All inspections: Care UK - Surrey - Care Quality Commission

This NHS 111 service is provided by Care UK - Surrey based in Dorking in Surrey. Care UK - Surrey is contracted by South East Coast Ambulance Service NHS Foundation Trust (SECAmb) for their provision of a NHS 111 service. At this inspection, Care UK -Surrey and SECAmb were inspected at the same time. To read the SECAmb report, please go to http://www.cqc.org.uk/. There is a shared management structure in place with SECAmb, to provide the NHS111 service across the same geographical area as SECAmb.

We inspected the service in May 2016 where Care UK- Surrey was rated as requires improvement overall. Specifically it was rated as inadequate in safe; requires improvement in effective and well led; and good in the caring and responsive domains.

We carried out an announced inspection on 17 and 18 May 2017 and the service is now rated as good overall and specifically outstanding in the well led domain.

We found the service had implemented a comprehensive recovery plan which had been signed off as completed in April 2017, to address the shortfalls found at our inspection in May 2016.

Our key findings from this inspection in May 2017 were:

The provider had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
Service performance was monitored and reviewed and actions to improve care were implemented.
Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
All opportunities for learning from internal incidents were discussed to support improvement. Information about safety was valued and used to promote learning and improvement.
Daily, weekly and monthly monitoring and analysis of the service achievements was measured against key performance targets and shared with the lead clinical commissioning group (CCG). Account was also taken of the ranges in performance in any one time period.
Appropriate action was undertaken where variations in performance were identified. Staff were trained and monitored to ensure safe and effective use of NHS Pathways, which are clinical triage tools.
Staff received annual appraisals and personal development plans were in place. Staff had the appropriate skills, knowledge and experience.
Patients using the service were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
We saw staff treated people with kindness and respect, and maintained patient confidentiality.
There was a comprehensive complaints system and all complaints were risk assessed and investigated appropriately.
Action was taken to improve service delivery where gaps were identified.
Care and treatment was coordinated with other services and other providers. There was collaboration with partners to improve urgent care pathways.
The service had long and short-term plans in place to ensure staffing levels were sufficient to meet anticipated demand for the service.
There was a clear leadership structure and staff felt supported by management. The senior leaders were visible and accessible to staff.
The provider had clear and appropriate policies and procedures to govern activity. Regular meaningful engagement with staff took place and there was evidence that this delivered their intended outcomes, whether strategic or operational
There were effective systems in place to monitor and improve the service.
High standards were promoted and owned by all provider staff and teams worked together across all roles.

We saw one area of outstanding practice:

There was a well-developed leadership structure that had supported innovative practice and new systems to be developed and embedded across the service. For example, the diamond pod training structure where staff had instant access to supervisory help on the floor, allowing new staff to be nurtured and valued without pressure of call targets, with more experienced staff able to give their time appropriately. There were initiatives to increase safety and welfare in the call centre for staff and patients, such as bright orange cards that could be used by call handlers to easily signal that immediate help was required. There was also a focus on continuously improving working relationships within the service management with SECAmb and the wider health and care service. Care UK management was striving to find more efficient and responsive ways of sharing and utilising knowledge from the acute and primary health providers, social care providers and voluntary agencies in order to improve service to patients and the working environment for all staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Care UK - Surrey on 22 to 24 November 2016 Overall the service is rated as good.

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 (NQRs).
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 some patient records, however, this depended on the ability of the patients’ GP service to provide the access required.
The out of hours staff shared relevant information about patients they had seen with their GP and the hospital, within the time frame set out in the national quality requirements.
The service managed patients’ care and treatment in a timely way.
Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their 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 worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience.
The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean, well maintained and well equipped.
The GPs and Advanced Nurse Practitioners who staffed the bases were mostly recruited from local GP practices and were expected to supply their own fully calibrated personal equipment. However, they were not provided with a list of expected equipment and the provider did not undertake spot checks to ensure it was fit for purpose. A back up set of equipment was supplied at each base should it be required.
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 should make improvement are:

Provide all self-employed staff with a list of the personal equipment they are expected to supply. Undertake regular spot checks to ensure equipment is calibrated and fit for purpose.

To review online training including chaperone training to ensure that it complies with current guidelines.

To monitor the use of local operating procedures at primary care centres to ensure that staff are operating them as intended.

Ensure that all staff comply with the requirement to record the contents of medicines cassettes. Introduce guidelines as to when a cassette should be returned for refill.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of the NHS 111 service provided by Care UK Surrey on 4 and 5 May 2016, to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

The NHS 111 service is provided by Care UK Surrey at Dorking in Surrey.

Care UK Surrey is contracted by South East Coast Ambulance Service NHS Foundation Trust (SECAmb) for their provision of NHS 111 and Care UK Surrey and SECAmb was inspected at the same time. To read the SECAmb report, please go to http://www.cqc.org.uk/.

There is a shared management structure in place with SECAmb, to provide the NHS111 service across the same geographical area as SECAmb.

Our key findings were as follows:

Care UK Surrey recognised that their performance in achieving the expected standards for the NHS 111 service (the national minimum data set) was not good enough, however, they had only identified limited actions to improve their performance and when these failed to provide the necessary results limited new actions were considered.
Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
All opportunities for learning from internal incidents were discussed to support improvement. Information about safety was valued and used to promote learning and improvement.
Risk management was embedded and recognised as the responsibility of all staff.
Staff took action to safeguard patients and knew how to make safeguarding referrals. Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including frequent callers to the service.
Staff were trained to ensure they used NHS Pathways safely and effectively.
Once trained there were comprehensive systems in place to monitor staff usage of NHS Pathways, for example high levels of audits of calls were conducted by the provider so that poor performance could effectively be identified and managed in a timely way.
Clinical advice and support was readily available to call handlers when needed
Care and treatment was coordinated with other services and other providers. There was collaboration with partners to improve urgent care pathways.
An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
Patients using the service were supported effectively during the telephone triage process. Consent to triage was sought and their decisions were respected. We saw that staff treated patients with compassion, and responded appropriately to their feedback
The provider had a number of agreed local operating policies and procedures to govern NHS 111 activity and held regular governance meetings.
The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The provider had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
The provider proactively sought feedback from staff and patients, which it acted on.
There was a strong focus on continuous learning at all levels.
During our inspection, we found sections of staff, notably health advisors, clinicians and first line managers to be highly dedicated to and proud of the work they were undertaking.
There was strength in the collaborative working between both Care UK Surrey and SECAmb.

We saw an area of outstanding practice:

The service used innovative approaches to developing pathways in response to specific needs resulting in improved outcomes for people. For example, the service identified factors that were impacting on the quality care for those at the end of their life care, or those who may have suffered a sexual assault. In partnership with others they developed tailored care pathways. These resulted in more positive experience for those using the service.

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

We identified regulations that were not being met and the provider must:

Ensure sufficient staff are employed and on duty to enable patients timely access to care and treatment when first contacting the service.

There were areas where the provider could make improvements and the provider should:

Review how it communicates with the population is serves by providing feedback on themes identified in annual reports such as the annual complaint report.

You can see full details of the regulations not being met at the end of this report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Comprehensive Inspection of 19 February 2014

At this inspection, we visited the head office for the Harmoni Surrey out-of-hours service in Dorking. There were eight other ‘satellite’ bases throughout the locality providing out-of-hours services. We also visited the out-of-hours satellite base in Epsom General Hospital as part of the inspection.

We also reviewed information we had asked the provider to send to us such as policies, procedures and some audits they had completed. During the inspection we talked with key people within the organisation such as the medical director, the registered manager, the clinical lead nurse and the quality assurance manager.

There were problems with the management of medicines within the service. We found upon inspection that some medication was out of date, and we have asked that the provider takes action to make sure that systems are in place so that patients receive prescribed medication that is safe to use.

People said the doctor displayed a kind and caring attitude and we observed patients being treated with respect whilst their dignity and confidentiality was maintained. However, patients told us during the inspection they would have liked to have been kept informed about the length of time they had to wait before they were seen by the doctor. Some patients said they had waited up to 45 minutes to see the doctor. We also received similar comments about long waiting times to see the doctor on our patient feedback cards.

Patients told us that they felt listened to during their consultation with the doctor and that treatment and symptom advice had been explained in a way that they could understand and follow.

During the visit we looked at the treatment records of patients who used the service. We saw there was a system to ensure that patient information was promptly shared with each patient’s own GP to ensure continuity of care.

The vehicle that transported the emergency doctor to patients’ homes was not at the base during the inspection, so we were unable to check equipment or talk to the driver or visiting doctor on this occasion.

In November 2012, the care provider Care UK acquired the Harmoni Group and has taken over the operation of the company. Currently the service is going through change and rebranding and aligning company policy and procedures with that of the new provider.

Focused Inspection of 27 October 2014

After our inspection of 19 February 2014 the provider wrote to us to say what they would do to meet legal requirements in relation to regulation 13 management of medicines.

We undertook a focused inspection under the same regulatory powers to check that they had followed their plan and to confirm that they now met legal requirements. We found that the provider was now compliant with the regulation. We found at this inspection there were systems in place to protect patients from the risks associated with medicines. The provider had developed policies and procedures and was regularly auditing the safe management, storage and disposal of medicines.