Harmoni West London is the provider of out-of-hours GP services for the boroughs of Hillingdon, Barnet, Ealing, Harrow, Brent and Hounslow. The service covers approximately 264 GP practices and provides advice and treatment to a population of over 1.345 million patients.

Before the inspection we looked at a wide range of information we held about the service and asked other organisations such as the local Clinical Commissioning Group (CCG) to share with us what they knew about it. We also asked patients prior to our visit to complete some comment cards about their experiences of the service they had received. The head office for the Harmoni West London out-of-hours service is based in Southhall, and there are three other ‘satellite’ bases throughout the locality that provided out-of-hours services. As part of the inspection the team visited the Southall office and one of the out-of-hours satellite bases which was located in the outpatients department at Hillingdon hospital.

There were effective systems in place to ensure the service could be delivered to the widest range of patients with varying levels of need. There was good collaborative working between the provider and other healthcare and social care agencies which ensured patients received the best outcomes in the shortest possible time. Patients experienced care that was delivered by dedicated and caring staff.

People we spoke with said staff displayed a kind and caring attitude and we observed patients being treated with respect and kindness whilst their dignity and confidentiality was maintained. Patients told us that they were happy with the care and treatment they received and felt safe.

There were robust systems in place to help ensure patient safety through learning from incidents. We saw that the provider had taken steps to ensure that all staff underwent a thorough and rigorous recruitment and induction process to help assure their suitability to care for patients. There was stringent monitoring of all clinician’s work which ensured that poor performance was dealt with quickly. Because of this, any risk to patient care and safety was minimised.

This service is rated as Good overall.

The key questions are rated as:

Are services safe? - Requires improvement

Are services effective? - Good

Are services caring? - Good

Are services responsive? - Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Care UK - North West London Out of Hours (OOHs) service on 19 September 2018 & 20 September 2018, as part of our inspection programme. The service operates from a single call centre and administrative base in Southall. Our inspection included a visit to the service’s call centre and also to each of its three out of hours primary care centres (OOHs PCCs).

At this inspection we found:

• There was an effective system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients and staff were assessed and well managed in some areas, with the exception of those relating to calibration of medical equipment, lone worker risk assessment and access to a paediatric pulse oximeter which could be required to enable assessment of a child patient with presumed sepsis.
• The service was unable to demonstrate that they had an effective monitoring system to assure themselves that appropriate health and safety checks had been undertaken regularly to maintain fire safety and legionella at the Hillingdon OOH PCC and the Harrow OOH PCC.
• There were safeguarding systems in place for both children and adults at risk of harm or abuse as well as palliative care (care for the terminally ill and their families) patients who accessed the out of hours to the service.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The National Quality Requirements (NQRs) standards were monitored and reviewed and improvements implemented.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The service proactively sought feedback from staff and patients, which it acted on.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• 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.
• Information about services and how to complain was available.
• There was a clear leadership structure. Communication channels were open and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Carry out disease specific audits to ensure effective monitoring of antimicrobial prescribing.
• Review feedback on the suitability of the premises at the Harrow OOH PCC and take any necessary action.
• Implement a system to ensure written records are maintained of oxygen cylinder checks at the call centre.
• Improve access to patients with hearing difficulties.
• Ensure all clinical staff have access to a paediatric pulse oximeter which could be required to enable assessment of a child patient with presumed sepsis.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice