The Care Quality Commission
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Archived: Practice Plus Group - NHS 111 South West

Overall: Outstanding read more about inspection ratings

Nicholson House, Lime Kiln Close, Stoke Gifford, Bristol, Avon, BS34 8SR (0117) 240 1135

Provided and run by:
Practice Plus Group Urgent Care Limited

Important: This service is now registered at a different address - see new profile

All Inspections

09 & 10 December 2021

During a routine inspection

We carried out an announced comprehensive inspection at Practice Plus Group - NHS 111 South West on 9 and 10 December 2021 and continued remotely until 15 December 2021.

Overall, the practice is rated as Outstanding.

Are services safe? – Outstanding

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Outstanding

Following our previous inspection on 12 and 13 June 2019, the practice was rated Outstanding overall. Safe, effective and well-led key questions were rated Outstanding. Responsive and caring key questions were rated Good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Practice Plus Group - NHS 111 South West on our website at www.cqc.org.uk

This inspection was part triggered as a result of a piece of work Care Quality Commission (CQC) was undertaking around the urgent and emergency care integrated pathway for patients in Gloucestershire.

Practice Plus Group - NHS 111 South West covers a wider geographical area than just Gloucestershire and data in this report focuses on the whole geographical footprint with intelligence extracted for the purpose of input into the Gloucestershire review.

The summary of overarching findings can be found in the subheading below.

We are mindful of the impact of COVID-19 pandemic on our regulatory function. We therefore took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate. This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

At this inspection, we found:

  • The service continued to operate comprehensive and well-embedded systems that proactively kept people safe from discrimination and maltreatment when using the service.
  • People who used services were at the centre of safeguarding systems and were protected from discrimination. Innovation was actively encouraged which achieved sustained improvements in safety and continual reduction in harm.
  • The provider continued with their well embedded, proactive approach to safeguarding processes. This included a 24-hour a day safeguarding hub. Two safeguarding leads were available within the call centre to support the team with coaching. In addition regular newsletters which highlighted important topics were sent to the team. There also was a central ‘Safe Chat’ digital system which allowed staff to raise any safeguarding concerns, questions or suggestions confidentially.
  • The service had a proactive safety record. It learned and made improvements immediately when things could have gone better. There were examples where the service had used outcomes of significant incident investigations as a trigger for auditing clinical areas to further improve their processes, including patient safety.
  • The provider continued to keep clinicians up to date with current evidence-based best practice. Staff had the necessary skills, knowledge and experience to carry out their roles. Staff worked well together and in collaboration with other organisations to deliver effective care and treatment.
  • The service’s audit programme for health and clinical advisors remained comprehensive. The management team were in the process of introducing NHS Pathways Gold Standard auditing, where calls were audited, self-audited and feedback given to the health advisor and clinician immediately ensuring responsive and effective learning.
  • We saw examples of where the use of technology had improved patient outcomes, increasing efficiency and reduced the impact on the local healthcare system.
  • The provider’s patient surveys for November 2021 were exemplary and showed the majority of patients overall had a good or very good experience when using the service.
  • The service saw complaints and concerns as an opportunity to make improvement. Any concerns raised were treated seriously and responded to appropriately to improve the quality of service provided.
  • The entire team continued to demonstrate a culture of high-quality sustainable care. The provider ensured there were experienced staff that were clear on their roles and responsibilities. The provider’s governance processes were comprehensive which included proactive risk assessments that enabled them to respond to patient risks quickly. This ensured they received appropriate care and treatment as part of a Real Time team and Clinical Delivery team process. This was where operational and clinical teams reviewed patients risk and the effectiveness and appropriateness of care and performance across the service live 24 hours a day, 7 days a week.
  • The service continued to display a culture of learning, continuous improvement and innovation and this included:
    • Trialling the Pathways Clinical Consultation Support Tool (PaCCs). This was a patient assessment and clinical consultation tool designed as an alternative offered nationally to NHS Pathways (a triage software used throughout 111 services). PaCCs gave clinicians who used the software, more autonomy. The trial showed a positive impact of a reduction in referrals to 999 and Emergency Departments. This supported the other areas of the local healthcare economy.
    • Trialling GoodSAM (a video or image sharing technology which is a one-way video call). This allowed clinicians to see the patient and supported them to identify concerns quickly. Clinicians were very positive about the use of this tool, as it allowed them to make a more accurate diagnosis.
  • The service had developed its own remote green button accessible to health advisors working remotely from home. It allowed advisors to easily access clinical support where a patient required cardiopulmonary resuscitation (CPR).

The organisation should continue to work closely with all system partners to tackle the capacity pressures on urgent and emergency care in the health and social care system in Gloucestershire

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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

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