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Inspection Summary


Overall summary & rating

Good

Updated 10 March 2016

We carried out this inspection of Herts Urgent Care NHS 111 on 3 and 4 November 2015. NHS111 is a 24 hours a day telephone based service where patients are assessed, given advice or directed straightaway to a local service that most appropriately meets their needs. For example that could be to their own GP, an out-of-hours GP service, walk-in centre or urgent care centre, community nurse, emergency dentist, emergency department, emergency ambulance or late opening chemist.

Herts Urgent Care (HUC) provides NHS111 services for Hertfordshire and Cambridgeshire from two call centres at Ascots Lane, Welwyn Garden City and City Care Centre, Thorpe Road, Peterborough.

The NHS111 service for Hertfordshire is an integrated NHS111/out-of-hours service. The out -of-hours service is subject of a separate inspection and report.

The NHS111 service had not been subject to any previous CQC inspection.

Our key findings were as follows:

  • Herts Urgent Care provided a safe, effective, caring , responsive and well-led service.
  • There were systems in place to help ensure patient safety through learning from incidents and complaints about the service.
  • The provider had taken steps to ensure that all staff underwent a thorough recruitment and induction process to help ensure their suitability to work in this type of healthcare environment.
  • The service was high achieving and had consistently met or exceeded the key performance indicators known as the Minimum Data Sets (MDS)
  • Patients experienced a service that was delivered by dedicated, knowledgeable and caring staff.
  • Staff were supported in the effective use of NHS Pathways. Call review and audit was regular and robust in its application.
  • We found that the service was well-led and managed by an effective senior management team and board of directors, and their values and behaviours were shared by staff.
  • Staff expressed positive views of the management and leadership and felt well supported in their roles.
  • Callers were satisfied with their experience of using the service.

We saw several areas of outstanding practice including:

  • At the conclusion of the CQC inspection the provider displayed total openness and honesty as all available staff were invited to listen to the feedback provided by the CQC inspection team.
  • The provider had developed links with the University of Hertfordshire in order to develop their clinical advisors by means of courses aimed effective telephone triage through history taking, asking sensitive questions and decision making. Clinical advisors had further been supported to attend the ‘Assessment- A Systematic Approach’ facilitated by the University which enabled clinicians, if they so wished, to progress further to assess and triage patients face to face as Clinical Navigators .

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Review health advisors awareness and knowledge of the Mental Capacity Act to ensure relevant callers are managed appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 March 2016

There were clear procedures and policies that staff were aware of to enable them to recognise and act upon any serious events or incidents. Any learning was shared with staff.

We found that the provider had systems in place to ensure that people seeking to work at Herts Urgent Care were appropriately recruited to ensure their eligibility and suitability to work in a healthcare environment.

All staff, both permanent and temporary underwent a thorough induction process upon starting work.

The provider had good systems in place to identify and safeguard patients at risk of harm.

There were robust systems in place designed to allow continuity of the NHS 111 service in the event of information technology or telephony  systems failures or other circumstances that might affect the delivery of the service.

Effective

Good

Updated 10 March 2016

We found that the service was effective in responding to calls and directing patients to the appropriate healthcare service that best met their needs.

The provider had consistently scored highly in a number of key indicators of performance, especially in times of high demand .

Clinicians were subject to continuing clinical supervision and case review to ensure their effectiveness in delivering the appropriate assessment for patients. All call taking staff were regularly monitored to ensure the effective and safe use of NHS Pathways.

The provider undertook regular measurement of the service effectiveness and achievement to continually assess and improve the service to patients.

There was an effective system in place to ensure information about patients coming into contact with the NHS 111 service was shared at the earliest opportunity.

There was good collaborative working between the provider and other healthcare and social care agencies to help ensure patients received the best outcomes in the shortest possible time.

Caring

Good

Updated 10 March 2016

Patient experience surveys showed a high degree of satisfaction with the service provided.

There was a process in place to ensure patients whose first language was not English were able to access the service through interpreter services.

We heard callers to the service being spoken with professionally, courteously and with empathy.

Staff were given the opportunity to attend courses aimed at helping them to ask difficult and sensitive questions of callers.

Responsive

Good

Updated 10 March 2016

There was an efficient complaints system and we saw that any learning from those complaints was shared with staff.

The provider undertook continuing engagement with patients to gather feedback on the quality of the service provided.

The provider undertook regular assessments of the efficacy of the service to ensure that patients’ needs were met.

There were systems in place to ensure that during anticipated high levels of demand, sufficient staff were available to maintain a high standard of service.

Well-led

Good

Updated 10 March 2016

Members of staff we talked with spoke positively about the management of the service and said the management team was keen for staff to continually learn and improve.

There was a strong and stable management structure; senior management were visible and an integral part of the staff team. Both the board of directors and the senior management team displayed high values aimed at improving the service and patient experience and took positive steps to remind and re-enforce those values with all staff.

There was a clear leadership and management structure and staff we spoke with were clear as to whom they could approach with any concerns they might have.

The provider supported both clinical and non-clinical staff by providing a range of training opportunities all aimed at delivering high quality, safe care and treatment to patients.

We saw good examples of the organisation exercising its duty of candour when things had gone wrong.

We witnessed absolute openness and honesty by the senior management team towards staff at the conclusion of the inspection.