Archived: Mallard House Call Centre Also known as NHS 111 Service

Updated 4 October 2016

Derbyshire Health United (DHU), is a social enterprise and not for profit organisation that holds the contract to deliver the integrated NHS 111 and out-of-hours service for Derbyshire with a headquarters based in Derby. This service is commissioned by North Derbyshire Clinical Commissioning Group on behalf of the North Derbyshire, South Derbyshire, Hardwick and Erewash Clinical Commissioning Groups.

District nursing services are provided to patients from 6pm until 8am across Derbyshire County and from 10pm until 8am across Derby City providing both planned and unplanned care to a population of approximately one million people . The total percentage of residents in this area who suffer with a long term health disability is higher than both regional and England averages

This service is provided by both a north and south nursing team who work across four locations including Mallard House Call Centre which is the main base for the south team and is located in Derby. A second service Ashgate Manor is the main base for the north team and is located in Chesterfield. Patients access this service for unplanned care by telephoning the NHS 111 service, where their medical need is assessed based on the symptoms they report when they call. Patients receiving planned care are scheduled for a visit by a coordinator using a computer software system. This system is also used by the GP out-of-hours and the 111 service and enables easier access to patient information and information sharing between these services. If patients need to be seen by a member of the district nursing team, appointments are allocated by a coordinator via an electronic system called ‘Adastra’. This system enables the coordinator to despatch patients to the most convenient community nursing team.

The district nursing teams provide services from the following locations:

Ashgate Manor, Ashgate Road, Chesterfield, Derbyshire, S40 4AA

Mallard House Call Centre, Stanier Way, Derby, DE21 6BF

Buxton Hospital, London Road, Derbyshire, SK17 9NJ

Whitworth Hospital, 330 Bakewell Road, Matlock, Derbyshire, DE4 2JD

During 2014-15, 14,419 patient consultations were provided during the evening period from 6pm until midnight. This figure consisted of 3,310 planned home visits and 11,289 unplanned. During the overnight period from midnight until 8am, 4,573 home visits were provided. This figure consisted of 25 planned home visits and 4,548 unplanned.

Pre-planned work was also referred into the evening service by the daytime nursing service provided by Derbyshire Community Health Service NHS Foundation Trust (DCHS) who commission the services for the evening and overnight district nursing service within Derbyshire of which DHU are the sub-contractor for this service. DHU began delivery of this service in 2011. DHU followed a TUPE process to integrate seven separate nursing teams who were working different shift patterns and working hours at that time. The service was re-structured and service improvements implemented with an aim to provide a consistent and equitable service across Derbyshire and Derby City.

At the time of our inspection, DHU had a governance structure in place for the evening and overnight district nursing service. This structure included a clinical director, deputy clinical director, head of community nursing and two team leaders who were responsible for the north and south team. The north team covered Ashgate Manor, Buxton Hospital and Whitworth Hospital. The south team covered Mallard house, Derby. Both the north and south team included smaller evening and overnight visiting teams. Each visiting team consisted of a nurse and a health care assistant, or two nurses. Members of staff were never required to work alone in the community. The service employed 62 contracted members of staff and 21 members of staff who were employed on a zero hours contract.

DHU staff have various lead roles across all their locations including a clinical lead for the GP out-of-hours service, service leads, information governance lead, director on call 24 hours per day, Caldicott guardian, infection control lead, medicines lead and safeguarding leads for both adults and children.

DHU was last inspected in November 2015. The inspection focused on the GP out-of-hours services and the NHS 111 services provided from the call centres and primary care centres at Ashgate Manor and Mallard House Call Centre.

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derbyshire Health United (DHU) evening and overnight district nursing service on 9 & 10 May 2016. As part of this inspection we visited Mallard House Call Centre where the south district nursing team were based. 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 reporting and recording significant events. Staff knew how to and understood the need to raise concerns and report incidents and near misses.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff had received extended training relevant to their role. For example, staff had undertaken training in varying aspects of end of life care, dementia awareness and domestic abuse awareness.
• A care concern referral process had recently been introduced. This system enabled referrals to be made where the concerns for the patient did not relate to suspected abuse but related to care needs or welfare of the patient.
• Through the comment cards patient completed for us, they said they were treated with compassion, dignity and respect. The also told us they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Patient information was available in different languages. Complaints were fully investigated and patients responded to with an apology and full explanation.
• Vehicles used to visit patients in their own homes were clean and well equipped.
• There was a clear leadership structure and staff felt supported by their team leaders and the senior management team.
• The provider proactively sought feedback from staff and patients, which it acted on.
• There were innovative approaches to providing integrated person-centred care. Rightcare plans were developed by the patient’s GP and shared with the evening and overnight district nursing service for clinically high demand patients including nearing end of life and those with complex health needs. Special notes were used to record relevant information about patients.
• There were effective safeguarding systems in place for both adults and children at risk of harm or abuse. There was an effective system in place for adults to support people about whom there were care or welfare concerns.
• There were clinical supervision and appraisal processes in place for all clinical roles and support was provided for those members of the nursing team who were required to revalidate.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice including:

• A daily comfort call system was in place for patients referred into this service with palliative care needs and those patients who were at the end of their life.These patients received a telephone call on a daily basis to assess their care needs and received priority visits when required.

• DHU worked towards achievement of a quality target to achieve a minimum of 95% of all requests for urgent visits to be achieved within a four hour time frame.During the period 1 April 2015 – 31 March 2016, a total of 18,361 patient contacts were recorded. The overall achievement of this target was 99.75% of urgent visits attended within a four hour timeframe. Data was monitored on a monthly basis and any reported breaches of this target were investigated on an individual basis to ascertain whether an actual breach had occurred.

• DHU carried out an end of life care admission audit which involved a review of all hospital referral rates and emergency 999 calls for terminally ill/palliative care patients. This audit monitored reasons for admission to hospital and any further communication with or actions taken by DHU and identified whether a Rightcare plan was in place for these patients. This enabled DHU to continually monitor the appropriateness of unplanned admissions to hospital and use of emergency services. The results of this audit showed that 75% of either hospital admission or emergency 999 calls were appropriate or unavoidable. Results highlighted that 50% of cases did not have a Rightcare plan in place. Reasons for either admission or an emergency 999 call were recorded for those cases deemed inappropriate to enable DHU to monitor trends and action plans were implemented as a result of this audit.

• An out of hours coordinator was in place on a daily basis who was also supported by a clinical lead who provided clinical oversight and support in the community to the nursing teams. The out of hours coordinator continually monitored the location of all members of the nursing teams when working in the community via the ‘Adastra’ electronic system and ensured regular communication with staff throughout their shift. The coordinator continually monitored and re-allocated workloads across all nursing teams to ensure work was re-allocated to other teams should a nursing team require to spend more time with a patient dependent upon their care needs, whilst ensuring other patients received a home visit as soon as possible by the most appropriate team. This system also ensured achievement of the quality target to achieve a minimum of 95% of all requests for urgent visits within a four hour time frame.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice