In January 2018 we undertook a comprehensive inspection at Apodi Healthcare Limited and found the provider was providing effective, caring, responsive and well-led services, but they needed to make improvements in the provision of safe services. We issued a requirement notice and the provider informed us they would make the required improvements.

We carried out an announced focussed follow up inspection on 24 September 2018 to ask the service the following key question; Are services safe.

We found that this service was providing safe care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At the last inspection the provider was in breach of regulation 12 Safe Care and Treatment due to a lack of system to identify and act on safety alerts. We also recommended the provider to consider their infection control monitoring systems and their adherence to the Equalities Act (2010) At this inspection we found the necessary improvements had been made.

Apodi Healthcare Limited provide care to patients via NHS services both in the community and hospital outpatient care. They support patients receiving medicines under specific programmes sponsored by the pharmaceutical industry. The programmes are negotiated directly between NHS providers and the pharmaceutical companies, and the latter offer Apodi Healthcare Limited’s services to NHS providers to undertake the monitoring and support of patients on these programmes.

A registered manager was in post. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• The provider had implemented a system to ensure medicine alerts were shared with staff and acted on where necessary.
• There were new infection control procedures in place and plans to undertake supervision with staff in order to audit their implementation.
• There had been consideration of the Equalities Act (2010) and that staff needed to follow the protocols belonging to the provider’s they worked at.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 8 January 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not always providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This was the first inspection undertaken at this service.

Apodi Healthcare Limited provide care to patients via NHS services both in the community and hospital outpatient care. They support patients receiving medicines under specific programmes sponsored by the pharmaceutical industry. The programmes are negotiated directly between NHS providers and the pharmaceutical companies, and the latter offer Apodi Healthcare Limited’s services to NHS providers to undertake the monitoring and support of patients on these programmes. The prescribing of the medicines under the programmes is undertaken only by NHS services and this is usually by consultants in NHS Acute Hospital Trusts. The provider monitors patients during treatments and this may include initiation and titration (a process of determining the correct dosage for medicines). Patients may continue on the medicines under the care and monitoring of hospital doctors or their GPs.

The programmes the provider were supporting at the time of the inspection were medicines for the treatment of heart failure, prostate cancer and multiple myeloma. In addition the service provided phone support for oncology and rheumatoid arthritis patients.

The clinical staff providing care were all registered nurses who had nurse managers overseeing their work. The nursing staff worked within community and hospital settings and the NHS services prescribed the medicines. Nursing staff from Apodi Healthcare Limited were inducted into the service where they would work in the same way as employed staff. Alongside this there were staff training and checks provided by Apodi Healthcare Limited. Patient monitoring data resulting from tests undertaken by the provider’s staff were recorded directly onto the NHS services patient records within the NHS services records. Anonymised data regarding the number of patients receiving the medicines and audits during the period they were initiated onto the medicines, were sent to the pharmaceutical companies. Information was provided to patients to ensure this was understood by those receiving care under the programmes.

The provider had no premises from which they provided care. They had a head office from which the regulated activities were managed and where they locate their patient phone support service.

Our key findings were:

• The provider had systems in place to identify and learn from clinical practice in order to improve services where necessary.
• Most risks associated with the provision of services were well managed. However, infection control processes should be reviewed.
• The provider did not have an appropriate system for ensuring any information related to medicine alerts was always acted on.
• The necessary checks required on staff who provided care were in place.
• Patients received full and detailed explanations of treatment including information enabling informed consent.
• The service was caring, person centred and compassionate.
• There were processes for receiving and acting on patient feedback.
• There were appropriate governance arrangements in place. The provider ensured clinicians maintained an up to date knowledge in their specialism and undertook relevant training and revalidation.
• There were systems in place to respond to incidents and complaints.

There were areas where the provider could must make improvements:

• Ensure care and treatment must be provided in a safe way for service users.

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

• Review infection control processes including the potential need for audit and processes.
• Review the means by which patients individual requirements and preferences are respected and met in terms of the Equalities Act 2010 and other relevant legislation.