Emergency Doctors Medical Service is operated by Emergency Doctors Medical Services Limited. The service supplies paramedics, doctors, emergency technicians, and emergency paediatric first aiders (EPFAs) to provide first aid and medical cover and, if necessary, patient transport services (PTS) at organised events such as music festivals and sporting events amongst others. We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 30 August 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this service was first aid and medical cover for events; however, this is not within our scope of regulation. We inspected this service under our emergency and urgent care framework. The service rarely conveys patients out of an event site. However, as the service has transferred patients from an event site via ambulance to local urgent and emergency centres between August 2016 and August 2017, the service falls into the scope of our regulation.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• There was an up-to-date incident reporting policy and staff knew how to report incidents. There was evidence of actions and learning following events, which were shared with staff consistently.

• Vehicles were clean and up to date with servicing and MOTs. Equipment within the vehicles matched the equipment checklist. There was a range of equipment for all sizes and ages including neonatal equipment and life support equipment for children and adults.

• Medicines, including controlled drugs, were stored securely and in line with service policy. All medicines we checked were in date.

• The service employed a medicines and pharmaceutical adviser who could provide guidance on medicines, for example following any significant changes to legislation, guidance or best practice.

• Records were completed appropriately and stored securely.

• All staff were up-to-date with training for safeguarding children and vulnerable adults and staff knew how to report safeguarding concerns.

• There was an internal mandatory training programme and all staff were up-to-date with mandatory training.

• Driver training was provided in-house, even for those staff who had their driver training records transferred from their NHS employer. It involved a four-day emergency driving course accredited by the Institute of Health Care Development (IHCD).

• Staff always had access to a doctor for further advice regarding management of a patient’s condition.

• Clinical staff were all trained in advanced life support (ALS) or immediate life support (ILS) and assessed on this yearly by a senior clinician.

• Policies and procedures were comprehensive, up-to-date and in line with national guidance. Staff knew how to access policies.

• There was a comprehensive local audit schedule, which took place at each event to monitor performance.

• All staff had an appraisal within the past 12 months and received local induction to the service upon commencing work.

• Staff completed a familiarisation drive upon starting with the service to ensure driving competence. The service had their own driving standards assessment for members of staff who were trained in-house.

• There was additional specialist training to develop staff competencies, for example in suture and wound closure, and fascia iliaca blocks.

• The service had a medical cycle response unit to help staff reach patients in areas that may be inaccessible by a rapid response vehicle (RRV) or ambulance.

• Staff spoke highly of the positive, team-based culture at the service and the support from managers and were proud to work at the service.

• The service had a clear aim, namely to reduce hospital admissions and NHS costs by providing effective patient care on site.

• Clinical governance was embedded into the service, and there was a designated clinical governance group, led by two doctors and the lead nurse.

• There were monthly ‘Capturing Learning in Professional Practice Settings’ (CLiPPS) meetings to discuss incidents, learning and updates to national guidance or policy. These meetings were open to all staff and staff were encouraged to take an active role in these meetings looking at issues of clinical governance.

However, we also found the following issues that the service provider needs to improve:

• Staff were not all familiar with the term duty of candour.

• Within the spill kit on one vehicle there was biocide spray and absorbent granules which had both expired in June 2017. We raised this to a member of staff who immediately replaced these. All other consumables were within date.

• The fridge, used for storing Rocuronium, had not been checked daily as specified by the policy.

Heidi Smoult

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals