Archived: MY NURSE Ltd

Overall rating for this core service Inspected but not rated ●

We carried out an announced inspection on 20 December 2016 to review the service arrangements for independent community health services. This was a routine planned inspection.

Due to the service still being under development, we did not inspect every key line of enquiry under the five key questions we inspected (safe, effective, caring, responsive and well led). We have therefore not rated the service for the five key questions and overall.

Our key findings were as follows:

Are services safe at this service?

• The service was planning to implement an electronic reporting system and had no reported incidents from July 2015 to December 2016.
• The service reviewed national safety databases regularly to ensure staff were updated with any changes to practice or equipment.
• The service had processes in place to escalate safeguarding concerns directly to the local authority.
• The service liaised directly with the patient’s GP for the safe management or provision of medications or dressings. The service did not store, prescribe or manage any medications.
• The service used paper record to record all patient treatment. The service aimed to train staff to use the GP’s electronic patient record system in 2017.
• Staff had completed all necessary training to provide safe patient care.
• The service had robust systems in place to assess patient risks on referral to the service and at regular intervals throughout their treatments. There were also systems in place to assess risks to staff attending patients’ homes, or those lone working.
• The service lead assessed all business plans to identify service requirements and possible risks prior to the agreement to complete planned work.
• There was no major incident plan in place at the time of inspection.

Are services effective at this service?

• The service had limited organisational specific policies and used national guidance for the safe management of patients.
• Patients were managed by their GPs with referrals made to the patients’ GP for any concerns identified relating to pain management, nutritional needs, changes to clinical condition or completion of treatments.
• Patients’ records were held separately to the GP records. These were scanned into the GP electronic system on completion of treatment. There were plans in place for staff to be trained in the electronic system to enable one record of all treatments and care.
• Patient outcomes were not measured, reported or monitored.
• Staff competency was maintained through regular updates and training.
• Staff were aware of their roles and responsibilities in the assessing and recording of patient consent, mental capacity and deprivation of liberty safeguards.

Are services caring at this service?

• Patients said they were treated with compassion, respect and with dignity and staff were caring.
• Staff took time to explain treatments to patients and their relatives, offering longer appointments and written information where necessary to assist with understanding.
• Staff were responsive to the emotional wellbeing of patients, allowing additional time or support to patients when necessary.

Are services responsive at this service?

• The service used information regarding patient care and treatment to identify areas for business development.
• Patients’ needs were used to arrange appointment scheduling, location and duration. This enabled bespoke appointments to suit individual needs.
• There were no systems or processes in place to monitor or track appointment scheduling, waiting times or treatment times.
• There had been no complaints for the service from July 2015 to December 2016.

Are services well-led at this service?

• The service had a clear strategy for development.
• The service lead had a clear understanding of their roles and responsibilities.
• Due to the infancy of the service, there were not yet established governance meetings for the reviewing of service data, performance and risks.

We saw several areas of outstanding practice including:

• The service provided bespoke patient centred appointments, which reflected the patient’s needs. For example, appointments were extended, increased in frequency, or completed within the patient’s home depending on the individual’s needs.
• Due to the service having a small number of employees, patients received a high level of continuity of care. The nurse/ patient relationship enhanced the therapeutic relationship, which enabled the identification of any changes to underlying physical, emotional or mental health conditions.

There were some areas for improvement. The service should take action to:

• Develop a robust governance process as the service expands, to facilitate the monitoring of patient outcomes and risk.
• Implement a service risk register to record actions taken to mitigate identified risks.
• Implement systems to systems to monitor complaints and track responses, learning and actions taken to prevent reoccurrence.
• Implement systems to monitor and track patient referral to treatment times, appointment waiting times and any delays.
• Implement systems so that patient records are accessible to the patient’s GP.
• Implement systems for recording mandatory training compliance.
• Develop a business continuity plan for the safe delivery of services in the event of a major incident.
• Develop service specific policies for all developing services and the safe management of patient care.

Edward Baker

Deputy Chief Inspector

Central Region