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Practice Plus Group - NHS 111 South West Outstanding


Inspection carried out on 12 and 13 June 2019

During a routine inspection

This service is rated as Outstanding overall. (Previous inspection September 2016 – Good)

The key questions are rated as:

Are services safe? – Outstanding

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Care UK – NHS 111 South West on 12 and 13 June 2019 as part of our inspection programme.

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 routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • 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 strong focus on continuous learning and improvement at all levels of the organisation and the culture ensured all staff were engaged to deliver high quality person centred care.

We saw areas of outstanding practice:

  • The implementation of a safeguarding hub, accessible 24 hours a day, to improve referrals for children and adults in need or at risk of abuse, had increased referrals, improved non-clinical and clinical handovers through implementation of handover tools, improved clinical availability during peak service demand and ensured follow-up for serious concerns to assure the service action had been taken.
  • There was a well-embedded culture of high quality sustainable care such as the bridge team, an operational and clinical team which reviewed patients risks and the effectiveness and appropriateness of the care and performance across the region immediately, as it happened. This meant experienced staff, supported by comprehensive risk assessments, assessed and responded to patient risks quickly to ensure they received the most appropriate care and treatment.
  • We saw a strong focus on continuous learning, quality improvement and risk management from complaints and incidents and performance management which included joint working and shared governance with partner organisations. The service demonstrated plans were consistently implemented, and had a positive impact on quality and sustainability of services. Improvement was evident as a result of shared learning and reviews with stakeholders. This included adapting auditing tools for quality assurance purposes to ensure learning was embedded and implementation of communication tools and apps. These processes were inclusive to agency staff.
  • There was a strong focus on staff wellbeing. For example, implementation of resources to improve the working environment such as equipment, apps and the foundation bay. The implementation of the foundation bay for new health advisors had improved staff competencies and job retention.

The areas where the provider should make improvements are:

  • Respond to direct questions raised within formal complaints about the service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 27 - 28 September 2016

During a routine inspection

We carried out this comprehensive inspection of Care UK – NHS 111 South West service on 27 and 28 September 2016. NHS111 is a 24 hours a day telephone based service where people are assessed, given advice or directed to a local service that most appropriately meets their needs.

Care UK – NHS 111 South West provides services to the areas of Bristol, South Gloucestershire, Bath and North East Somerset, Wiltshire and Gloucestershire. Care UK – NHS 111 South West has one call centre which manages calls for these areas, we inspected this call centre which is located at Lime Kiln Close on the outskirts of Bristol.

Our key findings were as follows:

  • There were systems in place to help ensure patient safety through learning from incidents and complaints about the service. All opportunities for learning from internal incidents and complaints were used to promote learning and improvement.
  • The provider had taken steps to ensure all staff underwent a thorough recruitment and induction process to help ensure their suitability to work in this type of healthcare environment.

  • The provider had developed a mobile phone ‘app’ that allowed senior managers to access real time information relating to call handling within the call centres. This allowed senior managers to support team managers at times of unexpected demand.

    • Staff were supported in the effective use of NHS Pathways. Regular audits of calls to the service monitored quality and supported improvement. Where issues were identified remedial action was taken and the employee was supported to improve.
    • People experienced a service that was delivered by dedicated, knowledgeable and caring staff.
    • People using the service were supported effectively during the telephone triage process. Consent to triage was sought and their decisions were respected. We observed staff treated people with compassion, and responded appropriately to their feedback.
    • Clinical advice and support was readily available to health advisors when needed. Care and treatment was coordinated with other services and other providers.
    • There was an overarching governance framework across the NHS 111 service, which supported the delivery of their strategy and good quality care. This included arrangements to monitor quality and identify risk.
    • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
    • Risk management was embedded and recognised as the responsibility of all staff.
    • The provider was aware of and complied with the requirements of the Duty of Candour. The provider encouraged a culture of openness and honesty. Systems were in place for notifiable safety incidents and key staff ensured this information was shared with staff to ensure appropriate action was taken.
    • There was a strong focus on continuous learning at all levels.

We saw an area of Outstanding practice:

The Care UK – NHS 111 South West had implemented a system called ‘The Bridge’ which provided a clinician an overview of calls waiting for a clinical call back. The clinicians used a risk assessment tool which supported their clinical reasoning and decision making to ensure calls were correctly prioritised and people were called back within the recommended timeframe. The system had been implemented by the team and shared across the organisation; they had audited ‘The Bridge’ calls and demonstrated the impact on people who used the service as in April 2015, 11.7% of callers were referred to Emergency Departments whilst by January 2016 this was reduced to 7.9% because clinical advisors were able to assess and direct people more appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice