Herts Urgent Care (HUC) provides out-of-hours General Practitioner (GP) services for more than 1.2 million patients living across Hertfordshire. It is registered with the Care Quality Commission to provide the regulated activities of transport services, triage and medical advice provided remotely and the treatment of disease, disorder and injury.

We carried out the inspection as part of our new inspection programme to test our approach going forward. It took place with a team that included three CQC inspectors, a GP, a GP practice manager, a nurse and an expert-by-experience.

We found the service was effective in meeting patients needs and had taken positive steps to ensure people who may have difficulty in accessing services were enabled to do so. There was an emphasis on involving groups of patients that had been considered to be hard to reach and engage, for example, people with a learning disability.

Patients told us that they were happy with the care and treatment they received and felt safe. There were systems in place to help ensure patient safety through learning from incidents, the safe management of medicines and infection prevention and control.

The provider had taken steps to ensure that all staff underwent a thorough recruitment and induction process to help ensure their suitability to care for patients.

Patients experienced care that was delivered by dedicated and caring staff. Patients and carers 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.

We found that the service was well-led and managed by an enthusiastic and knowledgeable senior management team and board of directors, and their values and behaviours were shared by staff. Members of the staff team we spoke with all held very positive views of the management and leadership and felt well supported in their roles. They told us the senior managers were approachable and listened to any concerns or suggestions they might have to improve the level of service provided to patients.

We carried out this inspection of Herts Urgent Care NHS 111 on 3 and 4 November 2015. 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.

Herts Urgent Care (HUC) provides NHS111 services for Hertfordshire and Cambridgeshire from two call centres at Ascots Lane, Welwyn Garden City and City Care Centre, Thorpe Road, Peterborough.

The NHS111 service for Hertfordshire is an integrated NHS111/out-of-hours service. The out -of-hours service is subject of a separate inspection and report.

The NHS111 service had not been subject to any previous CQC inspection.

Our key findings were as follows:

• Herts Urgent Care provided a safe, effective, caring , responsive and well-led service.
• 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.
• The service was high achieving and had consistently met or exceeded the key performance indicators known as the Minimum Data Sets (MDS)
• Patients experienced a service that was delivered by dedicated, knowledgeable and caring staff.
• Staff were supported in the effective use of NHS Pathways. Call review and audit was regular and robust in its application.
• We found that the service was well-led and managed by an effective senior management team and board of directors, and their values and behaviours were shared by staff.
• Staff expressed positive views of the management and leadership and felt well supported in their roles.
• Callers were satisfied with their experience of using the service.

We saw several areas of outstanding practice including:

• At the conclusion of the CQC inspection the provider displayed total openness and honesty as all available staff were invited to listen to the feedback provided by the CQC inspection team.
• The provider had developed links with the University of Hertfordshire in order to develop their clinical advisors by means of courses aimed effective telephone triage through history taking, asking sensitive questions and decision making. Clinical advisors had further been supported to attend the ‘Assessment- A Systematic Approach’ facilitated by the University which enabled clinicians, if they so wished, to progress further to assess and triage patients face to face as Clinical Navigators .

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Review health advisors awareness and knowledge of the Mental Capacity Act to ensure relevant callers are managed appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice