Archived: Hilltop Heights

Updated 13 April 2017

Hilltop Heights Cumbria Health on Call (CHoC) provides out of hours GP services from:

• Hilltop Heights, London Road, Carlisle, Cumbria, CA1 2NS.

We visited this site during our inspection. These premises are operated and managed by CHoC and consisted of the service’s call centre and head offices.The service operates 24 hours a day, seven days a wekk. The service gives telephone advice and books appointments and home visits for patients. The service employs GPs, nurse practitioners and nurses.

Hilltop Heights is one of seven locations registered by CHoC to provide out of hours services in Cumbria. On average, 2653 patients use the service each week across the six locations where patients are seen. CHoC provides care, treatment and support from Monday to Friday from 18:30 to 08:00, and on Saturday and Sunday from 08:00 to 08:00 for some 499,000 people over a land mass of 2,613 square miles. Cumbria is the second largest county in England and represents 48% of the land mass of the North West. Across Cumbria 51% of the population live in rural areas. There are 73 people per square kilometre on average.

In terms of patient population, there are above average numbers for all age groups over 50 and below average for all groups below 45. Average life expectancy for both males and females is close to the national average (males 78.6 years, females 82.2, compared to the national average of 78.9 and 82.8 respectively) however this does not reflect the large variation within Cumbria itself, where the life expectancy in the most deprived areas for men is 13 years lower, and for women eight years lower, than people in the least deprived areas. 56.3% of the population reports having a long-standing health condition (national average 54%). In terms of ethnicity, the population is 98.5% white (national average 85.4%) with the lowest percentages of any CCG area in England of patients from black/black British, mixed, or other ethnic groups (0.1%, 0.5% and 0.1% respectively).

We previously inspected Hilltop Heights CHoC in July 2013.  We were not rating services at that time, however we found CHOC to be compliant with all regulations.

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hilltop Heights (Cumbria Health on Call) on 30th November, 2016. Overall the service is rated as outstanding.

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

• There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.
• Risks to patients were assessed and well managed.
• Patients’ care needs were assessed and delivered in a timely way according to need. The service met the National Quality Requirements.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• There was a system in place that enabled staff access to patient records, and the out of hours staff provided other services, for example the local GP and hospital, with information following contact with patients as was appropriate.
• The service managed patients’ care and treatment in a timely way.
• 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 was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
• 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.

We saw some areas of outstanding service:

• The provider was highly responsive to the the needs of the predominantly rural population. For example, a pilot for telehealth appointments had recently been completed. This had reduced the average time for patients in rural areas to be seen for either a routine base or home visit from 146 minutes to 32 minutes. They worked closely with other service providers, such as North West Ambulance Service (NWAS), for whom they provided GP-triage. NWAS told us the most recent data showed that in 93% of cases when this service was used, a hospital admission was avoided for the patient.
• The leadership, management and governance assured the delivery of high quality care, and supported learning and innovation throughout the organisation. Leaders had an inspiring shared purpose and motivated staff to succeed. Staff we spoke to told us the executive team were highly approachable, and that this had a positive effect on staff morale.

• Governance and strategy were proactive and innovative. The provider had been proactive in addressing the specific recruitment difficulties faced by the service in this geographical area. As a result of a collaborative recruitment drive six new salaried GPs had been employed. This in turn improved capacity to meet demand and safety, as reliance on agency staff was sometimes as low as 5% of shifts per week.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice