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

Hertfordshire IUC Service and HUC HQ

Overall: Good read more about inspection ratings

The Old Ambulance Station, Ascots Lane, Welwyn Garden City, Hertfordshire, AL7 4HL 0844 560 6606

Provided and run by:
Herts Urgent Care Limited

All Inspections

20 and 21 November 2023

During a routine inspection

This service is rated as Good overall.

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? – Good

We carried out an announced comprehensive inspection of Hertfordshire IUC Service and HUC HQ on 20 and 21 November 2023. The service had previously been inspected in November 2015 where it had been rated as good overall, and in all five key questions.

The registered manager is the head of the 111 service. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • The service had clear systems to manage risk so safety incidents were less likely to happen. When incidents 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 patients with compassion, kindness, dignity and respect.
  • Patients found the service easy to use and reported they were able to access care when they needed it.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

  • The service had implemented a “graduate bay”, where new starters who had completed training were supported into work. Prior to beginning 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 the new starters to ensure they could assist with any queries raised by patients, and ensure new staff knew at what stage to involve clinical support. Staff who had been through the graduate bay programme told us that it was a supported introduction to work, and felt that it was positive.
  • The service required that training in Pathways (software utilised by health advisors to determine the best clinical pathway for a patient) was extended over and above that required by the Pathways licence. Managers told us that this was to ensure health advisors were confident in how and when to involve clinical input. Staff told us that this led to greater reassurance, and helped them in their role.

The area where the service should make improvements is:

  • The service should look to review and improve its performance targets against key performance indicators (KPIs).

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

3 and 4 November 2015

During a routine inspection

We carried out this inspection of Herts Urgent Care NHS 111 on 3 and 4 November 2015. NHS111 is a 24 hours a day telephone based service where patients are assessed, given advice or directed straightaway to a local service that most appropriately meets their needs. For example that could be to their own GP, an out-of-hours GP service, walk-in centre or urgent care centre, community nurse, emergency dentist, emergency department, emergency ambulance or late opening chemist.

Herts Urgent Care (HUC) provides NHS111 services for Hertfordshire and Cambridgeshire from two call centres at Ascots Lane, Welwyn Garden City and City Care Centre, Thorpe Road, Peterborough.

The NHS111 service for Hertfordshire is an integrated NHS111/out-of-hours service. The out -of-hours service is subject of a separate inspection and report.

The NHS111 service had not been subject to any previous CQC inspection.

Our key findings were as follows:

  • Herts Urgent Care provided a safe, effective, caring , responsive and well-led service.
  • There were systems in place to help ensure patient safety through learning from incidents and complaints about the service.
  • The provider had taken steps to ensure that all staff underwent a thorough recruitment and induction process to help ensure their suitability to work in this type of healthcare environment.
  • The service was high achieving and had consistently met or exceeded the key performance indicators known as the Minimum Data Sets (MDS)
  • Patients experienced a service that was delivered by dedicated, knowledgeable and caring staff.
  • Staff were supported in the effective use of NHS Pathways. Call review and audit was regular and robust in its application.
  • We found that the service was well-led and managed by an effective senior management team and board of directors, and their values and behaviours were shared by staff.
  • Staff expressed positive views of the management and leadership and felt well supported in their roles.
  • Callers were satisfied with their experience of using the service.

We saw several areas of outstanding practice including:

  • At the conclusion of the CQC inspection the provider displayed total openness and honesty as all available staff were invited to listen to the feedback provided by the CQC inspection team.
  • The provider had developed links with the University of Hertfordshire in order to develop their clinical advisors by means of courses aimed effective telephone triage through history taking, asking sensitive questions and decision making. Clinical advisors had further been supported to attend the ‘Assessment- A Systematic Approach’ facilitated by the University which enabled clinicians, if they so wished, to progress further to assess and triage patients face to face as Clinical Navigators .

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Review health advisors awareness and knowledge of the Mental Capacity Act to ensure relevant callers are managed appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

3 and 4 November 2015

During a routine inspection

We carried out this inspection of Herts Urgent Care out-of-hours service on 3 and 4 November 2015.

Herts Urgent Care (HUC) provides NHS111 and out-of-hours GP services for Hertfordshire under an integrated contract commissioned by East and North Hertfordshire Clinical Commissioning Group. The NHS 111 service was inspected at the same time as the out-of-hours service but is subject to a separate report.

The service provides for a population of approximately 1.12 million people living in Hertfordshire. Face to face consultations take place at nine primary care centres across the county.

Overall we found the service to be ‘Good’.

Our key findings were as follows:

  • The provider had a clear vision which focussed on quality and safety.
  • There were systems in place to help ensure patient safety through learning from incidents and complaints about the service.
  • The provider had taken steps to ensure that all staff and GPs underwent a thorough recruitment and induction process to help ensure their suitability to work in this type of healthcare environment.
  • The service was high achieving and had consistently met applicable key performance indicators known as National Quality Requirements.
  • Patients experienced a service that was delivered by dedicated, knowledgeable and caring staff.
  • The primary care centres where patients were seen had good facilities and were equipped to meet the needs of patients. Vehicles used for home visits were clean and well equipped.
  • We found that the service was well-led and managed by an effective senior management team and board of directors, and their values and behaviours were shared by staff.
  • Staff expressed positive views of the management and leadership. Generally staff felt supported by the senior management team although some staff at some primary care centres said they felt isolated and received minimal supervision.
  • The service worked proactively with other organisations and with the local community to develop services that supported hospital admission avoidance and improved the patient experience.
  • The service was responsive to feedback and used the information to drive service improvements.

We saw an area of outstanding practice:

  • The provider had developed links with the University of Hertfordshire in order to develop their clinicians by means of courses aimed effective telephone triage through history taking, asking sensitive questions and decision making. Clinicians had further been supported to attend the ‘Assessment- A Systematic Approach’ facilitated by the University which enabled clinicians, if they so wished, to progress further to assess and triage patients face to face as Clinical Navigators .

However, there were areas of practice where the provider needs to make improvements.

The provider could:

  • Ensure that staff receive appraisal that is of a consistent high quality.
  • Implement a system to identify which prescription numbers were allocated to vehicles used for home visits.
  • Work with other users of healthcare premises to improve signage to the out-of-hours service at primary care centres.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

24/03/2014

During a routine inspection

Herts Urgent Care (HUC) provides out-of-hours General Practitioner (GP) services for more than 1.2 million patients living across Hertfordshire. It is registered with the Care Quality Commission to provide the regulated activities of transport services, triage and medical advice provided remotely and the treatment of disease, disorder and injury.

We carried out the inspection as part of our new inspection programme to test our approach going forward. It took place with a team that included three CQC inspectors, a GP, a GP practice manager, a nurse and an expert-by-experience.

We found the service was effective in meeting patients needs and had taken positive steps to ensure people who may have difficulty in accessing services were enabled to do so. There was an emphasis on involving groups of patients that had been considered to be hard to reach and engage, for example, people with a learning disability.

Patients told us that they were happy with the care and treatment they received and felt safe. There were systems in place to help ensure patient safety through learning from incidents, the safe management of medicines and infection prevention and control.

The provider had taken steps to ensure that all staff underwent a thorough recruitment and induction process to help ensure their suitability to care for patients.

Patients experienced care that was delivered by dedicated and caring staff. Patients and carers we spoke with said staff displayed a kind and caring attitude and we observed patients being treated with respect and kindness whilst their dignity and confidentiality was maintained.

We found that the service was well-led and managed by an enthusiastic and knowledgeable senior management team and board of directors, and their values and behaviours were shared by staff. Members of the staff team we spoke with all held very positive views of the management and leadership and felt well supported in their roles. They told us the senior managers were approachable and listened to any concerns or suggestions they might have to improve the level of service provided to patients.