Letter from the Chief Inspector of General Practice

We carried out this announced comprehensive inspection of Hanover House NHS 111 on 27 and 28 July 2017. Hanover House NHS 111 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. For example, this could be to their GP, an out-of-hours GP service, walk-in centre or urgent care centre, community nurse, emergency dentist, emergency department, late opening pharmacy, or self-care home management advice.

Overall the service is rated as good. However, we found the service requires improvement for providing effective services.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, learning from these issues was not shared with all staff.
• The service had reliable systems and processes in place to ensure that patients were safe.
• Staff reported that the London office in particular was understaffed and that at busy times overall capacity was stretched. At the time of the inspection the provider was recruiting to address this.
• Staff were supported in the effective use of NHS Pathways which is a triage software utilised by the National Health Service to triage public telephone calls for medical care and emergency medical services.
• The service had not met all the National Quality Reporting standards and those requirements set by the commissioners of the service. For example, the service had not met the standard for calls answered inside 60 seconds in any of the six months prior to the inspection.
• Calls were audited to ensure that a high quality of service was being provided.
• We observed and listened to calls which demonstrated that people experienced a service that was delivered by dedicated, knowledgeable and caring staff.
• The service had a clear system for managing and learning from complaints, although learning from this was not widely shared among all staff.
• The service had an overarching governance framework in place, including policies and protocols which had been developed at a provider level and had been adapted to meet the needs of the service locally.
• The provider had a good understanding of the performance of the service. The service was not meeting one target set by National Quality Requirements action plan was in place to address this.
• The service had also built relationships with local patient participation forums at a regional level in order that patients could feed into the service being provided.
• The provider was aware of the requirements of the Duty of Candour. The provider encouraged a culture of openness and honesty. Systems were in place for notifiable safety incidents however the arrangements to ensure this information was shared with staff to ensure appropriate action was taken were inconsistent.

Importantly, the provider must:

• Develop effective systems and processes to ensure that staffing levels are sufficient to ensure safe care and treatment

In addition the provider should

• Ensure learning from significant events and complaints is being shared with all relevant staff.
• Ensure that the service meets national targets.
• Ensure that all responses to complainants are managed within the services specified 30 day deadline.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

This service is rated as requires improvement overall. The service was previously inspected on 27 July 2017. At that inspection the rating for the practice was good overall. This rating applied to the safe, caring, responsive and well led domains. Effective was rated as requires improvement.

The report stated where the service must make improvements:

• Develop effective systems and processes to ensure that staffing levels are sufficient to ensure safe care and treatment.

In addition, the provider should:

• Develop effective systems and processes to ensure safe care and treatment including learning from significant events and complaints is being shared with all relevant staff.
• Develop effective systems and processes to ensure good governance including ensuring that the service meets national targets.
• Ensure that all responses to complainants are managed within the services specified 30 day deadline.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Hanover House on 5 and 6 July 2018. As part of the visit we also visited the sites at Vocare House and Crutes House.

At this inspection we found:

• The service had good systems to manage risk so that safety incidents were less likely to happen. Learning from incidents was shared at two of the sites from which the service was run, but not the third.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided.
• Staff were supported in the effective use of NHS Pathways which is a triage software utilised by the National Health Service to triage public telephone calls for medical care and emergency medical services.
• The service had not met all the National Quality Reporting standards and those requirements set by the commissioners of the service. For example, the service had not met the standard for calls answered inside 60 seconds in any of the six months prior to the inspection.
• Audits were in place to monitor the performance of staff at the service, but some staff had not been audited.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• The service had a clear system for managing and learning from complaints. However, the service was not following its own policies regarding the timescales in which complaints were managed, and learning from this was not widely shared among all staff and other relevant organisations.
• The service had an overarching governance framework in place, including policies and protocols which had been developed at a provider level and had been adapted to meet the needs of the service locally.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The service had built relationships with local patient participation forums at a regional level in order that patients could feed into the service being provided.

The areas where the provider must make improvements as they are in breach of regulations are:

• Develop systems to ensure that the service can deliver local and national performance targets, including ensuring that sufficient clinical call handlers are available.
• Ensure that learning from incidents, safeguarding alerts and complaints is shared with all staff at the Hanover House site.
• Ensure that complaints are followed up in time and that actions are taken even where complainants are unavailable for follow up. To also ensure that complaints, and learning from them are shared with other healthcare providers where it is relevant to do so.
• Ensure that references are taken for all staff, including those working through employment agencies.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice