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Inspection carried out on 22 January - 24 january 2019

During a routine inspection

This service is rated as Outstanding overall. (Previous inspection February 2017 – Outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Medvivo on 22-24 January as part of our inspection programme.

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, there was a focus on openness, transparency and the service learned from them and improved their processes.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. Evidence base guideline updates were regularly cascaded to staff. However we found in the sample of medical records reviewed that documentation was not always in line current best practice and guidance. Staff involved and treated people with compassion, kindness, dignity and respect. Patients were valued as individuals and were empowered to have a voice in their own care.
  • Patients could access care and treatment from the service within an appropriate timescale for their needs. Care was person centred and services were tailored and delivered to meet the needs of an individual in a way that ensured flexibility and choice.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation and the culture ensured all staff were engaged to deliver high quality person centred care.

We saw several areas of outstanding practice:

  • The provider worked collaboratively with external stakeholders on a range of initiatives to improve access to care and patient experience for those who were vulnerable, had a disability or were from a minority group. An example of this was use of the Streetlink homelessness App and delivering care for refugees being repatriated to the UK.
  • There were innovative approaches to providing integrated patient-centred care. For example, the provider delivered an Urgent Care @Home service. The service ensured an integrated rapid health and social care response for service users in a health or social care crisis in their own home to avoid inappropriate admissions and expedite hospital discharges. This had not only improved patient outcomes but it has also supported the whole system in terms of increased capacity and financial savings.
  • There was a strong emphasis on staff wellbeing. The interventions initiated by the provider had led to a decrease in turnover of over 6% in the last 12 months. Examples of initiatives taken were a Health and Wellbeing Charter developed with staff, the introduction of Mental Health First Aiders, resilience workshops and self-awareness campaigns.

The area where the provider should make improvements:

  • Improve and monitor documentation of consultations, to ensure they are consistently in line with best practice and current guidance.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 7 and 8 February 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fox Talbot House known as Medvivo on 7 and 8 February 2017. Overall the service is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.
  • Risks to patients were assessed and well managed. A weekly risk meeting provided a focus for risk management throughout the organisation.
  • Patients’ care needs were assessed and delivered in a timely way according to need. The service consistently exceeded the National Quality Requirements.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had undertaken training to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • There was a system in place that enabled staff access to patient records, and the out of hours staff always provided other services, for example the local GP and hospital, with information following contact with patients as was appropriate.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The provider has proactively initiated public listening events to ensure people had the opportunity to shape the delivery of care they receive.
  • 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 worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience.
  • The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
  • The leadership and culture of the provider was used to drive improvements and deliver high quality person centred care.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

We saw several areas of outstanding service:

  • The service worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example the provider worked in partnership with the ambulance service to deliver a Lift and Assist service, in order to support patients who had fallen, had not sustained an injury but were unable to get up independently. We saw that 90% of the calls for the Lift and Assist service over a six month period were managed by their responders with no other involvement required.
  • There were innovative approaches to providing integrated patient-centred care. For example the provider delivered an Urgent Care @ Home service, which had been jointly commissioned by NHS Wiltshire Clinical Commissioning Group and Wiltshire County Council.The service ensured an integrated rapid health and social care response for service users in a health or social care crisis in their own home. Patients were actively supported for up to 72 hours whilst on-going support was arranged in order to avoid inappropriate admissions and expedite hospital discharges. Since its commencement three years ago the service had supported over 2,000 patients to remain at home or to return home from hospital as soon as possible.
  • The provider recognised the need to increase the resilience of the GP out of hours (OOH) cover and this had been achieved by employing and utilising paramedics to carry out a portion of appropriate domiciliary visits on behalf of the clinical team, therefore enabling a higher number of visits to be made. A trial period of five days over Christmas 2015 demonstrated improved patient outcomes from the increased clinical resource which had led to more efficient and effective home visits during busy periods. A decision has been made for this service to operate over future bank holidays.

The was one area where the provider should make an improvement :

  • Review systems to ensure that equipment owned and used by sessional GPs were regularly checked and calibrated.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 16 July 2013

During a routine inspection

We visited the call centre during the day and into the evening. We spoke with the management team and with staff. We listened to some telephone calls and looked at clinical records. We spoke the following day to people who had used the out of hours service or their relatives. People were all very positive about the service they had received. One person told us they were �delighted with the service.� Another person told us �the doctor was absolutely amazing�.

People told us they were treated with respect and we observed this to be the case. People were spoken to politely and with empathy and patience. People told us their needs were met promptly. One relative told us how delighted they were that their child was seen by a doctor only one hour after contacting NHS 111.

Staff understood their responsibility to safeguard vulnerable adults and children and they knew how to report concerns, both internally and to external agencies.

Staffing levels were constantly monitored to ensure that the service could respond to expected and unexpected levels of demand on the service. There were robust contingency plans for periods of high demand, such as holiday periods, or other situations where risks, such as adverse weather or a health pandemic, threatened service provision.

There were effective systems in place to monitor quality and safety and a culture in which complaints and incidents were welcomed as opportunities to make improvements.