The Care Quality Commission
  • Community
  • Community healthcare service

Archived: Primecare - Primary Care - Northampton

Overall: Good read more about inspection ratings

31 Billing Road, Northampton, Northamptonshire, NN1 5DQ 0330 123 1014

Provided and run by:
Nestor Primecare Services Limited

All Inspections

13 June 2017

During a routine inspection

Nestor Primecare Services Limited is the registered provider for Primecare Primary Care – Northampton (Primecare). Primecare provides community end of life care for adults over and under 65 years in Northamptonshire. The service is commissioned by Nene and Corby Clinical Commissioning Groups to provide dedicated care and support to patients, who are registered with a Northamptonshire GP and are thought to be in the last eight weeks of life and wish to die in their own home or in a care home.

We carried out an announced inspection of Primecare on 13 June 2017. During our inspection, we visited all clinical areas in the service. We spoke with the relatives of six patients, and six members of staff. We observed care and treatment and looked at 10 patient care records and we reviewed the service’s performance data.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate independent community end of life care services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • The service monitored and provided harm free care. There was a formal system in place to monitor and track incidents, investigations, and actions taken for sharing of learning.
  • There were arrangements in place to safeguard adults and children from abuse that met relevant regulation and local requirements.
  • Information about the outcomes of people’s care and treatment were routinely collected and monitored and outcomes were generally positive and used to drive improvements.
  • The service had sufficient staff, of an appropriate skill mix, to enable the effective delivery of care and treatment.
  • Services were planned and delivered to meet the needs of local people. The service was flexible and enabled patient choice and continuity of care.
  • Patients had timely access to initial assessment and urgent treatment.
  • The service had a clear vision and set of values based on the quality of patient care. There was an effective and realistic strategy, which prioritised quality care.
  • There was an effective governance framework to support the delivery of the strategy and high quality care.
  • There was evidence of strong national and local leadership, with accessible and responsive managers.

We saw several areas of excellent practice including:

  • We observed a strong, person-centred culture. Staff treated patients with compassion, kindness, dignity, and respect.
  • Staff understood and respected patients’ personal, cultural, social, and religious needs, and these were taken into account and were reflected in how their care was delivered.
  • Relatives we spoke with were consistently positive about the care their loved ones had
  • Staff were committed to providing compassionate care not only to patients but also to their families.

18 May and 4 June 2015

During a routine inspection

This announced inspection took place on 18 May and 4 June 2015. Primecare Primary Care - Northampton provide dedicated support to people who are nearing the end of their lives and wish to die in their own home or in a care home.

Primecare Primary Care - Northampton provide dedicated care and support to patients who are registered with a Northamptonshire GP, are thought to be in the last eight weeks of life and wish to die in their own home or in a care home.

The service dovetails with existing NHS care providers; Northampton and Kettering General Hospitals, District Nurses, GP’s, Marie Curie, Hospice At Home, Northamptonshire out of hour’s medical service, Macmillan and East Midlands Ambulance Service and is an integral part of the Northamptonshire End of Life Pathway.

There are three distinct aspects to the service; Advanced Nurse Practitioners based at Northampton and Kettering General Hospitals provide discharge planning and support for patients who are nearing the end of life and wish to be cared for at home or in their own care home. Advanced Nurse Practitioners and healthcare assistants provide a rapid response to people who are in their own home or care home and require support or treatment. People can contact the Primecare Care Coordination Centre 24 hours a day. Between 08:00and 01:00 the call regarding that person is passed immediately by the centre to the Primecare Rapid Response community nursing team. Out of these hours the referral is passed to directly Northampton’s out of hour’s medical service.

At the time of our inspection the service supported more than 90 people, and had supported over 650 to receive their end of life care in their chosen place of care. The numbers of people receiving the care from the service changed daily as people used the service when they required urgent relief of their symptoms.

At the last inspection in July 2013 we asked the provider to make improvements on the assessment of people’s needs to ensure the planning and delivery of care met their individual needs. These improvements had been completed.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager understood their responsibilities and demonstrated this by managing all aspects of the service to provide a high quality service.

People were involved in choosing where they received their end of life care. When people were being discharged from hospital staff listened to what people wanted and arranged care based around their wishes and need; this included arranging equipment and care at home to ensure a persons safety and comfort.

The service was easily accessible everyone who required the end of life care. Staff responded rapidly to requests for support for people receiving end of life care at home or in a care home. People who used the service valued the caring relationship with the staff, who ensured that people received care in a dignified and respectful way. Staff were flexible in the length of time given at each visit to meet the needs of people who used the service and their relatives.

The service worked in partnership with the local end of life providers. Staff kept health professionals informed about the care that people had received to ensure that people received continuity of care.

People were protected from avoidable harm and abuse as staff understood how to recognise and report any concerns. Staff understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There were sufficient numbers of skilled and experienced staff to meet people’s needs. All of the staff had undergone rigorous recruitment processes to ensure they had the required skills and experience to provide care to people at end of their lives. The Advanced Nurse Practitioners who prescribed medicines were qualified to practice as a Non-Medical Prescribers and attended regular professional development updates.

All staff received mandatory training, role specific training and regular updates. Staff received regular supervision and feedback on how well they were doing and how to improve their practice. Complaints were dealt with promptly and changes had been made to improve the service. Quality monitoring and people’s feedback was used to monitor and improve the service.

23, 26 July 2013

During a routine inspection

We spoke with one person and two relatives of people who had used the service. We also spoke with three staff, the registered manager and two health professionals who worked for another provider.

People and relatives of people who used the service told us that they received a good standard of care from the staff. One person told us that the staff were 'absolutely fantastic' and that they were 'the most compassionate human beings on the earth'. A relative of a person who used the service told us that the staff helped them to meet their family member's wish to die at home and that the staff had been 'calm and compassionate' when delivering their care.

We reviewed the improvements that the service had made following an inspection visit during December 2012. During this inspection visit we found that the provider had made improvements to their arrangements for supporting workers and that staff had been trained in moving and handling procedures. We also found that people using the service gave their consent for their treatment and people's families had been involved in decision making when people lacked the capacity to make decisions about their care. We also found that the provider operated an effective recruitment and complaints system. However, we had some concerns that there was not a formal assessment process in place to make sure people's needs were appropriately assessed.

6 December 2012

During a routine inspection

We spoke with three relatives of people who had used the service. They all told us that they were pleased with the level of care that was provided to their family members. They also told us that the planned care their family member received had made a huge difference to their family member's life. They told us that the staff from the service had also been supportive to the whole family. One of the relatives told us that the help they received from the staff had 'taken the pressure off' at a time when they were finding it difficult to manage all their family member's needs. The relatives also told us that the staff understood their family member's needs very well because they took the time to get to know them.

All the relatives told us that they had used the rapid response when they needed immediate care for their family member. One relative told us that this was a 'brilliant' service and that the staff 'could not do enough' for their family member. Most people told us when they used the rapid response service; a nurse came out to visit them straight away. One person said that there were a few occasions when they had to wait a couple of hours for the rapid response nurses to attend to them. However, they told us that the nurses kept them informed at all times, if they were going to be delayed in providing care. All the relatives told us that the service was very good.