Integrated Care 24 - Head Office Also known as South East Health Limited - Head Office

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Integrated Care 24 Limited – Ashford on 12, 13 and 14 July 2016. This is a GP out of hours services which provides health care for urgent medical problems outside normal surgery hours. Overall the service is rated as good.

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

• There was an effective system for reporting and recording significant events. A wide range of events was reported. They were systematically assessed and dealt with.

• Risks to patients were assessed and well managed.

• 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.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Comment cards that patients completed confirmed this finding.

• 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.

• Patients said they found it easy to make an appointment and data showed most patients were seen or contacted in a timely manner. The primary care centres, from which care was delivered, were well equipped to treat patients and meet their needs.

• There was a clear leadership structure. Governance framework was strong. Staff felt supported by management. Independent challenge at board level was welcomed.

• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The service had a systematic approach to working with other organisations to improve care outcomes. For example they had worked with UK Sepsis Trust to develop a protocol to improve diagnosis, safety and care of patients with sepsis (blood poisoning). The protocol was made widely available.

There is one area where the provider must make improvements:

• Review the arrangements for the management and recording of controlled drugs to make them more effective.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out this comprehensive inspection of IC24 NHS 111 service on 12 and 13 July 2016. 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, or home management advice.

IC24 provides NHS 111 services to the areas of North Essex, South Essex, Great Yarmouth and Waveney, and Norfolk and Wisbech. IC24 has three call centres that manage calls for these areas, we inspected two of these call centres at Ashford and Ipswich.

Our key findings were as follows:

• 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.
• Staff were supported in the effective use of NHS Pathways. Regular audits of calls to the service monitored quality and supported improvement and where issues were identified remedial action was taken and the employee was supported to improve.
• Patients experienced a service that was delivered by dedicated, knowledgeable and caring staff.
• 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.
• Clinical advice and support was readily available to health advisors when needed. Care and treatment was coordinated with other services and other providers.
• All opportunities for learning from internal incidents and complaints were used to promote learning and improvement.
• There was an overarching governance framework across the NHS 111 service, which supported the delivery of the strategy and good quality care. This included arrangements to monitor quality and identify risk.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Risk management was embedded and recognised as the responsibility of all staff.
• The provider was aware of and complied with the requirements of the Duty of Candour. The provider 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
• There was a strong focus on continuous learning at all levels.

We saw several areas of outstanding practice:

• The IC24 NHS 111 management team had developed a pilot towards the ‘Professionalisation’ of the health advisor role within the NHS 111 Urgent Care Setting. A proactive approach to addressing attrition and retention rates of the NHS 111 health advisor workforce (a known area of high attrition rates nationally) by nationally accrediting health advisor training and the introduction of a health advisor development framework, supported by additional distance learning packages. They had worked with a local higher education institution and NHS England to develop an accredited course.
• The service was developing an innovative pilot scheme in South Essex to support people who have called NHS111 but it has been established that they are not injured and unable to get up. They were working in collaboration with a local Fire service to support these patients and reduce the requirement to send a non-emergency ambulance response.
• The provider had developed a mobile phone ‘app’ that allowed senior managers to access real time information relating to call handling within the call centres. This allowed senior managers to support team managers at times of unexpected pressure.

However, there was an area of practice where the provider should make an improvement.

The provider should:

• Review their safeguarding process to consider referrals being made by health advisors and the auditing of safeguarding concerns when clinicians have determined that there is no further action required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice