This NHS 111 service is provided by Care UK - Surrey based in Dorking in Surrey. Care UK - Surrey is contracted by South East Coast Ambulance Service NHS Foundation Trust (SECAmb) for their provision of a NHS 111 service. At this inspection, Care UK -Surrey and SECAmb were inspected at the same time. To read the SECAmb report, please go to http://www.cqc.org.uk/. There is a shared management structure in place with SECAmb, to provide the NHS111 service across the same geographical area as SECAmb.

We inspected the service in May 2016 where Care UK- Surrey was rated as requires improvement overall. Specifically it was rated as inadequate in safe; requires improvement in effective and well led; and good in the caring and responsive domains.

We carried out an announced inspection on 17 and 18 May 2017 and the service is now rated as good overall and specifically outstanding in the well led domain.

We found the service had implemented a comprehensive recovery plan which had been signed off as completed in April 2017, to address the shortfalls found at our inspection in May 2016.

Our key findings from this inspection in May 2017 were:

• The provider had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• Service performance was monitored and reviewed and actions to improve care were implemented.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• All opportunities for learning from internal incidents were discussed to support improvement. Information about safety was valued and used to promote learning and improvement.
• Daily, weekly and monthly monitoring and analysis of the service achievements was measured against key performance targets and shared with the lead clinical commissioning group (CCG). Account was also taken of the ranges in performance in any one time period.
• Appropriate action was undertaken where variations in performance were identified. Staff were trained and monitored to ensure safe and effective use of NHS Pathways, which are clinical triage tools.
• Staff received annual appraisals and personal development plans were in place. Staff had the appropriate skills, knowledge and experience.
• Patients using the service were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• We saw staff treated people with kindness and respect, and maintained patient confidentiality.
• There was a comprehensive complaints system and all complaints were risk assessed and investigated appropriately.
• Action was taken to improve service delivery where gaps were identified.
• Care and treatment was coordinated with other services and other providers. There was collaboration with partners to improve urgent care pathways.
• The service had long and short-term plans in place to ensure staffing levels were sufficient to meet anticipated demand for the service.
• There was a clear leadership structure and staff felt supported by management. The senior leaders were visible and accessible to staff.
• The provider had clear and appropriate policies and procedures to govern activity. Regular meaningful engagement with staff took place and there was evidence that this delivered their intended outcomes, whether strategic or operational
• There were effective systems in place to monitor and improve the service.
• High standards were promoted and owned by all provider staff and teams worked together across all roles.

We saw one area of outstanding practice:

There was a well-developed leadership structure that had supported innovative practice and new systems to be developed and embedded across the service. For example, the diamond pod training structure where staff had instant access to supervisory help on the floor, allowing new staff to be nurtured and valued without pressure of call targets, with more experienced staff able to give their time appropriately. There were initiatives to increase safety and welfare in the call centre for staff and patients, such as bright orange cards that could be used by call handlers to easily signal that immediate help was required. There was also a focus on continuously improving working relationships within the service management with SECAmb and the wider health and care service. Care UK management was striving to find more efficient and responsive ways of sharing and utilising knowledge from the acute and primary health providers, social care providers and voluntary agencies in order to improve service to patients and the working environment for all staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice