The Care Quality Commission
  • Doctor
  • Out of hours GP service

Archived: PELC Out of Hours Service

Overall: Good read more about inspection ratings

PELC, 3rd Floor, Becketts House, 2-14 Ilford Hill, Ilford, Essex, IG1 2FA (020) 8911 1130

Provided and run by:
Partnership of East London Co-operatives (PELC) Limited

All Inspections

14 March 2019

During an inspection looking at part of the service

This service is rated as Good overall (Previous inspection 9,10,12 April 2018 – Overall Good rating).

We carried out an announced comprehensive inspection at Partnership of East London Cooperatives Limited (Out of Hours Service) on 14 March 2019. Our inspection included a visit to the service’s King George’s hospital location.

This inspection was to confirm the provider had carried out their plan to meet the legal requirements in relation to breaches in regulations that we identified in our previous inspection on 9,10,12 April 2018. At that time the service was rated as good for safe, effective, caring and responsive services and was rated good overall. The service was rated as requires improvement for well led services because governance arrangements did not ensure the Hepatitis B status of doctors was on file or ensure all relevant people were involved in learning from significant events and safety alerts.

This report only covers our findings in relation to those areas where requirements had not previously been met. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Partnership of East London Cooperatives Limited (Out of Hours Service) on our website at www.cqc.org.uk/location/1-199811091.

The key questions are rated as:

Are services well-led? – Good

At this inspection we found:

  • Action had been taken since our last inspection such that there were appropriate governance arrangements for ensuring the Hepatitis B status of all doctors was on file and for ensuring learning from significant events involved all relevant people.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

9 April to 12 April 2018

During a routine inspection

This service is rated as Good overall (Previous inspection 3,6 and 20 March 2017– Requires Improvement).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Partnership of East London Cooperatives Limited (Out of Hours Service) on 9,10,12 April 2018. Our inspection included a visit to the service’s headquarters and also to each of its five base locations.

This inspection was to confirm that the provider had carried out their plan to meet the legal requirements in relation to breaches in regulations that we identified in our previous inspection on 3,6,20 March 2017. At that time the service was rated as requires improvement for safe, effective and well led services; and rated overall as requires improvement. This report covers our findings in relation to those requirements and also in relation to additional improvements made since our last inspection.

At this inspection we found:

  • Action had been taken since our last inspection such that medicines management and quality improvement governance arrangements had improved.
  • However, we identified new concerns regarding governance arrangements for ensuring that the Hepatitis B status of doctors was kept up to date; and for ensuring that learning from significant events involved all relevant people.
  • Action had been taken since our last inspection such that clinical audit was now being used to drive quality improvements.
  • 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.
  • Patients said that they were treated with compassion, dignity and respect by reception staff and that clinicians involved them in decisions about their care and treatment.
  • Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
  • Patients’ care needs were assessed and delivered in a timely way according to need. The available data showed that the service consistently met the National Quality Requirements and exceeded the commissioner’s performance targets.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The service had good facilities and base locations were well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

3 ,6 and 20 March 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Partnership of East London Cooperatives Limited (Out of Hours Service) on 3,6 and 20 March 2017. Overall the service is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • Although the governance framework aimed to enable the delivery of good quality care, we noted that medicines management and quality improvement governance arrangements did not always operate effectively.

  • Risks to patients were generally assessed and well managed, although we noted the absence of a proactive approach to managing infection risks.

  • Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse but these were not always accessible to staff.

  • There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.
  • Patients’ care needs were assessed and delivered in a timely way according to need. The available data showed that the service consistently met the National Quality Requirements and exceeded the commissioner’s performance targets.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • There was a system in place that enabled staff access to patient records, and the out of hours staff provided other services with information following contact with patients as was appropriate.
  • The service managed patients’ care and treatment in a timely way.
  • Patients said that they were treated with compassion, dignity and respect by reception staff and that clinicians involved them in decisions about their care and treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The service had good facilities and base locations were well equipped to treat patients and meet their needs.
  • The vehicles used for home visits were clean and well maintained. When we highlighted that some emergency equipment was missing, the provider took immediate action to replace the items.
  • There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • Ensure that arrangements are in place for the safe management of medicines including protocols for checking emergency medicines and equipment at primary care centre base locations and in vehicles.

  • Introduce effective governance arrangements for clinical audit, internal audit and risk management.

  • Ensure that all staff undertaking chaperone duties have had training and checks through the Disclosure and Barring Service.

  • Ensure that all staff have received safeguarding training appropriate to their role and that policies are readily accessible to all staff.

  • Introduce reliable systems to prevent and protect people from a healthcare-associated infection including role appropriate staff training.

The area where the provider should make improvement is:

  • Ensure that all staff (including self-employed GP contractors) receive annual basic life support training and that there are appropriate monitoring systems in place.

  • Ensure that the needs of patients and local communities are identified and acted on.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

16 March 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Partnership of East London Co-operatives (PELC) Limited (NHS 111), on 16 March 2017. Overall the service is rated as good.

Our key findings were as follows:

  • There was an open and transparent approach to safety and an effective system in place to report and record significant events. Staff knew how to raise concerns, understood the need to report incidents and considered the organisation a supportive, culture. The provider maintained a risk register and held regular internal and external governance meetings.
  • The service was monitored against a National Minimum Data Set (MDS) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners about the level of service provided.
  • Staff had been trained and were monitored to ensure they used NHS Pathways safely and effectively (NHS Pathways is a licensed computer-based operating system that provides a suite of clinical assessments for triaging telephone calls from patients based on the symptoms they report when they call).
  • Patients using the service were supported effectively during the telephone triage process and consent was sought. We observed staff treated patients with compassion and respect.
  • Staff took action to safeguard patients and were aware of the process to make safeguarding referrals. Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including calls from children and frequent callers to the service.
  • The provider was responsive and acted on patients’ complaints effectively and feedback was welcomed by the provider and used to improve the service.
  • There was visible leadership with an emphasis on continuous improvement and development of the service. Staff felt supported by the management team.
  • The provider was aware of, and complied with, the Duty of Candour. Staff told us there was a culture of openness and transparency.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

10 February 2014

During an inspection

11 and 12 February 2014

During a routine inspection

The Partnership of East London Co-operatives (PELC) Ltd Out of Hours Service provides telephone advice for home treatment, face-to-face consultations, and home visits to people who need advice or treatment that can’t wait until the next available routine appointment. The service provides out-of-hours cover for over 1.1 million patients registered to GP surgeries in Waltham Forest, Redbridge, Havering, Barking & Dagenham and West Essex.

PELC also provides other urgent care services, including urgent care centres at two local hospitals and local NHS 111 services.

The service is registered with CQC to provide the regulated activities of transport services, triage and medical advice provided remotely and treatment of disease, disorder or injury.

During our inspection, we spoke with people who used the service, relatives, and carers, who were very complimentary about their treatment and care. We also used comment cards to ask people for their views, and these were also positive overall.

We found there was effective leadership in the organisation and that treatment and care was planned around the patient. Patients’ care pathways were coordinated, and integrated working across the range of urgent care services was designed to ensure patients received the right care in the right place at the right time. This meant that patients experienced a single, continuous and efficient service.

The provider used learning from incidents, patient surveys, compliments and complaints, and clinical audit to help them to improve the service. Senior clinical leaders took responsibility for checking and ensuring GPs provided effective treatment and care, in line with recognised best practice standards and guidelines. The provider recruited GPs and staff with suitable qualifications, skills and experience to meet the needs of people using the service. There were also provisions to enable the diverse population to access the service.

We found some risks associated with medicines and clinical equipment that the provider was not managing well. Medicines, clinical equipment and prescription forms at Becketts House were stored in an area that could only be accessed by staff and GPs working for the service. However, they were not stored sufficiently securely to mitigate the risk of unauthorised access and people misusing or tampering with them. Controlled drugs records were not maintained according to current guidance. There were no controls in place to ensure medicines were stored at the correct temperature and therefore fit for use. GPs were using items of clinical equipment that were not subject to the provider’s equipment safety checks. Other records were not readily available to demonstrate that routine safety checks on medicines and equipment had been carried out.

We have asked the provider to send us a report by 09 May 2014, setting out the action they will take to meet these safety standards. We will check to make sure that this action is taken.