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Reports


Inspection carried out on 24 January 2019

During a routine inspection

This service is rated as Good overall. (Previous inspection January 2018– Requires Improvement).

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, follow up inspection at North Central London (NCL) South Hub on 22 and 24 January 2019. CQC previously inspected the service on 23 and 25 January 2018 and asked the provider to make improvements because although the care being provided was effective, caring and responsive, it was not being provided in accordance with the relevant regulations relating to safe and well led care.

At our previous inspection we found the provider had breached Regulation 12 (1) (Safe care and treatment) and Regulation 17 (1) (Good governance) of the Health and Social Care Act 2008. This was because staff checks were not being undertaken to the appropriate level and because the provider’s decision not to carry oxygen in home visit vehicles had not been sufficiently risk assessed. We also noted the absence of appropriate systems for sharing learning from significant events and for ensuring safety alerts improved patient safety.

The service wrote to us to tell us what they would do to make improvements and we undertook this comprehensive inspection to check the service had followed their plan and to confirm they had met the legal requirements.

At this inspection we found:

•Action had been taken since our last inspection in January 2018, such that when safety incidents happened, systems were in place to ensure learning was shared and processes improved.

•Action had been taken since our last inspection, such that Disclosure and Barring Service (DBS) checks for home visit drivers were now being undertaken to the level stipulated in the provider’s Recruitment Policy. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.

•The service ensured care and treatment was delivered according to evidence-based guidelines.

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

•There was a strong focus on continuous learning and improvement at all levels of the organisation.

•The leadership, governance and culture of the service promoted the delivery of high-quality person-centred care.

The areas where the provider should make improvements are:

•Continue to carry out medicines audits to ensure prescribing patterns are in line with best practice guidelines for safe prescribing.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 23 & 25 January 2018

During a routine inspection

This service is rated as Requires Improvement.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at North Central London (NCL) South Hub Out Of Hour’s service on 23 and 25 January 2018 as part of our inspection programme.

At this inspection we found that:

  • Although overall, governance arrangements aimed to focus on the delivery of good quality care, arrangements regarding patient safety alerts and staff pre-employment checks did not always operate effectively.

  • Information available on the day of the inspection and shortly thereafter did not provide sufficient assurance that when things went wrong, reviews and investigations were thorough and included all relevant people.

  • Patients’ care needs were assessed and delivered in a timely way according to need.
  • Commissioners spoke positively about how NCL South Hub had met expectations regarding locally agreed performance targets. They told us that they met regularly with leaders and that they were sufficiently assured regarding quality and safety.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • The service managed patients’ care and treatment in a timely way.
  • Patients said they were treated with compassion, dignity and respect; and that they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The service’s base location had good facilities and was well equipped to treat patients and meet their needs. The fleet vehicles used for home visits were well equipped, well maintained and clean.
  • There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

  • There was a strong culture of innovation evidenced by the number of pilot schemes the provider was involved in.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Continue to use clinical audits to drive improvements in patient outcomes.

  • Continue to record recently commenced periodic checks of defibrillators.

  • Introduce a formal governance framework for its pilot Non-Medical Prescribers project.

  • Introduce appropriate systems to ensure that staff receive safeguarding training to the appropriate level and at the appropriate time.

Professor Steve Field

CBE FRCP FFPH FRCGP Chief Inspector of General Practice