Practice Plus Group - NHS 111 London

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found that the provider was providing safe services because the service had an embedded learning culture with which all staff were familiar. There were clear patient pathways in place. The service had clear safeguarding processes. The service was continuing to address staffing which was below complement at the time of the inspection in order that all shifts could be filled.

This service scored 62 (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 had a clear complaints process, and the responses to patients detailed investigations and learning undertaken by the service. The service undertook regular patient surveys, although no specific questions were asked about learning culture. As the service is telephony-based, CQC did not speak to any patients on the days of the inspection.

All of the staff we spoke to were aware of how to raise incidents. Staff we spoke to detailed how learning was shared with them on both an individual basis, and organisation wide. Leaders detailed how they supported the process, and staff as required.

There was a system for recording and acting on significant events and incidents. There were adequate systems for reviewing and investigating when things went wrong. The service learned and shared lessons, identified themes and took action to improve safety in the service. The service learned from external safety events and patient safety alerts. The service had an effective mechanism in place to disseminate alerts to all members of the team including sessional and agency staff. The provider took part in end-to-end reviews with other organisations. Learning was used to make improvements to the service.

The service undertook staff surveys to review the quality of care provided. Although the service did not question patients directly about pathways and transitions, 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.

The staff we spoke to were all aware of the Directory of Services for the service, which is the list of the services to whom they may refer. Leaders at the service said there had been a recent push to encourage health advisors to use the first service listed from the available options given by the Directory wherever possible, as this would be the most clinically suitable service for the patient to use.

Partners did not provide feedback about safe systems, pathways and transitions as part of this assessment.

In the 111 service, the service regularly monitored the number of calls abandoned and time to answer calls, which were the safety requirements required to be monitored and submitted to the commissioners. Call abandonment rates were between 4% and 18% for the service in the last twelve months. The organisation had been given a 3% target by the commissioners. The performance in this area had improved consistently in the past 12 months, and in the past 6 months had been better than the national average. The mean time to answer calls in the last 12 months was between 130 seconds and 140 seconds in the last 12 months. The service had delivered similar results to most providers in England in the last year, but targets were still below national targets. The service regularly monitored the number of calls that were forwarded to either a clinician in the Clinical Assessment Service (CAS), or a member of the clinical team in the 111 service. (CAS is independent of the 111 service and provides direct clinical advice directly to patients and the service itself.) The service had achieved over 40% in all of the last 12 months, and in each month had been above the national average.

Staff who spoke with us were aware of how to make safeguarding referrals, and knew the identity of leads if further advice was needed. Leaders told us how advice was available to health advisors and clinicians as required.

The commissioners of the service told CQC that they received monthly oversight reports relating to the safeguarding of children and vulnerable adults. They reported that they were satisfied with the reporting, and the way in which the provider interacted with other local healthcare providers.

The service worked with other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect. All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns. The service had a safeguarding methodology whereby potential safeguarding referrals were supported by a dedicated team prior to issue to the local authorities.

We did not find any concerns with regard how people were involved to manage risk.

We did not find any concerns with regard how people were involved to manage risk.

We did not find any concerns with regard how people were involved to manage risk.

The nature of the service is that it operates from a call centre, there were no clinical environments to review.

The nature of the service is that it operates from a call centre, there were no clinical environments to review. The call centre at which the service was based was fit for purpose.

The service was appropriately equipped to deliver the service. The office environment, equipment and facilities were well maintained and worked effectively. Information systems were secure.

Patient complaints received by the service regularly fed back that the amount of time that was taken for a clinical call back was too long. There were 25 upheld complaints from patients in the past 12 months over the delay in arranging a clinical call back.

Leaders reported that there had been shortages in staffing in the past, but they had recruited steadily and the number of staff had steadily increased in the past 12 months. Leaders acknowledged that there was still a shortage of clinical staff, and that clinical fill was still below 100%, but they provided details of ongoing recruitment to address this.

The service had workforce planning measures in place to ensure that the correct level of staffing was in place. Over the previous 12 months, the number of health advisors in place had increased consistently. The service had ongoing recruiting processes in place to increase the number of staff. The service had identified the initial dispensation following a call with a health advisor was that 60% of calls that required clinical input required a call back in 20 minutes. This target is met only 30% of the time nationwide, and due to lower than complement rota fill, was only met 20% of the time at the service. The service mitigated the risk by introducing an early clinical triage post call whereby a clinician could reclassify the urgency of the call based on the presenting condition. This allowed the most urgent calls to be called back in 20 minutes, and call backs to be undertaken by health advisors where necessary to ensure there had been no deterioration. All staff were appropriately qualified. The provider had an induction programme for all newly appointed staff. Staff told us they had regular one to one meetings with their managers. They reported that managers were supportive, and that they felt there were opportunities for promotion. The service had implemented a process where new starters to the team who had completed training received ongoing support. Prior to training, new staff could listen into calls to familiarise themselves with work they would be undertaking. On completion of training, an experienced health advisor would sit with new starters to ensure that they could field patient queries to ensure they knew when to seek clinical support. Staff were required to complete training on the Pathways clinical management software to a level over and above that required by the Pathways license. This ensured health advisors were confident in how and when to involve clinical input. Staff told us this gave them greater reassurance and helped them in their roles.

The service is based in a call centre which was fit for purpose. There were no clinical areas at the service, and as a consequence infection control was not reviewed.

The service is based in a call centre which was fit for purpose. There were no clinical areas at the service, and as a consequence infection control was not reviewed.

The service is based in a call centre which was fit for purpose. There were no clinical areas at the service, and as a consequence infection control was not reviewed.

The service is based in a call centre which was fit for purpose. There were no clinical areas at the service, and as a consequence infection control was not reviewed.

The service is not directly involved in the prescribing and monitoring of medicines.

The service is not directly involved in the prescribing and monitoring of medicines.

The service is not directly involved in the prescribing and monitoring of medicines.