Archived: Local Medical Services

Updated 24 March 2020

Local Medical Services is operated by Local Medical Services Limited. The current registered manager purchased the service in January 2017. It is an independent ambulance service based in Quainton, Buckinghamshire. The service provides pre-planned patient transport services for all age groups, for private organisations, privately funded patients and for some NHS Trusts. The service also provided high dependency transfers but did not transport patients detained under the Mental Health Act.

Local Medical Services also provided medical cover at private events and would convey off the event site to an NHS emergency department.

The service had not undertaken this activity or high dependency transfers since their registration for the regulated activity of Treatment of disease, disorder or injury in November 2019.

The service primarily serves the communities of Buckinghamshire, Oxfordshire, Hampshire and Northamptonshire. The service did not work with formal contractual or service level agreements, but on an as required basis for local authorities, private patients or NHS trust transfers.

The service consisted of seven vehicles which included ambulances, rapid response vehicles, and 4x4 vehicles.

We visited the service on 14 January 2020. This was the first inspection for the urgent and emergency care service since being registered for Treatment of disease, disorder or injury. At the same time, we completed a focused follow up inspection for the warning notice served in June 2019 for the patient transport service.

The governance and management arrangements were the same across the emergency and urgent care and patient transport service.

The service has had a registered manager in post since January 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage a service. Like registered providers, they are ‘registered persons. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how a service is managed.

Updated 24 March 2020

Local Medical Services is operated by Local Medical Services Limited. The service provides event cover (which we do not regulate) however they convey off event sites which we do regulate and patient transport services. Local Medical Services works on an when required basis for local authorities, private patients and NHS trust transfers.

We previously carried out a comprehensive inspection of Local Medical Services patient transport service in June 2019. Following that inspection, we issued the provider with a warning notice under Section 29A of the Health and Social Care Act 2008. The warning notice set out areas of concern, where significant improvements were required, these were:

• The recruitment records did not provide assurance that all staff had the required employment checks before they commenced work.

• Not all policies were relevant to the service and some referred to members of staff

• that did not work for the service. The service did not have assurance staff had read the policies.

• There was no assurance that there was a booking process for when a request came from a contractor to provide a service for a patient.

During this inspection we carried out an unannounced focused follow up inspection of the patient transport service and an unannounced inspection of the emergency and urgent care part of the service using our comprehensive inspection methodology. During the focused inspection of the patient transport service, we looked at all the issues raised in the warning notice which ranged across the safe and effective domains.

Even though the provider had made improvement and complied with the warning notice, the patient transport service rating remained at requires improvement as we do not rate focused inspections.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

This was the first time the emergency and urgent care aspect of the service had been inspected. At the time of the inspection we were unable to assess the safe running of the high dependency transfers due to the service not yet recruiting appropriately trained staff to fulfil the bookings.

We rated the emergency and urgent care service as Good overall.

Following the unannounced focused inspection for patient transport service we found the provider had made considerable progress on all issues identified in the warning notice and we found the following improvements:

• There was evidence that the recruitment processes and records now provided assurance that all staff had the required employment checks before they commenced work.

• The policies were now relevant to the service and referred to the correct members of staff working for the service. The service had introduced a system to ensure assurance that staff had read the policies.

• The service had implemented an online booking process for requesters to complete which included a risk assessment.

We rated the urgent and emergency service good overall because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

• Managers monitored the effectiveness of the service and made sure staff were competent.

• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.

• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff were focused on the needs of patients receiving care. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• While the provider securely stored medicines, they did not monitor the temperature of the storage spaces to ensure medicines were kept at the correct temperature.

• There were limited governance systems to improve service quality and maintain high standards of care.

• The service had limited systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals South and London on behalf of the Chief Inspector of Hospitals.

Updated 24 March 2020

Local Medical Services Ltd provided patient transport services primarily to the community of Buckinghamshire, Oxfordshire, Hampshire and Northamptonshire. The service had no formal contractual or service level agreements.  The service worked on an as required basis providing patient transport services for local authorities, private patients and NHS trust transfers.

Updated 24 March 2020

Local Medical Services Limited is an independent

ambulance service providing high dependency transfers and the ability to transfer off events on an when required basis. The service primarily serves the community of Buckinghamshire, Oxfordshire, Hampshire and Northamptonshire.

There service had no contractual or service level

agreements.

At the time of inspection there had been no urgent and emergency care activity undertaken since registration in November 2019.