Practice Plus Group - NHS 111 Devon

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.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

People were involved in assessments of their needs. Care was based on latest evidence and good practice. Staff made sure people understood their care and treatment to enable them to give informed consent.

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.

Telephone assessments were carried out using a defined operating model. Staff were aware of the operating model which included warm transfers (where during the initial pathways assessment calls were transferred to a clinician for immediate triage). Once a disposition had been reached then the directory of services would provide services for onward care and treatment.

In NHS 111, a disposition is the final outcome or recommended action determined by the clinical assessment system (NHS Pathways) after assessing a patient's symptoms. It specifies the required level of care, the appropriate service, such as AE, GP services or a pharmacy, and the timeframe for that care, such as an ambulance within 20 minutes or a callback within 1 hour.

There was also a local as well as national disposition in place which had information on services in the local area, based on the person’s postcode, such as toxic ingestions for people aged between 5 and 80 years old. These cases were placed in the clinical call back queue for triage by a clinician to determine the best course of action.

There were arrangements to deal with frequent callers, this included special notes on their records and liaising, when necessary, with in-hours service providers to agree a coordinated approach to their care and treatment.

There was a system to identify frequent callers and patients with particular needs. For example, palliative care patients.

When staff were not able to make a direct appointment on behalf of the patient, clear referral processes were in place.

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.

Systems had been formalised within the NHS 111 service, with specific referral protocols for patients referred to it. The service was able to book directly into appointments with in-hours GPs in the local area. An electronic record of all consultations was sent to patients’ own GPs so that they were aware of the need for further action.

Issues with the Directory of Services(DOS) were resolved in a timely manner. All DOS issues were managed by a dedicated team and staff were made aware of changes. (The Directory of Services contains information on local and national services which patients can be referred or signposted to for further care, treatment or advice, such as pharmacies and walk-in centres).

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

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 peoples need 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.

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.)

Clinicians used a dashboard of cases waiting a callback and worked through this in priority and time order. Data gathered on the day of the site visit (2 December 2025) showed that at 3.44 pm there were no calls waiting, 9 health advisors were available to take calls. A total of 491 calls had been answered with an average time to answer of 41 seconds. Data on calls volumes was collated on a 15-minute basis and at the end of each shift a daily performance report was produced and used to identify areas where targets had not been met. This information was used to inform workforce planning.

Call date for the day of the site visit (2 December 2025) was sampled to identify busy periods and staffing levels at these times. Findings showed:

• Between 8.45am and 9.45am the average call answer time went from 6 seconds to 230 seconds, before going down to 42 seconds.
• Between 11.15 am to 12.30pm the average time to answer calls went from 69 seconds to 153 seconds, before returning to 94 seconds.
• Between 15.45pm and 7.15pm the average time to answer went from 7 seconds to 404 seconds, before returning to 63 seconds at the end of the period.

These time frames aligned with periods when rota fill for clinical advisors were on average two thirds of the level of staffing predicted to be required and there were smaller shortfalls in the number of health advisors needed. Rotas over time showed that rota filled for the period 7 pm to 8 am the following morning were in line with or above the number of staff required for both roles.

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 patient’s mental capacity to make a decision.