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Practice Plus Group - NHS 111 London Good

Inspection Summary


Overall summary & rating

Good

Updated 21 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Care UK (NHS 111 London), Unit 1, Square One, Navigator Park, Southall Lane, UB2 5NH on 13 and 14 March 2017, at its single site location.

Our key findings were as follows:

Care UK (NHS 111 London) (the provider/the service) provided a safe, effective, caring, responsive and well-led service to a diverse population in London. Overall, the provider was rated as good.

  • There was an open and transparent approach to safety and an effective system in place to report and record significant events. Staff knew how to raise concerns, understood the need to report incidents and considered the organisation a supportive, culture. The provider maintained a risk register and held regular internal and external governance meetings.
  • The service was monitored against a National Minimum Data Set (MDS) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners about the level of service provided.
  • Staff had been trained and were monitored to ensure they used NHS Pathways safely and effectively (NHS Pathways is a licensed computer-based operating system that provides a suite of clinical assessments for triaging telephone calls from patients based on the symptoms they report when they call).

  • Patients using the service were supported effectively during the telephone triage process and consent was sought. We observed staff treated patients with compassion and respect.

  • Staff took action to safeguard patients and were aware of the process to make safeguarding referrals. Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including calls from children and frequent callers to the service.

  • The provider was responsive and acted on patients’ complaints effectively and feedback was welcomed by the provider and used to improve the service.

  • There was visible leadership with an emphasis on continuous improvement and development of the service. Staff felt supported by the management team.

  • The provider was aware of, and complied with, the Duty of Candour. Staff told us there was a culture of openness and transparency.

We saw one area of outstanding practice.

  • People are protected by a strong comprehensive safety system that identifies opportunities to learn and shares that learning internally and externally.

There were areas where the provider should make improvements:

  • Continue to address the challenges of recruiting substantive staff and the high reliance on agency staff to ensure adequate numbers of skilled staff are available to provide a safe and effective service.
  • Improve the process for documenting discussions, decisions and actions for internal meetings for audit purposes, including but not limited to, appraisals and development meetings.
  • Consider ways to engage with a variety of patient representative groups.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 June 2017

The provider is rated as good for providing safe services.

  • There was an open and transparent approach to safety and an effective system in place to report and record significant events. Staff knew how to raise concerns, understood the need to report incidents and considered the organisation a supportive culture. The provider maintained a risk register and held regular internal and external governance meetings.

  • Staff took action to safeguard patients and were aware of the process to make safeguarding referrals. Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including calls from children and frequent callers to the service. Level three safeguarding training had been undertaken by 100% of the clinicians.

  • Service performance was monitored and reviewed and improvements implemented.

  • Clinical advice and support was readily available to health advisors when needed.

  • Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. The provider faced challenges recruiting substantive staff and relied heavily on agency clinicians.

Effective

Good

Updated 21 June 2017

The provider is rated as good for providing effective services.

  • Daily, weekly and monthly monitoring and analysis of the service achievements was measured against key performance targets and shared with the lead clinical commissioning group (CCG) members.

  • Appropriate action was undertaken where variations in performance were identified. Staff were trained and rigorously monitored to ensure safe and effective use of NHS Pathways.

  • There was evidence that staff received annual appraisals and personal development plans were in place; however, these were not formally recorded. The service confirmed that they had regular informal discussions with staff, which were not always recorded. They were aware of the issue and had booked management staff to attend courses on how to formally undertake and record appraisals and personal development plans.

  • Staff recruited had the appropriate skills, knowledge and experience.

  • Staff ensured that consent as required was obtained from people using the service and appropriately recorded. There was an effective system to ensure timely sharing of patient information with the relevant support service identified for the patient and their GP.

  • People’s records were well managed, and, where different care records existed, information was coordinated.

  • Staff used the Directory of Services (DoS) and the appropriate services were selected. (The DoS is a central directory about services available to support a particular person’s healthcare needs and this is local to their location.)

Caring

Good

Updated 21 June 2017

The provider is rated as good for providing caring services.

  • We observed staff treated people with kindness and respect, and maintained people’s confidentiality.

  • Health advisors had access to the Language Line phone facility (a translation/interpreter service) for patients who did not have English as their first language, a text relay service for patients with difficulties communicating or hearing and a video relay service for British Sign Language (BSL) interpreters.

  • Feedback from people about the service was predominantly positive.

  • People using the service were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

Responsive

Good

Updated 21 June 2017

The provider is rated as good for providing responsive services.

  • The service had long and short-term plans in place to ensure staffing levels were sufficient to meet anticipated demand for the service.

  • There was a comprehensive complaints system and all complaints were risk assessed and investigated appropriately.

  • The provider implemented suggestions for improvements and made changes to the way it delivered services as a   consequence

    of feedback.

  • Action was taken to improve service delivery where gaps were identified.

  • Staff were alerted, through their computer system, to people with identified specific clinical needs and for safety issues.

  • The provider engaged with the lead Clinical Commissioning Group (CCG) to review performance and agree strategies to improve. Work was undertaken to ensure the Directory of Services (DoS) was kept up to date. (The DoS is a central directory about services available to support a particular person’s healthcare needs and this is local to their location.)

Well-led

Good

Updated 21 June 2017

The provider is rated as good for being well-led.

  • The provider had a clear vision and strategy to deliver a high quality service and promote good outcomes for people using the service. The vision and values were displayed around the call centre and staff we spoke with were aware of these.

  • There was a clear leadership structure and staff we spoke with told us management were supportive and approachable.

  • The provider’s policies and procedures to govern activity were effective, appropriate and up-to-date. Regular internal and external governance meetings were held.

  • There was an overarching governance framework, which supported the delivery of the strategy and a good quality service. This included arrangements to monitor and improve quality and identify risk. The provider held a risk register.

  • The provider was aware of and complied with the requirements of the duty of candour. The provider and managers encouraged a culture of openness and honesty. The provider had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • The provider sought feedback from people using the service via the contractual patient survey and text messaging. An annual staff survey was also undertaken.

  • There was a focus on continuous learning and improvement at all levels.