We carried out this comprehensive inspection of Care UK – NHS 111 South West service on 27 and 28 September 2016. NHS111 is a 24 hours a day telephone based service where people are assessed, given advice or directed to a local service that most appropriately meets their needs.

Care UK – NHS 111 South West provides services to the areas of Bristol, South Gloucestershire, Bath and North East Somerset, Wiltshire and Gloucestershire. Care UK – NHS 111 South West has one call centre which manages calls for these areas, we inspected this call centre which is located at Lime Kiln Close on the outskirts of Bristol.

Our key findings were as follows:

• There were systems in place to help ensure patient safety through learning from incidents and complaints about the service. All opportunities for learning from internal incidents and complaints were used to promote learning and improvement.
• The provider had taken steps to ensure all staff underwent a thorough recruitment and induction process to help ensure their suitability to work in this type of healthcare environment.

• The provider had developed a mobile phone ‘app’ that allowed senior managers to access real time information relating to call handling within the call centres. This allowed senior managers to support team managers at times of unexpected demand.

  • Staff were supported in the effective use of NHS Pathways. Regular audits of calls to the service monitored quality and supported improvement. Where issues were identified remedial action was taken and the employee was supported to improve.
  • People experienced a service that was delivered by dedicated, knowledgeable and caring staff.
  • People using the service were supported effectively during the telephone triage process. Consent to triage was sought and their decisions were respected. We observed staff treated people with compassion, and responded appropriately to their feedback.
  • Clinical advice and support was readily available to health advisors when needed. Care and treatment was coordinated with other services and other providers.
  • There was an overarching governance framework across the NHS 111 service, which supported the delivery of their strategy and good quality care. This included arrangements to monitor quality and identify risk.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • Risk management was embedded and recognised as the responsibility of all staff.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The provider encouraged a culture of openness and honesty. Systems were in place for notifiable safety incidents and key staff ensured this information was shared with staff to ensure appropriate action was taken.
  • There was a strong focus on continuous learning at all levels.

We saw an area of Outstanding practice:

The Care UK – NHS 111 South West had implemented a system called ‘The Bridge’ which provided a clinician an overview of calls waiting for a clinical call back. The clinicians used a risk assessment tool which supported their clinical reasoning and decision making to ensure calls were correctly prioritised and people were called back within the recommended timeframe. The system had been implemented by the team and shared across the organisation; they had audited ‘The Bridge’ calls and demonstrated the impact on people who used the service as in April 2015, 11.7% of callers were referred to Emergency Departments whilst by January 2016 this was reduced to 7.9% because clinical advisors were able to assess and direct people more appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice