Practice Plus Group - NHS 111 London

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We found that the service was providing effective services because the provider assessed patient needs in line with best practice guidance, and ensured all staff were aware of the service’s protocols and procedures. The service had a comprehensive programme of quality improvement activity and routinely received the effectiveness and appropriateness of the care provided. Staff worked together, and worked well with other organisations to deliver effective care and treatment. The service obtained consent to care and treatment in line with legislation and guidance.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service undertook patient surveys to review the quality of care provided. Although the service did not question patients directly about the full assessment of their condition, the majority of patients were satisfied with the service. As the service is telephony-based, CQC did not speak to any patients on the days of the inspection.

Staff told us that there were defined systems for health advisors to use to assess conditions, and policies and procedures for clinicians to follow.

Telephone assessments were carried out using a defined operating model which included processes for assessing patients’ symptoms through a triage algorithm, with options including transferring the call for a clinical review.

The service is telephony based, and as a consequence we were not able to ask patients about delivering evidence based care.

Staff told us they received regular updates from leaders at the service. Where there were updates to the Pathways operating system, training and monitoring was delivered within the scope of the licensing system.

Clinical staff had access to guidelines from the National Institute for Health and Care Excellence (NICE) and used this information to help ensure that people's needs were met. The provider monitored that these guidelines were followed. Patients’ needs were fully assessed. This included their clinical needs and their mental and physical wellbeing. Where patients’ needs could not be met by the service, staff redirected them to the appropriate service for their needs. Care and treatment was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

The service undertook patient surveys to review the quality of care provided. Although the service did not question patients directly about how staff, teams and services work together, the majority of patients were satisfied with the service. As the service is telephony-based, CQC did not speak to any patients on the days of the inspection.

Staff were aware of the need to complete accurate and full records, such that information did not need to be repeated by patients. Patients received coordinated and person-centred care. This included when they moved between services, when they were referred, or after they were discharged from hospital. Care and treatment for patients in vulnerable circumstances was coordinated with other services. Staff communicated promptly with patient's registered GP's so that the GP was aware of the need for further action. Staff also referred patients back to their own GP to ensure continuity of care, where necessary. There were established pathways for staff to follow to ensure callers were referred to other services for support as required.

The commissioners reported that they were satisfied with the way in which the service shared care and engaged with other healthcare providers in the local area.

The service ensured that care was delivered in a coordinated way and took into account the needs of different patients, including those who may be vulnerable because of their circumstances. There were clear and effective arrangements for booking appointments, transfers to other services, and dispatching ambulances for people that require them. Staff were empowered to make direct referrals and/or appointments for patients with other services. Issues with the Directory of Services were resolved in a timely manner. We saw that changes were made where relevant, including the prioritising of mental health services where indicated.

The service is a telephony based triage service which may refer patients to other services. The service advised patients on self-care as required.

The service is a telephony based triage service which may refer patients to other services. The service advised patients on self-care as required.

The service is a telephony based triage service which may refer patients to other services. The service advised patients on self care as required.

As part of the inspection we reviewed a selection of complaints raised by patients. We saw that complaints were used to inform learning at the service, and that the service informed patients of any changes that had been made.

Leaders and staff at the service told us that the method of quality review was through an audit of patient telephone consultations. Managers told us that this was now completed in real time; a dedicated team would review records on the same day that consultations were completed. Staff at the service told us that this felt more developmental and helpful as the call was still fresh in the memory at the time that they received feedback. Managers at the service told us that the provider would share overall audit findings with other services as a dataset if required.

Individual staff at the service were subject to regular audits of a percentage of their consultations. Where staff had not met the minimum standards required by these audits, there were escalation measures in place in line with both the organisation’s own policies, and (where relevant) the Pathways licensing agreement. The commissioners of the service reported that end to end reviews were completed monthly by the service in which topics such as end of life, safeguarding, under 5s and over 80s were covered by listening to the patient experience from calling 111 to the service received.

The service is telephony based, and as a consequence we were not able to ask patients about consent to care and treatment.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making.

Relevant staff had been provided with training in the Mental Capacity Act. The provider monitored the process for seeking consent from patients appropriately.