Archived: Milton Keynes

Updated 27 December 2019

This NHS 111 service is operated by 118 Limited. 118 Limited was registered with CQC on 1 February 2019.

118 Limited, also known as Conduit Global, is registered to provide the regulated activity of: Transport services, triage and medical advice provided remotely from two locations at:

• 2 Marlborough Court, Sunrise Parkway, Linford Wood, Milton Keynes, MK14 6DY
• Quayside House, Chatham, Kent, ME4 4QZ

The location at Chatham did not form part of this inspection.

The Milton Keynes location is located on the first floor of an office building and comprises an 89-seat call centre and associated administrative and management functions, together with staff welfare facilities. At the time of inspection, the service employed 109 members of staff, giving a whole time equivalent of 80. In addition to employed staff, the provider also made use of agency call handlers and health advisors.

118 Limited is a sub-contractor of NHS111 services and is used, at the date of inspection, to deliver overflow capacity by two NHS111 providers (clients).

The call centre can receive calls from any of the geographical areas covered as well as overflow calls routed from other NHS111 call centres in times of peak demand or in the event of failings in other providers systems.

On the date of inspection 118 Limited provided around 1000 call handler hours and 275 clinical hours per week to South Central Ambulance Service (SCAS) This was around 20% of the SCAS overall service delivery model.

118 Limited supplied around 400 call handler hours and 210 clinical hours per week to London Central and West Unscheduled Care Collaborative.

NHS111 is a telephone-based service where patients are assessed, given advice and directed to a local service that most appropriately meets their needs. The disposition can range from self-care, to out-of-hours GP consultations, attendance at accident and emergency department to emergency ambulance dispatch. People can call 24 hours a day, 365 days a year, and calls are free of charge from landlines and mobile phones. The NHS 111 service is staffed by a team of trained health advisors, supported by clinical advisors who are experienced nurses.

The service uses NHS Pathways and the Directory of Services (DOS) as a clinical tool for assessing, triaging and directing contact from the public to urgent and emergency care services such as GP out-of-hours, urgent care, accident and emergency, emergency and routine dental and mental health services or self- help. It enables patients to be triaged effectively and ensures that they are directed to the most appropriate service available at the time of contact. 118 Limited only employed call handlers (non- clinical) and clinical advisors (nurses). Where other healthcare assistance is required 118 Limited refer the call back to their client who has the necessary staff in place, for example dental nurses, mental health and pharmacists.

Pathways uses a “ruling out” technique, which is risk averse and will arrive at a disposition to manage the assessed risk.

After the disposition is reached the DOS is launched which lists in ranking order all the services which match the required skill set and are geographically appropriate for the patient.

118 Limited does not hold an NHS Pathways licence and uses Pathways under the umbrella of their clients who are themselves NHS Pathways licence holders.

The licence holders sponsor 118 Limited staff to become Pathways trainers who are then accredited to cascade training to 118 Limited staff.

Updated 27 December 2019

This service is rated as Good overall.

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, comprehensive inspection at 118 Limited, Milton Keynes NHS111 Call Centre on 10 October 2019. This was an inspection undertaken as part of our inspection program.

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, the service learned from them and improved their processes.
• The service had effective systems to help protect people from abuse but the process of ensuring a referral had been received needed strengthening.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care was delivered according to evidence-based guidelines and in accordance with NHS Pathways.
• Call handling performance in some indicators did not meet the minimum data set targets.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• The staff appraisal process was not yet embedded.

The areas where the provider should make improvements are:

• Continually review their call handling process to help achieve higher performance aligned to the minimum data set key performance indicators.
• Implement the digital safeguarding referral system to provide assurance that such referrals have been received.
• Implement and embed a formal process of staff appraisal.
• Review the capacity of senior managers to run the service and provide out-of-hours managerial cover.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care