Quality | 2009.11.08
Firm that hired GP loses NHS contract
Take Care Now to be replaced in east Cambridgeshire amid new safety concerns over shifts
The private company that hired a foreign doctor who accidentally killed a patient on his first UK shift as a locum has had an NHS contract terminated early due to new safety concerns, the Guardian can reveal.
Checks on Take Care Now by the national NHS safety watchdog and the NHS in Cambridgeshire have added to their unease about its ability to fill shifts and organise cover for weekend and evening GP services. Health chiefs in the county have arranged for a local doctors\' co-operative, Camdoc, to replace TCN in east Cambridgeshire and Fenland from 1 December pending a decision on round-the-clock care in the county. They had already served notice of a shakeup for services by four providers next April.
TCN\'s problems over unfilled shifts were revealed last month in an interim report by the Care Quality Commission (CQC), which is investigating the case of Daniel Ubani, who killed David Gray, 70, with a painkiller overdose in 2008 in Manea, Cambridgeshire. The Department of Health was so worried by the interim findings that it ordered all 152 NHS organisations responsible for overnight and weekend care to review patient safety.
Further checks conducted after the interim findings were ready for publication have deepened concerns over TCN.
TCN says it uses other staff, including emergency care practitioners or nurses, to cover gaps, and that much of the argument is over the way providers fulfil contracts. Insisting on having health staff in certain local bases is not the best use of resources nor the best indicator of care, it says.
TCN has other out-of-hours contracts, on its own or with other providers, with NHS trusts in Suffolk, Great Yarmouth and Waveney, Essex, and Worcestershire.
Chris Banks, chief executive of Cambridgeshire NHS, said it had been closely monitoring TCN since Gray\'s death, including 20 unannounced inspection visits. He said dissatisfaction with progress and concern about TCN\'s overall performance led to a formal remedial notice under the contract on 18 September.
The weekend after the interim report on 2 October, another check found "further deficiencies" in [TCN\'s] shift cover. The CQC said yesterday: "Unfilled shifts are a worry because people might wait longer to see a doctor and unnecessary pressure falls on other parts of the system."
TCN said it offered an alternative way of organising out-of-hours services rather than a "static and rigid framework" based on staff in specific locations. Jim Kennedy, the company\'s medical director, added: "Our 14 years of experience, supported by patient surveys, suggests a patient-centric approach provides a better service. We use a more adaptable model that allows resources across the area to be flexed from minute to minute to match patient demand where they are needed."
Ubani has been convicted in Germany of causing Gray\'s death by negligence and given a suspended prison sentence.The private company that hired a foreign doctor who accidentally killed a patient on his first UK shift as a locum has had an NHS contract terminated early because of new safety concerns, the Guardian can reveal.
Checks on Take Care Now by the national NHS safety watchdog and the NHS in Cambridgeshire have strengthened their unease about its ability to fill shifts and organise enough cover for weekend and evening GP services.
Health chiefs in the county have arranged for a local doctors\' co-operative to replace TCN in east Cambridgeshire and Fenland from 1 December pending a decision on new arrangements for round-the-clock care in the county. They had already served notice of a shakeup for services currently run by four providers but this will not happen until April.
TCN\'s problems over unfilled shifts were first revealed in an interim report by the Care Quality Commission (CQC ) last month. The watchdog is investigating the case of Daniel Ubani, who killed 70-year-old David Gray with a massive overdose of a painkiller in February 2008. The accident, which happened in Manea, Cambridgeshire, has already raised nationwide concerns over out-of-hours services.
The Department of Health was so worried by the interim findings that it ordered all 152 NHS organisations responsible for overnight and weekend care to review patient safety, including induction of doctors, call handling, prioritisation of cases and clinical decision-making.
Further checks by the commission and NHS Cambridgeshire conducted after the interim findings were ready for publication have deepened concerns over TCN.
The company says it uses other staff on duty, including emergency care practitioners or nurses, to cover gaps and claims much of the argument is over the way out-of-hours providers meet the obligations of their contracts.
Insisting on having doctors or other health staff in certain local bases is not the best use of resources nor the best indicator of patient care, it says.
TCN has other out of hours contracts, on its own or with other providers, with the NHS trusts in Suffolk, Great Yarmouth and Waveney, Essex and Worcestershire, and says, overall, it supplies NHS services to over 2.1 million people.
NHS Cambridgeshire began planning a reorganisation of out-of-hours services before all the consequences of the Ubani case were clear and had promised "tough questions" would be asked of all those wanting to bid to run the new services.
But the latest concerns have led to the appointment of Camdoc, a doctors\' co-operative that already provides cover in Cambridge and the south of the county, to replace TCN in east Cambridgeshire for four months before the changes occur. Chris Banks, chief executive of Cambridgeshire NHS, said it had been closely monitoring TCN\'s safety and performance since Gray\'s death, including 20 unannounced inspection visits and 13 unannounced telephone spotchecks. He added: "We recently became dissatisified with the progress being made and concerned about TCN\'s overall performance, such that on 18 September we served it a formal remedial notice under the contract."
The weekend after the CQC published its interim report on 2 October another check found "further deficiencies in the shift cover provided by TCN" . This "additional evidence of failure to provide contracted services" led to the latest developments, said Banks.
The commission said its inquiries into TCN and the NHS trusts commissioning its services were continuing. It added: "Unfilled shifts are a worry because people might wait longer to see a doctor and unnecessary pressure falls on other parts of the system that may have to step into the breach."
TCN said it offered an alternative more "patient centric" way of organising out-of-hours services than a "static and rigid framework" based on staff being in specific locations which might lead to "an expensive resource" sitting doing nothing while another was overloaded.
Jim Kennedy, the company\'s medical director added: "Our 14 years of experience, supported by patient surveys, suggests a patient-centric approach provides a better service. We use a more adaptable model that allows resources across the area to be flexed from minute to minute to match patient demand where they are needed."
Ubani, a German national of Nigerian origin, flew from Germany the day before his shift.
He has been convicted in Germany of causing Gray\'s death by negligence and given a suspended prison sentence. That has meant British police can no longer investigate a possible manslaughter charge over the same incident.
For more information, please visit
http://www.guardian.co.uk/society/2009/nov/09/tcn-contract-terminated
