This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

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 Herts Urgent Care (HUC) out-of-hours and NHS111 service provided from the City Care Centre in Peterborough, Cambridgeshire on 10 May 2018.

The service was inspected in March 2017 and rated as good, with the service being rated as requires improvement for delivering effective out-of-hours services. We did not inspect the NHS111 service in the March 2017 inspection.

In November 2016, HUC obtained the integrated NHS111 and out-of-hours contract for the whole county of Cambridgeshire. HUC therefore provided both NHS111 and out-of-hours services for the whole of Cambridgeshire at the time of this inspection.

At this inspection we found:

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.

• The provider actively monitored any patient contact involving child protection and safeguarding adults.

• The provider had systems and arrangements for managing medicines, including medical gases, emergency medicines and equipment and vaccines, which helped to minimise risks. Controlled drug registers were not consistently maintained in line with best practice guidance and there was no process to monitor the use of computer prescription forms. A senior member of staff we spoke with was not aware of the national guidance on prescription security. Following our inspection the provider took action and developed electronic solutions for recording information relating to prescriptions.

• The provider organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated people with compassion, kindness, dignity and respect.

• Some staff we spoke with explained that local leadership and guidance in the form of policies and procedures was not always as desired. Also, some staff felt guidance in the form of policies and procedures had been slow to be implemented. The provider explained that due to external circumstances, outside of the provider’s control, implementation of some systems, policies and procedures had taken longer than expected. The provider was in the process of trying to recruit a GP clinical lead and clinical workforce manager for the Cambridgeshire area.

• Performance did not always meet contractual targets but was in line with, or exceeded, national performance.

• There were arrangements and systems in place to support staff to respond to people with specific health care needs such as end of life care and those who had mental health needs.

We saw one area of outstanding practice:

• The provider had an option available for patients that dialled NHS111 because of a concern for their mental health wellbeing; they could be redirected to the local mental health service single point of contact without needing to speak to NHS111 staff first. This approach had been developed locally and was being considered in other areas of the country. The provider communicated with the mental health service on a regular basis and the direct access option was reviewed by the mental health service regularly, with any outcomes or learning shared between the two services.

The areas where the provider should make improvements are:

• Review the policy and process for managing Controlled Drugs.
• Continue to monitor electronic solutions for recording information relating to prescriptions.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Herts Urgent Care (HUC) out-of-hours service at the Peterborough City Care Centre on 8 March 2017.

The service was inspected under the previous provider and rated as Inadequate, following which HUC took the service over with the support of the commissioners in April 2016. In November 2016 HUC obtained the integrated NHS111 and out-of-hours contract for the county of Cambridgeshire. HUC therefore provided both NHS111 and out-of-hours services in Peterborough at the time of the inspection. We only inspected the out-of-hours part of the service as the NHS111 service was inspected in November 2015 and rated Good overall.

The out-of-hours service in Peterborough provides out-of-hours care for a population of approximately 188,000 people living in Peterborough and surrounding area.

Overall the service is rated as good.

Our key findings were as follows:

• The provider had a clear vision which focussed on quality and safety.
• There were systems in place to help ensure patient safety through learning from incidents and complaints about the service.
• The provider had systems in place to manage medicines but we found that improvement was needed to ensure these were effective. The provider was responsive to our findings and took immediate action.
• The service was not consistently meeting all applicable locally agreed key performance indicators or those known as National Quality Requirements.
• The primary care centre where patients were seen had good facilities and was equipped to meet the needs of patients. Vehicles used for home visits were clean and well equipped.
• Staff generally expressed positive views of the management and leadership. Generally staff felt supported by the senior management team, although some staff said they felt isolated due to shift work patterns.
• The service worked with other organisations and with the local community to develop services.
• The service shared experience reports with the clinical commissioning group (CCG) on a monthly basis which contained information on complaints, feedback from professionals, feedback from patients, incidents and accolades.

There were areas of practice where the provider needs to make improvements.

The provider should:

• Maintain medicine stock records appropriately so that they reflect actual stock levels.
• Maintain records of staff’s own equipment’s calibration.
• Record checks and restocks of clinical rooms and home visit equipment bags.
• Maintain performance in line with local and National Quality Requirement (NQR) key performance indicators’ expectations.
• Ensure complaints’ guidance is readily available for patients pursuing this.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice