Joan Richardson

3S

Telephone enquiries, please contact: NHS

Clinical Commissioning Group

Senior Coroner, West Yorkshire (Eastern)

Coroner's Office, , eee
71 Northgate, Pe
Wakefield,
WF1 3BS

22" August 2014

Dear Mr. Hinchiiff,

Inquest touching the death of Joan Dorothy Richardson (deceased)
Response to Regulation 28: Report to prevent deaths

Your report issued following the inquest into the death of Ms Richardson was passed to
me, as the responsible Medical Director, by the Chief Officer of
Leeds West Clinical Commissioning Group. The family have my, and the organisation’s,
sincere condolences. | hope | am able to reassure you and them that the actions outlined
in this response that have been taken, and are being taken, will prevent the likelihood of
future deaths in similar circumstances.

Please accept my apologies for the delay in this response but, as you will be aware, |
believed it was necessary to address fully the concerns raised in your report for me to
coordinate a response, not just on behalf of NHS Leeds West Clinical Commissioning
Group (the CCG), but also from NHS England (West Yorkshire Area Team). The latter
organisation is responsible for the contractual obligations and performance of general
practitioners and also for dealing with formal complaints when addressed to several parts
of the NHS as is this case. The CCG is responsible, among other things, for supporting
quality improvement in general practice which includes the commissioning of staff training
as well as the necessary medical cover provided to maintain safe access to care for
patients during training sessions. Your key matter of concern is the provision of safe
medical cover during training sessions in general practice for the reasons raised in your
report

As you rightly state, it is correct and appropriate for GP Practices to have time, and
continue to have time, for staff training. For many years in Leeds a regular cycle of haif-
day training afternoons have been held called TARGET (Time for Audit, Reflection,
Guidelines, Education & Training). In Leeds West ten such afternoons are held each year
with five being in-house sessions where practices arrange their own event and five are
organised centrally with GPs, practice nurses and other practice staff being required to
attend an organised training event off-site. These sessions are organised on dates set
over a year in advance. The Leeds CCGs commission the provision of GP out-of-hours
care (the services which operates during the times practices are closed at night and
weekends) to provide additional cover during this protected learning time commencing at
@uaideclay on the training day.

&
(
ey NHS Leeds West Clinical Commissioning Group
e : Unit 2-4, WIRA House, West Park Ring Road, Leeds, S16 6EB
e Tel. 0113 843 5470 Fax. 0113 843 5471

INHS

Leeds West
Clinical Commissioning Group

This service consists of identical cover to that during out-of hours periods, that is a
clinically based telephone triage (accessed via the NHS 111 urgent care number operated
by the Yorkshire Ambulance Service NHS Trust) with the option for further telephone
assessment and advice, face-to-face consultation at a number of primary care facilities in
the city, or the provision of a home visit by a GP depending on the patient's clinical
condition (operated under contract to the NHS by Local Care Direct). The three Leeds
CCGs run their TARGET events in very similar fashion but they are held on different days
to allow the providers of the medical cover to more easily provide the necessary capacity.

As you state in your report, practices should provide patients and the public with advance
and adequate notice of practice closures for training and with clear instructions on how to
seek urgent medical attention. The usual processes for doing this include:

* a telephone recorded message informing callers to the practice of the NHS 111
service if urgent medical attention is required;

e clearly visible signs at the entrances to a practice stating how to access urgent
medical attention (ie via calling NHS 111);

e similar notices can be displayed in waiting rooms, in practice leaflets and
newsletters, and on practice websites.

The first two methods are expected as a minimum and the other methods are
recommended as good practice.

I refer you to the attached letter for (acting Medical Director, NHS
England West Yorkshire Area Team) which sets out the obligations of practices to provide
medical cover during contracted hours. This includes during agreed closure periods such
as TARGET. You will note that she and her team are taking responsibility to ensure that:

1. Fountain Medical Centre is meeting the required standards

2. all practices in West Yorkshire are reminded of their obligations and

3. your concerns are communicated to NHS medical director colleagues across the
country.

| have discussed the recommendations of your report with my colleagues, the Medical
Directors of Leeds South & East CCG and Leeds North CCG, and we have agreed the
following:

1. A letter will be sent to all practice managers and senior partners in Leeds jointly from
the local CCG medical director and NHS England (West Yorkshire) acting Medical
Director reminding practices of their obligations as set out above and recommending:

a. They review the prominence and clarity of their advertising of how to seek
medical attention when the practice is closed for training

b. They ensure recorded telephone messages are similarly clear

c. They all provide advanced notice of training closure days and how to access
urgent medical attention on their websites, on practice noticeboards and
practice newsletters / leaflets

NHS Leeds West Clinical Commissioning Group

Unit 2-4, WIRA House, West Park = Road — 7 ee

Leeds West
Clinical Commissioning Group

d. They undertake appropriate training with reception staff to ensure that
consistent, clear and safe messages are given to any patient who attends in
person at the practice reception if clinical staff are away from the practice at
a training event.

e. Particular attention will need to be paid by practices who operate from
buildings where other services are also located and which may remain open
during the training sessions to ensure that the advertising and the training of
other staff within the building are able to safely advise any patients who
arrive at the building of how to seek urgent medical attention.

2. At the earliest possible opportunity, a statement will be made at a centrally
organised TARGET event in each of the three CCGs reiterating the obligations and
recommendations set out in the letter.

NHS England will then continue to monitor and ensure that practices are meeting their
contractual obligations.

t hope these actions assure you that we are taking appropriate steps to address your
concerns.

One further matter of concern which has become apparent during the preparation of this
report is that during initial investigations into a complaint raised by the deceased’s partner,
carried out by NHS England (West Yorkshire), it appears the deceased attended another
NHS contracted service (the St George's Minor injuries Unit provided by Local Care
Direct) on the morning of 21*' November 2013 although this was not referred to in your
report. An investigation led by NHS Engiand is continuing into the care received at this unit
and | have been assured that the Medical Director of Leeds North CCG (which holds lead
contractor responsibility for urgent care services on behalf of the three Leeds CCGs) and |
will be informed of the progress and findings of this investigation.

If | can be of any further assistance please do not hesitate to contact me.

Medical Director,
NHS Leeds West Clinical Commissioning Group

Encl Letter fon acting Medical Director, NHS England (West Yorkshire)

C
Medical Director, Leeds North CCG
Medical Director, Leeds S&E CCG
NHS Leeds West Clinical Commissioning Group

Unit 2-4, WIRA House, West Park Ring Road, Leeds, LS16 6EB