London Ambulance Service Headquarters

Updated 4 March 2022

The London Ambulance Service NHS Trust (LAS) was established in 1965 from nine previously existing providers and became an NHS Trust on 1 April 1996. The main role of the LAS is to respond to emergency 999 calls, 24 hours a day, 365 days a year. LAS has delivered a 111 service in South East London (SEL) since 2013 when it became the step-in provider; SEL 111 covers the boroughs of Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark. Its offices are based in Southern House, Croydon (5 minutes’ walk from East Croydon station).

The 111 service transitioned to an integrated urgent care (IUC) service through phased mobilisation from 26th February to 8th May 2019. LAS was awarded, through open tender, the contract to deliver the Integrated Urgent Care (IUC) Clinical Assessment Service (CAS) for the boroughs of Barking & Dagenham, City & Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest, which commenced in 1 August 2018. This North East London (NEL) provider is based at Maritime House, Barking (five minutes’ walk from Barking station). Only the NEL site was inspected on 6 December 2021.

In line with the national specification, the new LAS IUC CAS has a multidisciplinary team of GPs, Advanced Practitioners, Pharmacists, Nurses, Paramedics, Health & Provider Advisors providing expert advice over the phone and working closely with other urgent care providers in the area as part of the overall integrated urgent care system. The model for an IUC CAS requires access to urgent care via NHS 111, either on a free-to-call telephone number or online. The provider provides:

• Triage by a Health Advisor;
• Consultation with a clinician using a clinical decision support system or an agreed clinical protocol to complete the episode on the telephone where possible;
• Direct Appointment Booking post clinical assessment into a face-to-face provider where necessary;
• Self-help information delivered to the patient.

Updated 4 March 2022

We carried out an inspection of the London Ambulance Service between 2, 6 and September 2019 and 13 September 2019. Three core services were inspected: 111 Integrated Urgent Care Clinical Assessment Service, the Urgent and Emergency Service and the Emergency Operations Centre. The inspection of these services was conducted as a result of a number of whistleblowing concerns from different staff members across two of the services, over a period of one to two months.

This report covers the inspection of the London Ambulance Service’s (LAS) 111 Integrated Urgent Care Clinical Assessment Services in south east London (SEL) and north east London (NEL). NEL was visited on 3 September 2019 and SEL was visited on the 5 and 13 September 2019.

The 111 services have been rated as good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

At this inspection we found:

• Staff were supported in the effective use of NHS Pathways which is a triage software utilised by the National Health Service to triage public telephone calls for medical care and emergency medical services.
• However, we found that not all staff were aware of how to deal with complex calls.
• The service had not met all the National Quality Reporting standards and those requirements set by the commissioners.
• The service had good systems to manage risk so that safety incidents were less likely to happen. Learning from incidents was shared at and between the two sites; however, some staff reported that they were not routinely made aware of incidents that occurred.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided.
• Call audits were in place to monitor the performance of staff at each service.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• The services had an overarching governance framework in place, including policies and protocols which had been developed at a provider level and had been adapted to meet the needs of the services locally.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The provider was in the early stages of starting a patient participation forum at a regional level so that patients could feed into the services being provided.

The areas where the provider should make improvements are:

• Provide time for staff to complete additional duties such as completing the service’s incident database.

• Effectively disseminate information to staff and improve the use of required communication tools so that information is correctly documented.

• Liaise with the clinical commissioning group to discuss ways to improve the Directory of Services.

• Continue with efforts to achieve the services rota fill targets.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care