Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at International House ( Part of Mastercall Healthcare Out of Hours Service) on 6 and 7 March 2017. Overall the provider is rated as good.

Our key findings across all the areas we inspected were as follows:

• The provider demonstrated an open and transparent approach to safety. They had a clear cohesive system was in place for reporting, recording and providing feedback on significant events, identified risks, near misses, patient complaints and safeguarding referrals.
• The Quality and Safety Team held detailed profiles relating to identified risks, complaints, significant events and safeguarding referrals. Risk ‘champions’ had been identified amongst the workforce to encourage high levels of reporting amongst staff.
• The service was monitored against the National Quality Requirements (NQRs) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners in relation to the level and quality of service being delivered. Where variations in performance were identified, the reasons for these were reviewed and action plans implemented to improve the service.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received appropriate training and updating which provided them with the skills, knowledge and experience to deliver effective care and treatment.
• Performance monitoring processes were in place. Clinicians received weekly audits of their clinical practice using the Royal College of GPs (RCGP) urgent care tool the ‘Clinical Guardian’ system.
• The provider had developed in-house software to support individual ‘My Performance’ reports which benchmarked individual clinicians against their peers in relation to assessment outcomes, for example in relation to percentage of patients who received telephone advice, or who attended treatment centres or hospital.

• Following initial assessment by NHS111 service, patients were triaged by clinicians at International House and offered telephone advice, a face to face appointment at Stockport or Trafford; or a home visit, in accordance with the outcome of the assessment.

• Information about services and how to complain was available on the provider website and in house at treatment centres. Complaints were investigated and patients received an apology and explanation of actions taken as a result of their complaint.

• Staff had access to safeguarding policies and procedures and received training appropriate to their role. Staff demonstrated their awareness of their safeguarding responsibilities in relation to vulnerable children and adults; including frequent callers to the service.

• Vehicles used to transport GPs to home visits were clean, well maintained and appropriately equipped. Patient Transport Services were available for those patients without transport, who needed to access a treatment centre

• There was a clear leadership structure within the organisation. Staff we spoke with described feeling supported by immediate and senior managers.

• The provider proactively sought feedback from staff and patients, and acted on this feedback.

• There were systems in place to provide integrated person-centred care. Staff had access to information relating to end of life care through the use of Special Patient Notes, EMIS viewer and Electronic Palliative Care Co-ordination System (EPaCCS).

• The provider was aware of, and complied with the requirments of the duty of candour.

We saw areas of outstanding practice:

• The provider was the first out of hours service to be awarded ‘Daisy’ accreditation, which originated from the National Dignity Council, and had been adopted by Community Healthcare Trusts for Tameside, Glossop and Stockport; for dignity in care. Dignity champions had been identified throughout the service to reinforce this approach.

  However the provider should:

• Improve uptake of annual appraisals, particularly in relation to nursing staff.

• Continuously monitor, review and develop action plans in relation to their performance against National Quality Requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice