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COVID-19 UPDATE BRIEFING DDLMC – 25.05.2020

BANK HOLIDAY SPECIAL - CQC

I hope everyone has managed to get some downtime in the beautiful sunshine and relax over this weekend. I just wanted to say a huge thank-you to you all for amazing messages of support and digging deep into your pockets during a very uncertain time. It just goes to show how lucky we all are to work in the Derbyshire GP family. This morning I received notification of an anonymous donor who took us to exactly £2600 with gift aid for MIND Derbyshire which has a lovely Karma to it all.

CQC Emergency Support Framework. The new offer of support from CQC can be found here . I thought it would be useful to share our first experiences of this new framework ahead of the Webinar on Wednesday.

Under the new framework CQC are able to use other sources of information to investigate organizations that might need support. As we have been supporting practices with resilience and suggestions of how to improve mental health, CQC deemed that this is a regulated activity provided by a multi-disciplinary team that includes a listed health care professional and was therefore in scope for registration. They therefore instigated a call to us as they had some major concerns about what we were doing. Although they don’t publish these as an inspection report, they do provide a summary report and I thought it would be useful to share some of that information.

Dear LMC

It has come to our attention that the LMC has been carrying out unregulated activity that is not registered with CQC, by providing pastoral and mental health support to GP practices across Derbyshire. In particular (following some forensic analysis of data sources – LMC website, Facebook and Virgin Money Giving) our attention was drawn to a pop-up service called “The Marathon Challenge”. In line with our guidance our findings would have resulted in an inadequate rating and formal proceedings to shut down this service so we would have been arranging a full inspection at the earliest opportunity, had the service not been closed down. The main areas are listed below:

Safe. INADEQUATE. There are major areas of concerns:

  • The main protagonist has no formal mental health training.
  • There are no records showing there was any training before running 26 miles.
  • No evidence of DBS checks, references or any formal interview process in recruiting for support roles. Apart from his family, the supporters appear to have self-selected on the basis that they wanted to help and were friends who fancied a socially distanced run. The lack of DBS was particularly worrying as one of the supporters bought his children with him.
  • There was no risk assessment carried out for any of the activities, this is particularly worrying as there was no evidence of legionella testing for the water (drawn from the participants own house) that was used throughout the event.
  • The unprescribed use of “pre-emptive” ibuprofen, and paracetamol bought from a supermarket shows there are no adequate medicines management checks in place.
  • The only supervision during the first 6 miles was provide by “Duke and Tilly”. This was totally inadequate as they are dogs.
  • In mitigation the support towards the end was provided by a GP, but there is no evidence that the GP had any equipment with him, other than a very smart bike.

Effective. REQUIRES IMPROVEMENT. This activity may have provided a light-hearted uplift to practices, but the service is an outlier, falling some £32,792,465 short of the gold standard set by a pop-up 100 year-old fundraiser in Bedfordshire who managed 100 laps of his garden as opposed to a paltry 26 miles. The significant event analysis (prompted by walking instead of running in Monsal Tunnel on the return leg and uphill along Coombs Lane towards the end) did have some useful insights:

  • “I had no doubt that this would be a tough challenge and while I wouldn’t recommend attempting such a thing without training, it has shown me that the human brain is an incredible thing. In the same way that making differences to our physical lifestyle (such as diet and exercise) can reduce our risk of physical illness these can also help our mental wellbeing and reduce the risks of succumbing to some mental health illnesses. While I am not saying for one moment that you can prevent all mental illness by “pulling yourself together and getting on with it” the power of positive thought is an incredible thing and a growth mindset really can change you outlook. In Monsal Tunnel (at around 18 miles) I was really feeling the pain and instead of thinking “Oh no I’m never going to finish this and if I walk that will be a failure”, I convinced myself that by that stage I had run 5 miles further than I had ever run before and a short period of walking would help me regather myself and be able to continue to the finish even if I had to walk the remaining 8 miles. After a few hundred metres, some real encouragement from Karen and a drink, I felt better and started running again” Seemingly insurmountable challenges do seem easier if you break them down, literally one step at a time. I also think I actually over-estimated my own resilience and realised that not only is it okay to let other people help and support you, but by doing so you actually massively improve your own performance. My family support crew (check points at Hassop and Millers Dale in both directions and running the last few miles with me) were fantastic as ever. Given the short notice, I was also very very thankful to Karen, Rob and Ben (and family) for keeping me company along various stages of the majority of the event. The chat about all sorts of things helps takes your mind off the pain. My final observation is why do dogs always decide to poo a couple of hundred metres past the only two bins on route (for the first 6 miles) thus ensuring I got to carry the black bag of shame for most of the first leg (I certainly wasn’t going back!)”

Caring. GOOD. There is good evidence from social media and e-mail comments that both the LMC and this pop-up Marathon Challenge do really care about their constituent practices and they even reach out to help non-levy paying practices. However, since these sources of information are unsubstantiated (mostly Facebook) and not reflected in the annual survey that is now 18 months out of date we are unable to include these in our report or consider them for the establishment of the rating.

Responsive. GOOD. As a very short notice pop up service this was impressive. In a period of 60 hours from 6pm on Wednesday, they saw an opportunity to help pastorally and with mental health. In addition, there was a bonus of raising some money for MIND Derbyshire as they support the wider community with mental health across the county.

However, despite the inspector rating this as outstanding, it had to go through our formal panel process and a national panel who have no first-hand experience or contact with the provider disagreed and re-rated this as good. This is not as a result of a capping exercise on the number of outstanding ratings that we can give.

Well Led. INADEQUATE. This is the other area where we have very serious misgivings:

  • There is no evidence of a strategic plan including this activity.
  • There is no evidence of internal governance in approving this plan. It seems as if a member of the team thought this would be a good idea and just went ahead with it.
  • External Governance. There was some evidence of a late notice “Any Other Business” nod of approval at a PCN CD Zoom Meeting on Friday. While the CCG were represented at the meeting, we can find no other evidence of structured governance, audit or review of this activity. We would expect to see a consultation with the PPG, minuted approval by a mental wellbeing subcommittee, a full paper submitted to PCCCCCC, which after answering some questions would have been referred to the CCG Governing Board. Approval from that Board should then have been granted after waiting the mandatory 14-day period for the publication of national guidance. The final irony, given the activity in question, is that not once during the governance process was the term “at pace” used to hurry this along. The use of Zoom is also deemed to be a threat to national security by NHSD and NHSX. Given their impeccable delivery of huge IT projects (reports of problems with the latest track and trace NHS App have been grossly overstated) this must be taken very seriously.

Summary. This well-intentioned pop-up activity obviously produced some good outcomes but the tardy planning, appalling governance structures and flagrant disregard for safety meant that we were about to issue enforcement action against this provider, until we had assurances that they will not be doing anything so foolish again. The national panel have also concluded that the challenge they have chosen for next Saturday (a 26-second-long game of tiddlywinks) does not fall under our inspection regime. We have reported this to the English Tiddlywinks Association (http://www.etwa.org/home.html) but would not recommend that you try and contact this organization since ArdenGEM have deemed there website to be a security risk and have blocked access from NHS IT.

Dr Ropey Jobsworth – Senior Inspector

AND FINALLY…

There is a genuine Emergency Support Framework update from CQC as part of the LMC Webinar on Wednesday 27th May at 11:00.  We are experimenting with Microsoft Teams so please use this link to join Join Microsoft Teams Meeting .

I hope I haven’t offended anyone and you realized this is not an official LMC policy statement. This was intended as a bit of fun to brighten up your day and please don’t take offence at my slightly off-beat view of the crazy world we live in.

I’m sure you all have your own amazing support networks (and please don’t forget that we can be a small part of that) and I wanted to indulge myself by sharing a picture of my fantastically supportive, loving and long suffering family from Saturday at about mile 24 as we came down through Rowsley. From L to R Tilly, Jessica, Duke, Isobel and me. Thank you   

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