The Care Quality Commission
  • Doctor
  • Out of hours GP service

Cambridge and Peterborough IUC Services

Overall: Good read more about inspection ratings

Thorpe Road, Peterborough, Cambridgeshire, PE3 6DB 0844 560 5040

Provided and run by:
Herts Urgent Care Limited

All Inspections

15 March 2022

During an inspection looking at part of the service

The findings of this review relate to the overall system of care provision in this area and are not all specific to this provider alone. The following details the findings of this system wide review:

A summary of CQC findings on urgent and emergency care services in Cambridge and Peterborough .

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Cambridgeshire and Peterborough below:

Cambridgeshire and Peterborough

Provision of urgent and emergency care in Cambridgeshire and Peterborough was supported by services, stakeholders, commissioners and the local authority.

We spoke with staff in services across primary care, urgent care, acute, mental health, ambulance services and in care homes and domiciliary care agencies (social care). Staff had worked very hard under sustained pressure across health and social care services. Staff reported feeling tired and frustrated due to the sustained pressure and the impact this had on their wellbeing and on the delivery of training.

We identified a need for more capacity in primary care to meet people’s needs in Cambridgeshire and Peterborough. We found some concerns in relation to access for patients trying to see or speak to a GP; however, other services proactively reviewed patients’ attendance at emergency departments and took action to reduce avoidable attendances and improve access to appointments.

We visited a primary care unit run by an acute trust; whilst this was working well, we were told it was addressing an issue in access to primary care and was a short-term solution. We were told of a GP liaison service which enabled GPs and Consultants to work together to discuss individual patient needs. This service had successfully supported a significant number of people to stay at home or to access an alternative pathway and avoid going to an Emergency Department.

Access to NHS111 services for people in Cambridgeshire and Peterborough was generally in line with or better than elsewhere in England. Performance was closely monitored and there were plans in place to address staff shortages, and there was a successful on-going recruitment campaign.

System partners in Cambridgeshire and Peterborough had been part of a collaborative project to launch a Virtual Waiting Room within the Cambridge and Peterborough region. The initiative aimed to help patients who call NHS 111 receive the care they need while alleviating the pressure on Emergency Departments (EDs).

Staff working in ambulance services reported a significant volume of calls which were inappropriate for a 999 response and could have been dealt with in primary care or urgent care services. Staff also reported a high number of elderly people seeking support through emergency services because they felt their care packages were insufficient and did not meet their needs.

Ambulance crews also highlighted their frustrations with the variation in pathways at different hospitals across Cambridgeshire and Peterborough and that ambulance crews were not prioritised for accessing alternative pathways. By streamlining pathways and handover arrangements, ambulance crews felt they could be more efficient.

For many complex reasons, including ambulance handover delays and staffing shortages, there were not enough crewed ambulances to respond to 999 calls within national targets. This posed a risk to people in the community waiting for a 999 response.

Staffing shortages in some Emergency Departments impacted on the delivery of safe and effective care. Staff were not all up to date with mandatory training and did not always assess risks appropriately.

We visited a mental health service and found it met the needs of people who presented in the Emergency Department or transferred between acute and mental health services. However, staff within Emergency Departments reported problems in accessing mental health services and were not able to make referrals 24 hours, seven days a week. This impacted on the ability to provide appropriate care and treatment and moving patients to the appropriate service.

Whilst we found some examples of collaborative working focused on developing system wide resilience, we found Emergency Departments remained under significant pressure. Patients experienced significant waiting times in these departments and staff reported the challenges of caring for patients within the department for such long periods of time. Some staff felt too much risk was accepted and held within emergency departments and didn’t always feel supported by system leaders.

Same Day Emergency Care pathways aimed to relieve the pressure from Emergency departments. However, these services also experienced staff shortages, and some were only available during set times. Opportunities were lost to use admission avoidance pathways for the frail and elderly and increasing the risk of patient harm such as falls and skin pressure damage’

Delays in discharge for patients in hospital were significant and impacted on their health and wellbeing. Staffing issues were also impacting on the social care provision in Cambridgeshire and Peterborough; although there were beds available in care homes, there was not always enough staff to enable admissions. The staffing issues were also present in domiciliary care agencies which reduced the availability of care at home.

Staff working across health and social care reported poor discharge processes. Staff working in care homes and domiciliary care services reported that patients were often discharged late at night and with insufficient information to ensure a safe transfer of care.

Staff working in these services also reported significant delays in ambulance responses, however they gave very positive feedback in relation to welfare calls received by GPs or 111 and 999 call handlers.

We found a lack of knowledge across social care services in relation to managing deteriorating patients. By increasing staff awareness, services may be able to meet people’s needs without needing to request emergency services.

We observed some local and system escalation meetings and found there was limited, if any action taken in response to issues and risks escalated.

We carried out an announced focused inspection at Cambridge and Peterborough IUC Services on 15 March 2022. We are mindful of the impact of COVID-19 pandemic on our regulatory function. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

This focused inspection was carried out using our Pressure Resilience methodology which meant that we did not use all the key lines of enquiry and the report has not been rated.

The service was last inspected in July 2018 when it was rated as Good throughout. This inspection of Cambridge and Peterborough IUC Services NHS 111 and out-of-hours formed part of a system review of urgent and emergency care provision in Cambridge and Peterborough.

At this inspection we found:

  • The service had good systems to manage risk so that safety incidents were less likely to happen.
  • The service had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. The service was generally within the target range for any indicator and they actively monitored their performance.
  • There was an effective system to manage infection prevention and control.
  • The service respected and promoted patients' privacy and dignity.
  • The service had an experienced leadership team with the capacity and skills to deliver high-quality, sustainable care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

The findings of this review relate to the overall system of care provision in this area and are not all specific to this provider alone. The following details the findings of this system wide review:

A summary of CQC findings on urgent and emergency care services in Cambridge and Peterborough .

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Cambridgeshire and Peterborough below:

Cambridgeshire and Peterborough

Provision of urgent and emergency care in Cambridgeshire and Peterborough was supported by services, stakeholders, commissioners and the local authority.

We spoke with staff in services across primary care, urgent care, acute, mental health, ambulance services and in care homes and domiciliary care agencies (social care). Staff had worked very hard under sustained pressure across health and social care services. Staff reported feeling tired and frustrated due to the sustained pressure and the impact this had on their wellbeing and on the delivery of training.

We identified a need for more capacity in primary care to meet people’s needs in Cambridgeshire and Peterborough. We found some concerns in relation to access for patients trying to see or speak to a GP; however, other services proactively reviewed patients’ attendance at emergency departments and took action to reduce avoidable attendances and improve access to appointments.

We visited a primary care unit run by an acute trust; whilst this was working well, we were told it was addressing an issue in access to primary care and was a short-term solution. We were told of a GP liaison service which enabled GPs and Consultants to work together to discuss individual patient needs. This service had successfully supported a significant number of people to stay at home or to access an alternative pathway and avoid going to an Emergency Department.

Access to NHS111 services for people in Cambridgeshire and Peterborough was generally in line with or better than elsewhere in England. Performance was closely monitored and there were plans in place to address staff shortages, and there was a successful on-going recruitment campaign.

System partners in Cambridgeshire and Peterborough had been part of a collaborative project to launch a Virtual Waiting Room within the Cambridge and Peterborough region. The initiative aimed to help patients who call NHS 111 receive the care they need while alleviating the pressure on Emergency Departments (EDs).

Staff working in ambulance services reported a significant volume of calls which were inappropriate for a 999 response and could have been dealt with in primary care or urgent care services. Staff also reported a high number of elderly people seeking support through emergency services because they felt their care packages were insufficient and did not meet their needs.

Ambulance crews also highlighted their frustrations with the variation in pathways at different hospitals across Cambridgeshire and Peterborough and that ambulance crews were not prioritised for accessing alternative pathways. By streamlining pathways and handover arrangements, ambulance crews felt they could be more efficient.

For many complex reasons, including ambulance handover delays and staffing shortages, there were not enough crewed ambulances to respond to 999 calls within national targets. This posed a risk to people in the community waiting for a 999 response.

Staffing shortages in some Emergency Departments impacted on the delivery of safe and effective care. Staff were not all up to date with mandatory training and did not always assess risks appropriately.

We visited a mental health service and found it met the needs of people who presented in the Emergency Department or transferred between acute and mental health services. However, staff within Emergency Departments reported problems in accessing mental health services and were not able to make referrals 24 hours, seven days a week. This impacted on the ability to provide appropriate care and treatment and moving patients to the appropriate service.

Whilst we found some examples of collaborative working focused on developing system wide resilience, we found Emergency Departments remained under significant pressure. Patients experienced significant waiting times in these departments and staff reported the challenges of caring for patients within the department for such long periods of time. Some staff felt too much risk was accepted and held within emergency departments and didn’t always feel supported by system leaders.

Same Day Emergency Care pathways aimed to relieve the pressure from Emergency departments. However, these services also experienced staff shortages, and some were only available during set times. Opportunities were lost to use admission avoidance pathways for the frail and elderly and increasing the risk of patient harm such as falls and skin pressure damage’

Delays in discharge for patients in hospital were significant and impacted on their health and wellbeing. Staffing issues were also impacting on the social care provision in Cambridgeshire and Peterborough; although there were beds available in care homes, there was not always enough staff to enable admissions. The staffing issues were also present in domiciliary care agencies which reduced the availability of care at home.

Staff working across health and social care reported poor discharge processes. Staff working in care homes and domiciliary care services reported that patients were often discharged late at night and with insufficient information to ensure a safe transfer of care.

Staff working in these services also reported significant delays in ambulance responses, however they gave very positive feedback in relation to welfare calls received by GPs or 111 and 999 call handlers.

We found a lack of knowledge across social care services in relation to managing deteriorating patients. By increasing staff awareness, services may be able to meet people’s needs without needing to request emergency services.

We observed some local and system escalation meetings and found there was limited, if any action taken in response to issues and risks escalated.

We carried out an announced focused inspection at Cambridge and Peterborough IUC Services on 15 March 2022. We are mindful of the impact of COVID-19 pandemic on our regulatory function. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

This focused inspection was carried out using our Pressure Resilience methodology which meant that we did not use all the key lines of enquiry and the report has not been rated.

The service was last inspected in July 2018 when it was rated as Good throughout. This inspection of Cambridge and Peterborough IUC Services NHS 111 and out-of-hours formed part of a system review of urgent and emergency care provision in Cambridge and Peterborough.

At this inspection we found:

  • The service had good systems to manage risk so that safety incidents were less likely to happen.
  • The service had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. The service was generally within the target range for any indicator and they actively monitored their performance.
  • There was an effective system to manage infection prevention and control.
  • The service respected and promoted patients' privacy and dignity.
  • The service had an experienced leadership team with the capacity and skills to deliver high-quality, sustainable care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

10/05/2018

During a routine inspection

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Herts Urgent Care (HUC) out-of-hours and NHS111 service provided from the City Care Centre in Peterborough, Cambridgeshire on 10 May 2018.

The service was inspected in March 2017 and rated as good, with the service being rated as requires improvement for delivering effective out-of-hours services. We did not inspect the NHS111 service in the March 2017 inspection.

In November 2016, HUC obtained the integrated NHS111 and out-of-hours contract for the whole county of Cambridgeshire. HUC therefore provided both NHS111 and out-of-hours services for the whole of Cambridgeshire at the time of this inspection.

At this inspection we found:

  • The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.

  • The provider actively monitored any patient contact involving child protection and safeguarding adults.

  • The provider had systems and arrangements for managing medicines, including medical gases, emergency medicines and equipment and vaccines, which helped to minimise risks. Controlled drug registers were not consistently maintained in line with best practice guidance and there was no process to monitor the use of computer prescription forms. A senior member of staff we spoke with was not aware of the national guidance on prescription security. Following our inspection the provider took action and developed electronic solutions for recording information relating to prescriptions.

  • The provider organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • Staff involved and treated people with compassion, kindness, dignity and respect.

  • Some staff we spoke with explained that local leadership and guidance in the form of policies and procedures was not always as desired. Also, some staff felt guidance in the form of policies and procedures had been slow to be implemented. The provider explained that due to external circumstances, outside of the provider’s control, implementation of some systems, policies and procedures had taken longer than expected. The provider was in the process of trying to recruit a GP clinical lead and clinical workforce manager for the Cambridgeshire area.

  • Performance did not always meet contractual targets but was in line with, or exceeded, national performance.

  • There were arrangements and systems in place to support staff to respond to people with specific health care needs such as end of life care and those who had mental health needs.

We saw one area of outstanding practice:

  • The provider had an option available for patients that dialled NHS111 because of a concern for their mental health wellbeing; they could be redirected to the local mental health service single point of contact without needing to speak to NHS111 staff first. This approach had been developed locally and was being considered in other areas of the country. The provider communicated with the mental health service on a regular basis and the direct access option was reviewed by the mental health service regularly, with any outcomes or learning shared between the two services.

The areas where the provider should make improvements are:

  • Review the policy and process for managing Controlled Drugs.
  • Continue to monitor electronic solutions for recording information relating to prescriptions.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

8 March 2017

During a routine inspection

We carried out an announced comprehensive inspection of Herts Urgent Care (HUC) out-of-hours service at the Peterborough City Care Centre on 8 March 2017.

The service was inspected under the previous provider and rated as Inadequate, following which HUC took the service over with the support of the commissioners in April 2016. In November 2016 HUC obtained the integrated NHS111 and out-of-hours contract for the county of Cambridgeshire. HUC therefore provided both NHS111 and out-of-hours services in Peterborough at the time of the inspection. We only inspected the out-of-hours part of the service as the NHS111 service was inspected in November 2015 and rated Good overall.

The out-of-hours service in Peterborough provides out-of-hours care for a population of approximately 188,000 people living in Peterborough and surrounding area.

Overall the service is rated as good.

Our key findings were as follows:

  • The provider had a clear vision which focussed on quality and safety.
  • There were systems in place to help ensure patient safety through learning from incidents and complaints about the service.
  • The provider had systems in place to manage medicines but we found that improvement was needed to ensure these were effective. The provider was responsive to our findings and took immediate action.
  • The service was not consistently meeting all applicable locally agreed key performance indicators or those known as National Quality Requirements.
  • The primary care centre where patients were seen had good facilities and was equipped to meet the needs of patients. Vehicles used for home visits were clean and well equipped.
  • Staff generally expressed positive views of the management and leadership. Generally staff felt supported by the senior management team, although some staff said they felt isolated due to shift work patterns.
  • The service worked with other organisations and with the local community to develop services.
  • The service shared experience reports with the clinical commissioning group (CCG) on a monthly basis which contained information on complaints, feedback from professionals, feedback from patients, incidents and accolades.

There were areas of practice where the provider needs to make improvements.

The provider should:

  • Maintain medicine stock records appropriately so that they reflect actual stock levels.
  • Maintain records of staff’s own equipment’s calibration.
  • Record checks and restocks of clinical rooms and home visit equipment bags.
  • Maintain performance in line with local and National Quality Requirement (NQR) key performance indicators’ expectations.
  • Ensure complaints’ guidance is readily available for patients pursuing this.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice