Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hilltop Heights (Cumbria Health on Call) on 30th November, 2016. Overall the service is rated as outstanding.

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 recording, reporting and learning from significant events.
• Risks to patients were assessed and well managed.
• Patients’ care needs were assessed and delivered in a timely way according to need. The service met the National Quality Requirements.

• 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.
• There was a system in place that enabled staff access to patient records, and the out of hours staff provided other services, for example the local GP and hospital, with information following contact with patients as was appropriate.
• The service managed patients’ care and treatment in a timely way.
• 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.
• The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw some areas of outstanding service:

• The provider was highly responsive to the the needs of the predominantly rural population. For example, a pilot for telehealth appointments had recently been completed. This had reduced the average time for patients in rural areas to be seen for either a routine base or home visit from 146 minutes to 32 minutes. They worked closely with other service providers, such as North West Ambulance Service (NWAS), for whom they provided GP-triage. NWAS told us the most recent data showed that in 93% of cases when this service was used, a hospital admission was avoided for the patient.
• The leadership, management and governance assured the delivery of high quality care, and supported learning and innovation throughout the organisation. Leaders had an inspiring shared purpose and motivated staff to succeed. Staff we spoke to told us the executive team were highly approachable, and that this had a positive effect on staff morale.

• Governance and strategy were proactive and innovative. The provider had been proactive in addressing the specific recruitment difficulties faced by the service in this geographical area. As a result of a collaborative recruitment drive six new salaried GPs had been employed. This in turn improved capacity to meet demand and safety, as reliance on agency staff was sometimes as low as 5% of shifts per week.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Cumbria Health on Call Ltd (CHOC) provided GP out of hours’ services and also a day time bi weekly cardiology clinic at the Hilltop Heights location. We did not inspect the cardiology service during our visit, this will be inspected separately. At this inspection, at the main office location, our focus was upon looking at the provision of urgent primary health care services across Cumbria and how the service monitored and assessed the quality of the service it provided and managed any identified risks. We saw that the services activities were subject to continuous monitoring and review.

We visited the office and spoke with the people involved in different but vital parts of the patient pathway. We met, spoke with and spent time with the managing director, senior clinical manager, the operations manager, control room manager, triage and control room staff. All the people we spoke with and spent time with were well aware of their responsibilities and what was expected of them to provide a responsive and effective service. All of these people were able to answer our questions to a high level and provide us with the data we requested in a variety of forms, electronic, hard copy, statistical and through explanation of the IT system.

The non clinical call handlers we talked with had been trained to enable them to follow the most effective criteria to gather information and to identify whether a patient had an immediately life threatening condition (ILTC).