Agarwal, including: Medicines management / Patient Incident reports

17.05.18 21.05.1812 noon

29.05.18 34 – File Note from Quality Mgr 34 - Email from Riaz re feuding GPs34 - All audit scores



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Any formal performance concerns 34 - screenshot of enhanced audit preparation34 - Meds incident email34 - Email from SS re Dr A tel no34 – Email from D Grant re prescribing case numbers34 – Performance Report 34 – Dr A Telephone Audit Nov 2017

35 Evidence of ‘reprimands’ of staff for referrals to A&E

17.05.18 21.05.1812 noon

23.5.18 35 – Cover email and letter re patient being sent to A&E (supplied in PDF and word)35 – email and attachment re UHL ED Handbook35 – SELDOC Weekly Bulletin35 – email re A&E incident and discussion re learning of referrals35 – email re dissemination of guidelines following incident35 – email acknowledging incident re appendicitis and agreeing to investigate. For 111 calls, the clinical decision support software is ‘NHS Pathways’ https://digital.nhs.uk/services/nhs-pathways

36 Confirmation and information of any clinical decision support software in place

17.05.18 21.05.1812 noon

29.05.18 36 - Call Handler Tool kit

37 Evidence of any review of compliance with any algorithms within clinical system or agreed care pathways.

17.05.18 21.05.1812 noon

29.05.18 37 - SELDOC do not use algorithms – Pathways updated regularly to latest version in 111

38 Organisational structure and governance structure for the period June – July 2017

17.05.18 21.05.1812 noon

26.5.18 38 – Organisational structure before 1 November 2017


https://digital.nhs.uk/services/nhs-pathways

https://digital.nhs.uk/services/nhs-pathways


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39 Organisational structure and governance structure for the period March – May 2018

Supplementary question Re governance – do you have any board sub committees?

Supplementary 3.6.18The SI policy refers to an “Operations & Strategy Subcommittee” is this in place?

17.05.18

28.05.18

3.6.18

21.05.1812 noon

29.05.18

4.6.18

26.5.18

29.05.18

8.6.18

39 – Organisational structure after 1 November 2017

39 – File Note re organisational structure

39 – File Note re organisational structure

40 Any specific recommendations or action plan in relation to Whistleblowing concern (summer 2017). (Or confirmation that there is no action plan / further documentation).

17.05.18 21.05.1812 noon

26.5.18 40 – Whistleblowing concern summer July 2017 response

41 Provide confirmation as to whether the Whistleblowing concern (summer 2017) was shared with the CCG and any evidence to support any discussion / outcome to show whether the CCG was happy with the investigation.

Supplementary questionDid the CCG give any feedback re the investigation and / or agree with findings? We are seeking to establish CCG role (if any) in this.

17.05.18

28.05.18

21.05.1812 noon

29.05.18

26.5.18

29.05.18

41 – Whistleblowing concern summer July 2017 response (reference to sharing the findings with the CCG)

41 – Email from CCG to SELDOC (D Witt) (see also no 48)

42 Removed (reference investigation 2)

43 Copy of Whistleblowing Policy 28.05.18 29.05.18 29.05.18 43 – Whistleblowing / Protected Disclosure Policy (Jan 2015)

44 SELDOC Way Booklet and Training Programme 31.05.18 01.06.18 5.6.18 44 – SELDOC Way (June 16)

45 Grievance Policy 31.05.18 01.06.18 31.05.18 45 – Grievance and Disputes Policy (Jan 15 – expired Aug 17)

46 Access to On-line Induction Programme / System 31.05.18 01.06.18 01.16.18 Access given.



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47 Checklist that is given to Agency when requesting: Locum GPs Locum Nurses

31.05.18 01.06.1831.05.18

5.6.185.6.18

47 – Checklist for GP Locums47 – Duty Doctor Checklist47 – Duty Doctor SWL47 – Locum Nurse Checklist (dated 26.4.18)

48 Attachments and recommendations to SELDOC Response / Report in respect of the Whistleblowing Concern – Summer 2017

31.05.18 01.06.18 31.05.18 48 – Attachments 1-19 of SELDOC Response to Whistleblowing Concern – Summer 2017

48 -1 Failed Contact Process May 201748 – 2 Weekly Broadcast June 201748 – 3 Addition to weekly bulletin48 – 4 Email and reply to GP re SD tone / style of email48 – 5 Weekly Broadcast48 – 6 email response re urgent site visit following summer 2017 concern48 – 7 Zero Tolerance Policy (April 15 – April 17)48 – 8 Redacted zero tolerance letter re repeat prescribing etc48 – 9 SEL Patient Experience Qtr 448 – 10 Blue Bag48 – 11 Blue Bag Sheet 148 – 12 GP Audit Criteria48 – 13 SEL Performance Report48 – 14 SWL Performance Report48 – 15 Balanced Scorecard Update48 – 16 Repeat Prescribing Policy (July 16 – July 17)48 – 17 Letter to patient re repeat



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prescribing48 – 18 SPN for zero tolerance case48 – 19 High Risk Medicines Prescribing Policy (July 16 – July 17)

Further attachments following queries from CCG (see 48a11 for context)48a1 – Call Handlers Log April 1748a2 – Call Handlers Log May 1748a3 – Example GP148a4 – Example of quarterly email to GPs re performance data48a5 – Failed contact process 201448a6 – Failed contact process July 201748a7 – GP 2 Quarterly Performance48a8 – GP Audit Criteria May 201748a9 – Performance Policy for Duty Doctors (May17-May 19)48a10 – Redacted email to GP1 re quarterly performance below standard48a11 – SELDOC Whistleblowing response with CCG questions and SELDOC responses tracked

49 Minutes of the Contract Monitoring Meeting in 2017 where the response to the Whistleblowing Concern – Summer 2017 was discussed.

31.05.18 01.06.18 12.6.18 49 – Contract monitoring minutes Sept 2017 (reference section 4)

50 Terms of Reference for the Quality Committee 31.05.18 01.06.18 31.05.18 50 – Terms of Reference Board and Clinical Governance Committee (2015)

51 Minutes of the last three Contracting Monitoring Meetings (in particular, looking for concerns raised

31.05.18 01.06.18 8.6.18 51 – Minutes of Meeting March 2018 (Provided by Jean Young, CCG)



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by LMC at meeting re GPs being referred to GMC, and Sarah Donald’s response).

Minutes not as clear as conversation with JY suggested re challenge about Doctor performance and RO referrals

52 Balanced Scorecard 31.05.18 01.06.18 01.06.18 52 – Balanced Scorecard (Contains PID)

53 Details of HR Structure / Arrangements 31.05.18 01.06.18 12.6.18 Tel Call with Sandra Ketter 12.6.18

54 GP Performance Policy 31.05.18 01.06.18 12.6.18 54 - Duty Doctor Performance Policy (next review May 2019)

55 Further examples of Weekly Bulletins from Clinical Governance Team

31.05.18 01.06.18 24.6.18 55 – Weekly Bulletin 2.2.1855 – Weekly Bulletin 27.4.1855 – Weekly Bulletin (no date)55 – Newsletter broadcast snapshot

56 Examples of monthly newsletter from Clinical Governance Team

31.05.18 01.06.18 12.6.18 56 – Clinical Newsletter Aug 1756 – Clinical Newsletter June 17

57 Outcome of enhanced prescribing audit being undertaken by Prescribing Lead.

Supplementary 7.6.18Please confirm that the allegation that triggered the enhanced audit was due to the “16 co-codamol incident” or was there an allegation regarding something else especially controlled drugs?

31.05.18

7.6.18

04.06.18

8.6.18

7.6.18

7.6.1812.6.18

57 – Enhanced Audit Dr xxxx.

57 – Prescribing statement57a – Email from Prescribing Lead

58 Examples of Derek Witt’s ‘Friday Briefings’ for South East London

31.05.18 01.06.18 01.06.18 58 – Briefing 10/11 March58 – Briefing 30th March – 2nd April58 – Briefing 26/28 May

59 Information re incidents and complaints, staff concerns, compliments for south east area showing increase, with comparative data for last 12 months

5.6.18 13.6.18 12.6.18 59 – Email with graphs re complaints and incidents



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with themes.

60 Please provide categories used for themes and complaints.

5.6.18 13.6.18 12.6.18 60 – Complaints Domain Assessment Tool60 - Complaints and Compliments Policy

61 Describe the process for the production, review and approval of all corporate (non-clinical) policies, including whose responsibility this is, and the governance route for approval.

5.6.18 12.6.18

Revised to 20.6.18

21.6.18 61 – Corporate governance policy review file note

62 In particular, can you advise who is responsible for reviewing and approving the Whistleblowing Policy and when this was last reviewed.

Further context from TC emailed to SK 12.6.18 On the website we could see a version that was

dated to expire in august 2017 (and this is still the version on the website so it’s what staff will see)

When we asked formally for the policy we were sent one that expires in august 2018

I couldn’t see any difference – so could you find out what the difference is please and who changed it and by what process?

The resolution of this is key as the review process for policies that we have been told about doesn’t seem to have worked with this one – and if it’s on the public part of the website and it’s out of date, particularly if there is a new one then staff who wished to use the policy will be using the wrong one.

As part of the info you send us could you

5.6.18 12.6.18

Revised to 20.6.18

No response received.



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include a response to this query and also the process for getting a new or updated policy on the website after it has been updated via the governance route

63 Can you please describe the process for communicating new or amended corporate (non-clinical) policies to staff at all levels of the organisation?

5.6.18 Revised to 20.6.18

21.6.18 63 – Communication of policies statement

64 Can you please confirm the route for staff to access / view corporate (non-clinical) policies?

5.6.18 Revised to 20.6.18

21.6.18 64 – Staff access of policies

65 Can you please provide a copy of your Grievance Policy and advise when this was last reviewed?

5.6.18 Revised to 20.6.18

21.6.18 65 – Grievance and Disputes Policy (Review date was May 2018)

66 Recruitment policy 12.6.18 20.6.18 21.6.18 66 – Recruitment and Selection Policy (Review date June 2018)

67 List or screenshot of policies on the V drive that staff can access

12.6.18 20.6.18 21.6.18 67 – Print screen of policies on V Drive

68 Staff Survey results – January 2018 12.6.18 20.6.18 21.6.18 68 – Staff Survey (Feb 2018)

69 Patient Satisfaction Survey 19.6.18 19.6.18 69 – Patient Satisfaction Report (SEL Qtr 3 17/18)


Documents

· Web view35 – Cover email and letter re patient being sent to A&E (supplied in PDF and word) 35 – email and attachment re UHL ED Handbook 35 – SELDOC Weekly Bulletin