Archived: DHU 111 - Fosse House Call Centre

Updated 14 July 2022

DHU 111 (East Midlands) C.I.C is a community interest company that provides NHS111 services for Derbyshire, Leicestershire and Rutland, Leicester City, Lincolnshire, Northamptonshire, Nottinghamshire, Milton Keynes, Wiltshire, Bath and North East Somerset and some parts of London in conjunction with London Ambulance Service.

It is registered with Care Quality Commission to deliver the regulated activities of:

• Transport services, triage and medical advice provided remotely from:
• Orbis 1 Building, Riverside Court, Riverside Road, Pride Park, Derby DE24 8HY
• Ashgate Manor, Ashgate Road, Chesterfield S40 4AA.
• Chippenham Call Centre, Fox Talbot House, Belinger Close, Chippenham, SN15 1BN
• Fosse House, 6 Smith Way, Grove Park, Enderby, Leicester LE19 1SX.

Orbis 1 Building is the primary location. The governance, managerial and administrative functions of the Fosse House call centre are also centred at this location. We visited this location on 31 March 2022 and Fosse House call centre on 5 April 2022.

All four call centres can receive calls from any of the geographical areas covered as well as overflow calls routed from other NHS111 call centres in times of peak demand or in the event of failings in other providers systems.

NHS111 is a telephone-based service where patients are assessed, given advice and directed to a local service that most appropriately meets their needs. People can call 24 hours per day, 365 days a year, and calls are free from landlines and mobile phones. The NHS 111 service is staffed by a team of service advisors, health advisors and clinical advisors who are experienced nurses, paramedics, pharmacists, mental health nurses, paediatric nurses , clinical practitioners and dental nurses.

At the time of inspection, the service employed approximately 550 health advisors (whole time equivalent WTE 400) and 170 clinical advisors (WTE 120) across the four sites.

The service covers a population of 8.8 million which is 15.7% of the England population. Overall, the service receives approximately 2.3 million calls per annum of which approximately 484,000 are for the Leicester, Leicestershire and Rutland area, which has a population of some 1.1 million. DHU 111 is the third largest (in terms of population coverage) NHS111 provider in England.

The service used NHS Pathways and the Directory of Services as a clinical tool for assessing, triaging and directing contact from the public to urgent and emergency care services such as GP out-of-hours, urgent care, accident and emergency, emergency and routine dental and mental health services or self- help. It enabled patients to be triaged effectively and ensured that they were directed to the most appropriate service available at the time of contact.

The parent company of DHU 111 (East Midlands) C.I.C is DHU Health Care C.I.C, which provides a wide range of health care services across the East Midlands. This included out-of-hours GP services, evening and night-time nursing services, district nursing services, GP practices, GP extended hours hubs and GP streaming in acute hospitals, community hospital GP services and urgent care centres. DHU, formally known as Derbyshire Health United, started in 2006 when it was formed from the merger of Derbyshire Medical Services and Derbyshire Healthcare.

In total DHU employs approximately 1,800 staff across all its services.

The provider website is www.dhuhealthcare.com

Updated 14 July 2022

This service is rated as Outstanding overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection of Fosse House Call Centre, 6 Smith Way, Grove Park, Enderby, Leicester between 11 March and 15 March and 2 August 2019 as part of our scheduled inspection programme. Fosse House Call Centre is one of three NHS111 call centres operated by DHU 111 (East Midlands) C.I.C. The other call centres were located at The Johnson Building, Derby and Ashgate Manor, Chesterfield.

Johnson Building was the primary centre and housed the managerial and administrative functions. Therefore, the findings set out in the report for The Johnson Building are reflected in this report.

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 advice from the service within an appropriate timescale for their needs.
• Performance had been consistently higher than other similar services.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The service innovated to improve patient outcomes and to benefit the wider health care community and stakeholders.
• There was an effective governance structure with clear lines of responsibility.
• Staff expressed positive feedback about working in the call centres and their employers concern for their well-being.

We saw areas of outstanding practice including:

• The provider had collaborated with the commissioners to ensure that special patient notes had clear and easy to read instructions that helped ensure that health advisors got the patient to the right outcome within their own individualised and care pathway.
• The introduction of interactive voice recognition allowed for appropriate types of calls to be streamed via the telephony to the Service Advisor team. This in turn increased the capacity for Health Advisors to deal with more detailed assessments.
• The provider understood the needs of its population and tailored services in response to those needs. The service had introduced an Interactive Voice Response patient menu. This enabled patients and others calling the service to direct their calls more specifically using menu options relevant to their need. This enabled them to receive the most efficient and timeliest intervention. The options included dental, repeat prescriptions, new or worsening symptoms and care plans for end of life patients. Additionally, there were three silent options for ambulance crew on scene, care homes and health care professionals.
• Data from the Minimum Data Sets showed DHU NHS111 consistently performed better than other NHS111 providers and had done so over a period of time.
• The provider had placed a strong emphasis on staff health and well-being. They had put into  place a suite of measures to support their  staff’s own physical and mental health. This included flu vaccinations at the place of work, physical health checks, health promotion advice, additional support for staff following difficult or distressing calls and free, rapid access to counselling and psychotherapy.
• The provider had recognised that 76% of the workforce was female. In the last year DHU had worked to change the composition of the Senior and Executive Team to make it more balanced and moving forwards they aimed to continue to create a culture that encouraged equal representation in senior positions.
• The provider had introduced the NHS111 Career Framework which provided career progression such as Senior Health Advisor and Senior Clinical Advisor. These were seen as the foundations for careers in management roles.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care