Ailsa House

Updated 3 December 2021

Ailsa House is a registered location of Partnering Health Ltd (PHL) and is currently registered with the Care Quality Commission (CQC) to provide the following regulated activities:

• Diagnostic and screening procedures,
• Transport services, triage and medical advice provided remotely,
• Treatment of disease, disorder or injury.

These regulated activities are delivered via:

• An Integrated Urgent Care (IUC) Clinical Assessment Service (CAS) (remote telephone and video triage and clinical assessment) for patients in Hampshire and the Isle of Wight. This service is a collaborative commissioned approach with an ambulance trust and two local Clinical Commissioning Groups (CCGs). The ambulance trust provides the NHS 111 service with Health Advisors and Clinical Advisors that will refer to the PHL Clinical Assessment Service following a pathways assessment needing further clinical assessment.
• Within the Integrated Urgent Care Clinical Assessment Service is the Paediatric Desk. Paediatric Patients are referred from NHS 111 to the paediatric desk following a pathways assessment needing an Emergency Department (ED) validation. Remote Clinical assessment via telephone or video consultation is provided by Paediatric Specialist Nurses.
• A new NHS111 First service has been incorporated into the existing Clinical Assessment Service. This is an NHS England driven initiative where patients are to call NHS111 first and avoid unnecessary waiting in an Emergency Department waiting area and reduce pressure on parts of the urgent and emergency care departments. Patients are assessed via NHS 111 pathways and referred to the 111 First CAS service needing a category 3 and 4 ambulance validation or an Emergency Department validation. This service is provided by Doctors and Advanced Clinical Practitioners that can book appointments in the Emergency Department of refer to Same Day Emergency Care (SDEC) and other appropriate primary care services via the Directory of Services.
• A Home visiting Service for housebound patients in West Hampshire, Southampton City, Fareham, Gosport and South East Hampshire in the traditional out of hours period evenings, overnight, weekends and bank holidays. The service is also provided to Portsmouth in the overnight period seven days a week. Home visiting during the daytime hours is also provided to parts of Hampshire to support local GP practices with increasing primary care workload for clinical assessment and treatment.
• A COVID at Home service providing remote monitoring of patients in their own home with confirmed or suspected COVID-19 and meet eligibility criteria for remote monitoring with oximetry. This service is for West Hampshire patients.
• A clinical triage and visiting service for community hospitals in Portsmouth and Southampton for patients in step down and step up beds that require additional medical assessment and treatment. This service is provided in partnership with an NHS Trust.
• An Extended Access and Urgent Care Primary Care Service at Badger Farm in Winchester, called Appointments +. This out of hours service is for planned primary care appointments made via patients’ own GP and urgent out of hours assessed as needing a face to face appointment via the CAS.
• A primary care services (known as the Special Allocation Scheme) for the community in Portsmouth, South East Hampshire, Fareham and Gosport, West Hampshire and Isle of Wight. This primary care provision is for patients that have been referred from their GP service as having been removed from their list due to an incident. This service is provided via remote telephone consultation and face to face clinical assessment at various sites in Hampshire and the Isle of Wight.
• A primary care assessment, diagnosis and treatment service for patients referred by their GP with symptoms suggestive of Attention Deficit Hyperactivity Disorder. This service is provided in partnership with an NHS Trust for patients living on the Isle of Wight.

The main address for Ailsa House is also the head office for PHL and is based at:

3 Turnberry House, The Links, 4400 Parkway, Whiteley, Fareham, PO15 7FJ.

To support the out of hours GP home-visiting service which covers a wide geographical area in Hampshire, the service has additional storage facilities and car parking spaces at the following locations:

• North Harbour Site Cosham – 6 Quay Point, North Harbour Road, Portsmouth, PO3 3TD
• Biz Space, Steel House, Plot 4300, Solent Business Park, Fareham, Hampshire, PO15 7FP (a temporary location until the North Harbour Site is fully operational).

Regulated activity for the Appointments + service is delivered from:

• Friarsgate Badger Farm Surgery, Badger Farm, Winchester, SO22 4QB.

Updated 3 December 2021

This service is rated as Good overall. (Previous inspection September 2019 rated 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 focused inspection at Ailsa House on 11, 12, 13 October 2021. to follow up on breaches of regulations. We inspected the following key questions:

• Safe
• Effective
• Well Led

At our previous inspection we found:

• There was learning from significant events but it was not always disseminated fully.
• Performance data was not in line with targets.
• The provider did not stock naloxone (naloxone is used to counteract the effects of opioids on a patient’s respiratory system) and had not risk assessed this.
• Staff training records were not adequately maintained to be fully assured that all staff were compliant with training requirements.

At this inspection we found:

• The service had taken steps to address the breaches of regulations identified at our previous inspection.
• We found learning from significant events and complaints was disseminated amongst staff and we identified that improvements had been made a result.
• The specific data used to measure performance had changed since the last inspection. In addition, the provider had ceased to deliver an NHS111 call centre. Instead, an Integrated Urgent Care (IUC) Clinical Assessment Service (CAS) (remote telephone and video triage and clinical assessment) was delivered in a collaborative commissioned approach. Due to the change in contract and commissioning arrangements it was not possible to directly compare performance between the two inspections.
• Mandatory training was closely monitored and there were very high levels of compliance both amongst clinical and non-clinical staff.
• 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.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The provider was highly innovative and we identified several areas of outstanding practice generated as a result of pioneering practice.

We saw several areas of outstanding practice:

• The Attention Deficit Hyperactivity Disorder (ADHD) service for patients on the Isle of Wight had had a significant impact for patients using the service, reducing waiting time from two years to six months. This had met a gap in the system which previously meant patients were living with a distressing condition without assessment or treatment for considerable periods of time.
• We saw a positive culture demonstrating inclusivity and a caring attitude towards staff. The provider had supported World Menopause Day 2021, by sharing information with staff about where they could find information and seek help and by supporting staff to have conversations in the workplace. There was a monthly support group available for staff who were experiencing symptoms of the menopause. The provider had held a mental health week during which staff were encouraged to go for walks on their breaks and take time for themselves.
• The provider had created an integrated solution for remote patient monitoring called YOULA. The system enabled remote monitoring in a non-invasive way, through in-home sensors and human interactions, and was being piloted for patients on the Isle of Wight. The system monitored basic movements such as how often the kettle was switched on, how often the front door was opened and how often the fridge door was opened. Artificial intelligence was used to understand each person so that when something was out of the ordinary it could be quickly identified, and help alerted automatically. The service was managed via a real time dashboard. Patients also received a daily telephone call. The impact on the integrated care system (ICS) meant a 24/7 bridge between acute and primary care, patients receiving care in their own home rather than a hospital environment, facilitated early discharge from secondary care, hospital admission/readmission avoidance all resulting in significant cost savings. Of the 150 patients who had trialled the YOULA 92% reported the service to be excellent or good.
• The paediatric (paeds) desk had been developed as a pilot which had been very successful and expected to be extended. The service had piloted the GoodSam app which enabled paediatric trained nurses to see children via a video call, staff were able to effectively assess children and provide reassurance for distressed parents. There were strict protocols around the use of the GoodSam app and a private area had been set up in the call centre. This project had had a big impact on reducing A&E admissions.
• The provider played an important role in supporting the integrated care system (ICS) by bridging gaps in the system between primary and acute care. The ability of the provider to diversify (often with little notice) supporting multiple systems provided resilience to the overall system. This meant waiting lists were able to be reduced and patients had access to care and treatment when they needed it.

The areas where the provider should make improvements are:

• Continue to review and improve key performance indicators for the contact centre.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care