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 inspection at Urgent Care 24 Limited (an out of hours provider) on the 19  and 20 March 2018. This was carried out as part of our inspection process and a comprehensive inspection was completed. During the inspection we visited four of the provider's out of hours locations.

At this inspection we found:

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

• The service had clear systems to keep people safe and safeguarded from abuse.

• There was an effective system to manage infection prevention and control, at the time of inspection infection audits were taking place at each of the locations used by the provider.

• The service had reliable systems for appropriate and safe handling of medicines, which included regular audit and external scrutiny.

• The service routinely reviewed the effectiveness and appropriateness of the care it provided. The provider had systems to keep clinicians up to date with current evidence based practice. They ensured that care and treatment was delivered according to evidence- based guidelines.

• The service was actively involved in quality improvement activity, including working closely with external agencies and commissioners to meet patient’s needs.

• Staff had the skills, knowledge and experience to carry out their roles. They involved and treated people with compassion, kindness, dignity and respect.

• Patients were able to access care and treatment from the service within an appropriate timescale for their needs. Staff worked together, and worked well with other organisations to deliver effective care and treatment.

• Patient feedback we reviewed including the NHS Friends and Family Test, internal service surveys and other feedback collected by the service was positive about the care and service patients received.

• The provider understood the needs of its population and tailored services in response to those needs. The provider engaged with commissioners to secure improvements to services where these were identified.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. For example, the service took complaints and concerns seriously and responded to them appropriately to improve the quality of care.

• Leaders at all levels were visible and approachable. They worked closely with staff and others to make sure they prioritised compassionate and inclusive leadership. Senior management was accessible throughout the operational period, with an effective on-call system that staff were able to use.

• There were clear responsibilities, roles and systems of accountability to support good governance and management.

• A full and diverse range of patients’, staff and external partners’ views and concerns were encouraged, heard and acted on to shape services and culture.

• There was a focus on continuous learning and improvement at all levels within the service.

We saw a number of areas of outstanding practice:

• There was evidence that incident reporting was widely promoted across the organisation. Staff had received risk management and root cause analysis training and there were high numbers of incidents reported through the Datix system. This suggests there was good awareness of the importance of reporting patient safety incidents and near misses across the service. When significant events had occurred there were good systems for reviewing and investigating, learning and sharing lessons to improve safety in the service.

• The provider improved services where possible in response to unmet needs. For example, prior to December 2017 an electronic Escalation Management System (EMS) was introduced into the service. This information system was in operation across a number of service providers across the Clinical Commissioning Group (CCG). The aim of the new system was to ensure that all staff in each organisation were kept aware of service pressures and activities across the healthcare providers, so that patients could be diverted to services that were less busy. All service and shift managers provided support for this along with members of the executive team.

• There was a strong emphasis on the safety and well-being of all staff. As a team they supported each other and we saw that events and training were organised to build a strong team ethic. We saw that a food bank for staff had been set up by the provider, so food could be left anonymously for staff members if they were struggling financially at home.

• The service provided a free taxi service to patients who were unable to pay for their journey to the outreach clinics.

The areas where the provider should make improvements are:

• Review and develop an overarching management system to ensure that all the premises where care and treatment are delivered are clean, suitable for the intended purpose, maintained and where required, appropriately located. This should include annual assurance that health and safety and infection control risk assessments required have been completed and any issues identified have been addressed.

• Review the Datix system and risk register to ensure that all reported significant events are closed off the system when investigations and actions have been taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice