Practice Plus Group - Devon OOH/CAS

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed to good.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Clinical staff had access to guidance, assessment tools and triage templates from the National Institute for Health Care Excellence (NICE); National Early Warning Scores (NEWS- which is used to assess people at risk of deterioration), the British National Formulary (used to guide medicine prescribing) and used this information to help ensure people’s needs were met. The provider monitored use of this guidance through clinical audits. (Triage is the process of assessing and sorting people or problems based on urgency to prioritise care.)

Structured triage templates were available for clinicians and audits were carried out to ensure that clinician checked a person’s age, their support network, their medical history; known disabilities; and documented a discussion of the person’s current symptoms; and safety advice should the person become more unwell.

Individual care records were written and managed in a way that kept people safe. Regular audits of the quality and completeness of documentation took place and staff received feedback about this.

Clinicians working at the bases carried out telephone triaging and face to face appointments, which were booked after the initial telephone/video call. There were also clinicians who work remotely and carried out telephone triage and when appropriate, offer advice and referrals to services, such as pharmacies and minor injuries units.

The service had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.

Clinicians made appropriate and timely referrals in line with protocols and up to date evidence-based guidance.

The service was able to access summary care records and special notes for repeat callers or those who had specific health needs, such as palliative care. If this information needed to be updated, clinical staff used an authorised system to share this with the person’s own in hours GP. Frequent callers to the NHS 111 service were flagged on the system and accessed by staff at the out of hours service so that appropriate support could be given to the person.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider had systems to keep clinicians up to date with current evidence based practice. Clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols.

Clinical staff had access to guidelines from the National Institute for Health and Care Excellence (NICE) and used this information to help ensure that people’s needs were met.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked together and with other organisations to deliver effective care and treatment. Records showed that all appropriate staff, including those in different teams, services and organisations, were involved in assessing, planning and delivering care and treatment.

Clinicians were able to access an online system - Pathways Clinical Consultation Support (PaCCs) - to search services available to support people, including booking ambulances, in hours GP and clinic appointments for immediate and follow up care.

A paramedic from the local ambulance service was usually based at the main site and this enabled real time conversations about appropriateness of ambulance requests and whether the priority should be changed in response to information such as when a person’s condition worsened. If a paramedic was not on site, then there was a direct line to the ambulance service to get advice.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff were consistent and proactive in empowering people and supporting them to manage their own health and maximise their independence.

The service identified people who may be in need of extra support. For example, people who were homeless. Where appropriate, staff gave people advice so they could self-care. Systems were available to facilitate this.

Where people’s needs could not be met by the service, staff redirected them to the appropriate service for their needs.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

All providers of out-of-hours services are required to comply with the Integrated Urgent Care Key Performance Indicators and Quality Standards 2018. The performance indicators and quality standards are used to show the service is safe, clinically effective and responsive. Providers are required to report monthly to their integrated care board (ICB) on their performance against the standards which included: audits; response times to phone calls: whether telephone and face to face assessments happened within the required timescales: seeking people’s feedback: and actions taken to improve quality.

The service used national set key performance indicators to monitor their performance and improve outcomes for people. Regular reports were provided to the integrated care board (ICB) who were responsible for commissioning the service. (ICBs are NHS organisations responsible for planning health services for their local population.)

The service also used local key performance indicators (KPIs) to monitor their performance and improve outcomes for people. The provider shared data about its performance with the ICB every month.

Where the service was not meeting a target, the provider had put actions in place to improve performance in this area. The service used information about care and treatment to make improvements. Examples included: focussed recruitment of clinical and non-clinical staff and the review and development of staffing rotas.

The service made improvements using information from completed audits. Clinical audit had a positive impact on quality of care and outcomes for People. There was clear evidence of actions taken to resolve concerns and improve quality.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff respected confidentiality at all times and understood the requirements of legislation and guidance when considering consent and decision making. Where appropriate, they assessed and recorded a person’s mental capacity to make a decision.