We previously inspected Primary Care Ambulance service in July 2013. At that inspection we raised minor concerns regarding the robustness of recruitment checking practices to ensure that appropriately qualified competent staff were employed. We also had minor concerns regarding the lack of quality monitoring systems in place to ensure the service provided to people was of a good standard.

We went back to the headquarters for Primary Ambulance Care services on the 25 November 2013 and found that appropriate actions had been taken to ensure all recruitment checks were actioned before anybody started work at the service. We found that additional quality monitoring systems had been put in place to monitor the levels of service provided including a patient survey. We saw positive quotes from recent customers in the last three months such as, “outstanding service” “extremely helpful, polite professional staff.” All the completed surveys seen noted that they would recommend the service to family and friends.

We found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. They were provided with appropriate information about Primary Ambulance Services to show that people's privacy, dignity and independence were respected.

We saw that people experienced care and support that met their needs and protected their rights. Systems were in place so people were protected against the identifiable risk of acquiring infections.

Developments were needed regarding recruitment checks to ensure that staff were screened appropriately prior to employment.

We found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

Primary Ambulance Services Ltd is operated by Primary Ambulance Services Ltd. The service provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 29 March 2017, along with an unannounced visit to the provider on 6 April 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.

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 issues that the service provider needs to improve:

• The service did not have any systems or processes in place for the reporting, investigating and sharing of learning around incidents. Incidents were not recognised. Staff had not received training in incident reporting.

• There was no process in place for the deep cleaning of vehicles to prevent the spread of infection.

• There was no system in place to monitor vehicle servicing and maintenance. There was no audit to ensure that vehicle daily checks were being completed accurately. We found faulty equipment in vehicles, which posed a risk to staff and patients.

• We were unable to gain assurances that staff had received the necessary mandatory training to carry out their roles safely and effectively.

• There was no contemporaneous record of decisions taken in relation to the care and treatment provided to patients by the service.

• Processes to assess patient eligibility were lacking. There were no inclusion or exclusion criteria in place.

• There was a lack of oversight of staff compliance with mandatory training. There was no appraisal process to assess staff competencies. There was a lack of regular and documented staff engagement.

• The service had weak governance systems and poor oversight of risk.

  However, we found the following areas of good practice:

• Vehicles contained personal protective equipment for staff.

• All vehicles had an up to date MOT and tax.

• Staffing was sufficient to meet patient need and was planned in advance.

• Patient feedback was consistently positive.

• The service was planned and delivered to meet the individual needs of local people.

• Staff described management as approachable and supportive. They reported feeling valued in their role and felt that the service was a positive place to work.

  Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with section 29 Warning Notice that affected patient transport service. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals