The Care Quality Commission (CQC) has published its report into the GP out-of-hours provider, Take Care Now (TCN). The regulator’s investigation was triggered by the case of Mr David Gray, a patient killed by an overdose of 100 mg diamorphine in February 2008.
The drug was administered by Dr Ubani, an out-ofhours doctor from Germany employed by TCN. Dr Ubani has since been struck off the General Medical Council (GMC) register and is no longer permitted to practise in the UK. CQC looked in-depth at TCN’s out-of-hours service to assess its performance dating back to April 2007. It also assessed whether lessons had been learned and action taken following the death of Mr Gray. As part of its investigation, CQC considered how the five PCTs that used TCN’s out-of-hours services monitored the quality of the service being provided. CQC’s report shows that prior to the death of Mr Gray, TCN did not take sufficient action to ensure the safe use of diamorphine. This is despite a senior clinician warning TCN managers that it “was only a matter of time before a patient is killed” due to an overdose of the drug. The warning followed two non-fatal overdoses of diamorphine, which occurred in Suffolk in the year before Mr Gray’s death (April and August 2007). In both cases the drug was administered by doctors from Germany, where diamorphine is not routinely used. Clinicians suggested changes to prevent future overdoses, but these were not implemented. The report highlights further systemic failings by TCN. CQC published evidence that:
• Staffing levels were potentially unsafe. Unfilled shifts and lack of clinical cover could have compromised the care of patients. There were occasions when one nurse was the only clinical cover for 70 miles.
• TCN failed to investigate, act on and learn from serious incidents. This included the two previous overdoses of diamorphine.
• Reporting of activity to the PCTs was not clear and transparent. “Double counting” of some patients would have given the impression that TCN was treating more patients and could have affected contract negotiations with the PCTs.
• Local GPs were not confident in the service provided by TCN. Fifty per cent of GPs surveyed by CQC said the ability of the organisation to provide clinical care in people’s home was “poor” or “very poor”.
• TCN grew rapidly, taking on more contracts with PCTs, but apparently without the clinical governance in place to ensure the quality of its services.
The CQC commented that the PCTs involved have since taken action to improve commissioning and monitoring of out-of-hours services. From April 2012, companies providing GP out-of-hours services must be registered with CQC in order to legally provide services.
