Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at LCW UCC (St Charles Centre for Health and Wellbeing) on 19 May 2015. This was to follow up an inspection we carried on 12 March 2014 as part of our new inspection programme to test our approach going forward. We found at that inspection that in relation to premises the provider was not fully meeting the essential standards of quality and safety (since superseded by the fundamental standards of care). Our latest inspection was also to rate the quality and safety of the services under our rating scheme introduced in October 2014. Overall the provider is rated as good.

Specifically, we found the provider to be good for providing safe, effective, caring, responsive and well led services.

Our key findings across all the areas we inspected were as follows:

• The provider had addressed shortcomings identified at our previous inspection.
• Patients were protected from risk of harm because systems and processes were in place to keep them safe.
• Staff were clear about reporting incidents, near misses and concerns and there was evidence of communication of lessons learned with staff.
• The provider was proactive in developing links with other local providers to share best practice and improve patient outcomes
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The provider implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.
• The provider had good facilities and was well equipped to treat patients and meet their needs The premises and services had been adapted to meet the needs of people with disabilities.

• There was an effective complaints system, and information about the complaints procedure was made readily available to patients.
• The provider had a clear vision to provide quality patient centred services ensuring care in a timely, consistent, safe and seamless way.
• There was an open culture and staff felt supported in their roles.

The areas where the provider should make improvement are:

• Ensure the programme of training in safeguarding of vulnerable adults is completed for all GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

St Charles Centre for Health & Wellbeing provides telephone advice for home treatment, face-to-face consultations, and home visits to people who need advice or treatment out of normal surgery hours that can’t wait until the next available routine GP appointment. The service provides out-of-hours cover for over 800,000 patients registered with GP surgeries in the London boroughs of Hammersmith & Fulham, Kensington & Chelsea, Westminster, and Brent, and for non-registered or temporary residents from the inner north west London boroughs. The service is provided by London Central West Unscheduled Care Collaborative. The premises are shared with other providers and services.

During our inspection, we spoke with people who used the service and their relatives. They were complimentary about their treatment and care. We also used comment cards to ask people for their views, and this feedback was positive too. We observed people being treated respectfully and given information that was clear and concise.

There was effective clinical and operational leadership of the organisation. The focus was on delivering high quality patient care and improving patients’ experience of out-of-hours services.

To help to improve its service, St Charles Centre for Health & Wellbeing used the learning from incidents, feedback from patient surveys, compliments and complaints, and information from clinical audit. Clinical leaders took responsibility for checking and ensuring that GPs provided effective treatment and care, in line with recognised best practice standards and guidelines. The Centre recruited GPs with suitable qualifications, skills and experience to meet the needs of people using the service, and provided support for GPs’ continuing professional development.

The service was responsive to patients’ needs, performing well against national response time targets. There were provisions to enable the diverse population to access the service.

People were protected from the risks associated with medicines and from unsafe and unsuitable medical equipment. Consulting rooms were clean and infection control policies were in place to protect people from the risk of healthcare acquired infection. However, people were not protected from all risks associated with unsafe or unsuitable premises. Most of the waiting area for patients who came in after 9pm to see a GP was out of sight of the staff on reception duty. This increased the risk of a patient’s deteriorating condition going unnoticed.

We have asked the service to send us a report by 30 June 2014 setting out the action they will take to meet this safety standard. We will check to make sure that this action is taken.

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of the NHS 111 service provided by the London Central & West Unscheduled Care Collaborative Limited on 2 and 3 March 2017 at its NHS 111 single site location at St Charles Hospital, London W10 6DZ. 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.

Our key findings were as follows:

The London Central & West Unscheduled Care Collaborative Limited (LCW UCC) NHS 111 service provided a safe, effective, caring, responsive and well-led service to a diverse population in West and North Central London. Overall the provider was rated as good.

• There was an open and transparent approach to safety and an effective system in place to report and record significant events. Staff knew how to raise concerns, understood the need to report incidents and considered the organisation a supportive culture. All opportunities for learning from internal incidents were discussed to support improvement. Information about safety was valued and used to promote learning and improvement.
• The provider maintained a risk register to identify and take preventative action and promote service resilience, and held regular internal and external governance meetings.
• Staff took action to safeguard patients and were aware of the process to make safeguarding referrals. Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including calls from children and frequent callers to the service.
• The provider had a thorough recruitment and induction process in place for all staff to help ensure their suitability to work in this type of healthcare environment.
• The service was monitored against a National Minimum Data Set (MDS) and Key Performance Indicators (KPIs). These data collection tools provided intelligence to the provider and commissioners about the level of service being provided. Data provided showed the provider was meeting the majority of its targets. Action plans were implemented where variation in performance was identified.
• Staff had been trained and were monitored to ensure they used NHS Pathways safely and effectively (NHS Pathways is a licensed computer-based operating system that provides a suite of clinical assessments for triaging telephone calls from patients based on the symptoms they report when they call).
• Patients using the service were supported effectively during the telephone triage process and consent was sought. We observed staff treated patients with compassion and respect.
• The provider had been part of several collaborative pilots to improve care pathways and enhance access to care and treatment for patients.
• The provider was responsive and acted on patients’ complaints effectively and feedback was welcomed by the provider and used to improve the service.
• There was visible leadership with an emphasis on continuous improvement and development of the service. Staff felt supported by the management team.
• The provider was aware of, and complied with, the Duty of Candour. Staff told us there was a culture of openness and transparency.

There were areas where the provider should make improvements:

• Continue to address the challenges of recruiting substantive staff and the reliance on agency staff to ensure adequate numbers of skilled staff are available to provide a safe and effective service.
• Continue to monitor and manage through action plans National Minimum Data (MDS) and Key Performance Indicator (KPI) targets which fall below national targets.
• Ensure that all staff are aware of and understand the principles and responsibilities of the Duty of Candour.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice