The under-fire GP out-of-hours service for Norfolk and Wisbech requires further improvement, inspectors have ruled in a report published today.

Health watchdog the Care Quality Commission (CQC) launched an investigation after it was revealed that service providers Integrated Care 24 (IC24) had only one doctor covering a population of around 830,000 on certain nights.

Internal documents were leaked to this newspaper in February 2016 by an NHS whistleblower.

In a recent unannounced inspection, CQC bosses found that further changes were needed to ensure people were provided with a safe service, but that the process of change had begun and that IC24 leadership was capable of delivering this.

The time taken to answer 111 calls was slower than the national average in February but is now better than the national average, an NHS England spokesman said.

A CQC report, published today, ruled that more protocols were needed to ensure out-of-hours staff who make clinical judgments by telephone make safe and appropriate decisions.

An effective process for ensuring medicines held at primary care centres are within the manufacturers' recommended expiry dates must be put in place, along with systems to ensure staff files and recruitment procedures are effectively recorded.

There must be contingency arrangements, so appropriately trained staff are present at all primary care centres when gaps in GP cover arise.

And background security checks for all staff must be carried out in a timely and orderly manner.

The CQC was working with the region's clinical commissioning groups and NHS England to ensure sustainable improvements take place.

Janet Williamson, deputy chief inspector of general practice and dentistry in the CQC's central region, said procedures to prevent patients being put at risk of harm were not always in place, but there was evidence of improvement.

'We will return to this service again soon to check it has taken action to ensure everyone who uses this service gets safe, high quality care,' she said. 'If, when we return, we are not satisfied that this has happened we will consider taking further action.'

Yvonne Taylor, chief executive of IC24, said the inspection happened withing the 'transition and bedding in period of the new contract'.

'Those issues identified within the CQC's report were already known to us and being dealt with, as stated by the regulator,' she said.

She praised IC24's dedicated staff for their continued efforts and hard work.