We visited the call centre during the day and into the evening. We spoke with the management team and with staff. We listened to some telephone calls and looked at clinical records. We spoke the following day to people who had used the out of hours service or their relatives. People were all very positive about the service they had received. One person told us they were “delighted with the service.” Another person told us “the doctor was absolutely amazing”.

People told us they were treated with respect and we observed this to be the case. People were spoken to politely and with empathy and patience. People told us their needs were met promptly. One relative told us how delighted they were that their child was seen by a doctor only one hour after contacting NHS 111.

Staff understood their responsibility to safeguard vulnerable adults and children and they knew how to report concerns, both internally and to external agencies.

Staffing levels were constantly monitored to ensure that the service could respond to expected and unexpected levels of demand on the service. There were robust contingency plans for periods of high demand, such as holiday periods, or other situations where risks, such as adverse weather or a health pandemic, threatened service provision.

There were effective systems in place to monitor quality and safety and a culture in which complaints and incidents were welcomed as opportunities to make improvements.

This service is rated as Outstanding overall. (Previous inspection February 2017 – Outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Medvivo on 22-24 January as part of our inspection programme.

At this inspection we found:

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, there was a focus on openness, transparency and the service learned from them and improved their processes.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. Evidence base guideline updates were regularly cascaded to staff. However we found in the sample of medical records reviewed that documentation was not always in line current best practice and guidance. Staff involved and treated people with compassion, kindness, dignity and respect. Patients were valued as individuals and were empowered to have a voice in their own care.
• Patients could access care and treatment from the service within an appropriate timescale for their needs. Care was person centred and services were tailored and delivered to meet the needs of an individual in a way that ensured flexibility and choice.
• There was a strong focus on continuous learning and improvement at all levels of the organisation and the culture ensured all staff were engaged to deliver high quality person centred care.

We saw several areas of outstanding practice:

• The provider worked collaboratively with external stakeholders on a range of initiatives to improve access to care and patient experience for those who were vulnerable, had a disability or were from a minority group. An example of this was use of the Streetlink homelessness App and delivering care for refugees being repatriated to the UK.
• There were innovative approaches to providing integrated patient-centred care. For example, the provider delivered an Urgent Care @Home service. The service ensured an integrated rapid health and social care response for service users in a health or social care crisis in their own home to avoid inappropriate admissions and expedite hospital discharges. This had not only improved patient outcomes but it has also supported the whole system in terms of increased capacity and financial savings.
• There was a strong emphasis on staff wellbeing. The interventions initiated by the provider had led to a decrease in turnover of over 6% in the last 12 months. Examples of initiatives taken were a Health and Wellbeing Charter developed with staff, the introduction of Mental Health First Aiders, resilience workshops and self-awareness campaigns.

The area where the provider should make improvements:

• Improve and monitor documentation of consultations, to ensure they are consistently in line with best practice and current guidance.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care