We decided to visit this service in the evening to gain a wider view of the service provided. This inspection was also part of a 'out of normal hours' pilot project being undertaken in the North East region

We did not speak to people using the service. Instead, we observed the telephone operators talking to patients and looked at documentation showing how the provider complied with clinical quality and safety. We observed staff providing information and advice to people in a respectful manner and they were aware of their professional reponsibilities. For example, unqualified staff did not attempt to provide clinical advice.

All of the staff we spoke with were aware of the safeguarding procedures and knew how to raise concerns in accordance with whistle blowing policies.

We saw that information was shared between providers such as the NHS 111 Out of Hours Service, Local Care Direct and the patients own GP. We also saw that the appropriate information sharing agreements were in place.

We looked at the recruitment records of four people, which included a GP and nurse. We saw appropriate checks were in place to ensure people employed had the necessary skills, experience, qualifications and were of good character.

We also looked at the quality monitoring arrangements and saw there were appropriate systems in place for monitoring the quality of the service. This included clinical meetings, serious incident and complaints sub group, information governance meetings and quality group meetings.

We carried out a comprehensive inspection visit on 3 and 4 March 2015 and the overall rating for the practice was good. The inspection team found after analysing all of the evidence the practice was safe, effective, caring, responsive and well led.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• The service was responsive and ensured patients received accessible, individual care, whilst respecting their needs and wishes.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice including:

• Every clinician working in urgent care had three of their cases audited each month by the Clinical Governance lead and a team of six GPs. This information was used by the clinical staff as evidence of their out of hours work when they had their revalidation.

• The service had a flexible transport system. For example, wherever possible the call handlers arranged and the service provided free transport for patients who had insufficient monies to use public transport.

• The service was working 75% above their service contract in meeting patients’ needs and although this had an effect on the waiting time to see a clinician, there was a system in place to alleviate this.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice