Primary Care 24 (Merseyside) Limited

Updated 30 October 2023

Primary Care 24 Ltd (Merseyside) Limited is located in the head office at Roy Castle Lung Foundation Building, 4-6 Enterprise Way, Wavertree Technology Park, Liverpool, L13 1FB. The provider is a social care enterprise organisation.

The service is commissioned by Liverpool Place as the lead commissioner for OOH services across Cheshire and Merseyside. In total the organisation provides services to a population of 1.32 million patients in the out of hours period.

The organisation provides the following services for patients who contact NHS 111:

• An OOH service telephone triage, face-to-face appointment, and home visiting service for patients in Halton, Knowsley, Liverpool, Sefton (North and South), St Helens and Warrington. The OOH service operates from 6.30pm to 8am, Mondays to Fridays and 24 hours a day on weekends and bank holidays.
• A clinical assessment service for patients who would benefit from further assessment of their symptoms and clinical advice. This service is available every day, 365 days a year.

In addition, the organisation provides:

• An extended access appointment service with GP’s and clinicians for patients in Knowsley and Liverpool. Patients are booked into these appointments via their own GP practice.
• A call answering and GP advice service from other healthcare professionals, on behalf of patients, who require further assessment from a clinician.

All services are coordinated from the Wavertree headquarters with face-to-face care being offered at the following locations across the commissioning areas. Some are not open every day but are available should the service be needed, and staffing levels allow:

• Old Swan Neighbourhood Centre
• Sefton Litherland NHS Treatment Centre
• Southport District General Hospital
• Formby Clinic
• Huyton Nutgrove Villa
• St Helens Lowe House, Primary Care Resource Centre
• Warrington Bath Street Health and Wellbeing Centre
• Wavertree
• South Liverpool Treatment Centre, Garston

Extended Access is also coordinated from Wavertree Headquarters, however there is a small number of clinicians that will undertake this work remotely at home. Face-to-face appointments are available from the following sites:

• Garston Walk in Centre, 32 Church Road, Garston, Liverpool L19 2LW. Monday to Friday 6pm to 11pm.
• Townsend Health Centre, 98 Townsend Lane, Anfield, Liverpool, L6 0BB. Monday to Friday 4pm to 10pm, Saturday 9am to 4pm.
• Whiston Primary Care Resource Centre, Old Colliery Road, Whiston, Prescot, L35 3SX. Thursday 10am to 2pm.
• St Chads Clinic, Kirkby, 132 St Chad's Drive, Kirkby, Liverpool, L32 8RE. Monday, Wednesday and Friday 10am to 2pm, Saturday 10am to 3pm.

During the inspection we visited Lowe House Primary Care Resource Centre, 103 Crab Street, St Helens, WA10 2DJ and Wavertree Headquarters.

The service operates against nationally and locally agreed Integrated Urgent Care key performance indicators which are monitored by commissioners monthly.

The provider is registered to provide the following regulated activities:

• Transport services, triage and medical advice provided remotely.
• Treatment of disease, disorder, or injury.
• Diagnostic and screening procedures.

Updated 30 October 2023

We undertook an announced comprehensive inspection at Primary Care 24 (Merseyside) Limited on 22 and 23 August 2023. We carried out this inspection to follow up on:

• A breach of regulation from a previous inspection in May 2022.
• Areas identified where we told the provider they should make improvements.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Primary Care 24 (Merseyside) Limited on our website at www.cqc.org.uk

We have rated this practice as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – not inspected, rating of good carried forward from previous inspection.

Are services responsive? – Good

Are services well-led? – Good

The key questions reviewed during this inspection on 22 and 23 August 2023 included:

• Safe
• Effective
• Responsive
• Well Led

We found that:

• Action had been taken to address the breaches of regulations identified at the last CQC inspection in May 2022.

At this inspection we found:

• The service had clear systems in place to keep people safe and safeguarded from abuse.
• The provider had reviewed the staffing arrangements to ensure that patient needs were met. This included increasing the number of clinicians working at the service and improving oversight of risk and performance, particularly during busy periods.
• The provider had systems to keep clinicians up to date with current evidence-based practice. We saw that clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols.
• The service had formalised systems with the NHS 111 service with specific referral protocols for patients referred to the Out of Hours (OOH) service. There were clear and effective arrangements for booking appointments, transfers to other services, and dispatching ambulances for people that required them.
• The provider understood the needs of its population and tailored services in response to those needs. To do this the provider engaged with commissioners to secure improvements to services, where these were identified.
• The provider monitored the performance of the time disposition which included monitoring clinical and operational staffing levels against planned levels. This was for telephone consultation, face-to-face appointments, and home visits.
• Patients with the most urgent needs had their care and treatment prioritised.
• The service took complaints and concerns seriously and responded to them appropriately to improve the quality of care.
• The provider had introduced several new leadership roles and new staff had been recruited to these.
• Openness, honesty, and transparency was demonstrated when responding to incidents and complaints.
• There were clear responsibilities, roles, and systems of accountability to support good governance and management. This included an effective process to identify, understand, monitor, and address current and future risks including risks to patient safety.
• The service involved patients, the public, staff, and external partners to support high-quality sustainable services.

Whilst we found no breaches of regulations, the provider should:

• Continue to monitor and improve service performance against the locally agreed Integrated Urgent Care key performance indicators.
• Further develop and use clinical audits, including two cycle audits as part of the organisations quality improvement processes.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services