Practice Plus Group - NHS 111 South West

Updated 16 March 2022

Practice Plus Group – NHS 111 South West was rebranded on 1 October 2020 from Care UK NHS 111 South West. It is part of Practice Plus Group Urgent Care Limited.

Practice Plus Group - NHS 111 South West operates from Nicholson House, Lime Kiln Close, Bristol BS34 8SR. The service offers a remote clinical advice service.

Practice Plus Group Urgent Care Limited have four call centres registered with CQC across England in Ipswich (East of England), Dorking (Surrey), Southall (London), and the South West call centre in Bristol. Each is registered as a separate location. The provider also covers integrated urgent care services and standalone GP out of hours services in areas of the country.

Practice Plus Group – NHS 111 South West is registered for the regulated activity of transport services, triage and medical advice provided remotely.

The South West registered location provides urgent health advice for Bristol, North Somerset, South Gloucestershire (BNSSG), Gloucestershire and Somerset 24 hours a day, seven days a week. The area covers 2.2 million people, eight acute trusts and 236 GP practices.

Updated 16 March 2022

We carried out an announced comprehensive inspection at Practice Plus Group - NHS 111 South West on 9 and 10 December 2021 and continued remotely until 15 December 2021.

Overall, the practice is rated as Outstanding.

Are services safe? – Outstanding

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Outstanding

Following our previous inspection on 12 and 13 June 2019, the practice was rated Outstanding overall. Safe, effective and well-led key questions were rated Outstanding. Responsive and caring key questions were rated Good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Practice Plus Group - NHS 111 South West on our website at www.cqc.org.uk

This inspection was part triggered as a result of a piece of work Care Quality Commission (CQC) was undertaking around the urgent and emergency care integrated pathway for patients in Gloucestershire.

Practice Plus Group - NHS 111 South West covers a wider geographical area than just Gloucestershire and data in this report focuses on the whole geographical footprint with intelligence extracted for the purpose of input into the Gloucestershire review.

The summary of overarching findings can be found in the subheading below.

We are mindful of the impact of COVID-19 pandemic on our regulatory function. We therefore took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate. This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

At this inspection, we found:

• The service continued to operate comprehensive and well-embedded systems that proactively kept people safe from discrimination and maltreatment when using the service.
• People who used services were at the centre of safeguarding systems and were protected from discrimination. Innovation was actively encouraged which achieved sustained improvements in safety and continual reduction in harm.
• The provider continued with their well embedded, proactive approach to safeguarding processes. This included a 24-hour a day safeguarding hub. Two safeguarding leads were available within the call centre to support the team with coaching. In addition regular newsletters which highlighted important topics were sent to the team. There also was a central ‘Safe Chat’ digital system which allowed staff to raise any safeguarding concerns, questions or suggestions confidentially.
• The service had a proactive safety record. It learned and made improvements immediately when things could have gone better. There were examples where the service had used outcomes of significant incident investigations as a trigger for auditing clinical areas to further improve their processes, including patient safety.
• The provider continued to keep clinicians up to date with current evidence-based best practice. Staff had the necessary skills, knowledge and experience to carry out their roles. Staff worked well together and in collaboration with other organisations to deliver effective care and treatment.
• The service’s audit programme for health and clinical advisors remained comprehensive. The management team were in the process of introducing NHS Pathways Gold Standard auditing, where calls were audited, self-audited and feedback given to the health advisor and clinician immediately ensuring responsive and effective learning.
• We saw examples of where the use of technology had improved patient outcomes, increasing efficiency and reduced the impact on the local healthcare system.
• The provider’s patient surveys for November 2021 were exemplary and showed the majority of patients overall had a good or very good experience when using the service.
• The service saw complaints and concerns as an opportunity to make improvement. Any concerns raised were treated seriously and responded to appropriately to improve the quality of service provided.
• The entire team continued to demonstrate a culture of high-quality sustainable care. The provider ensured there were experienced staff that were clear on their roles and responsibilities. The provider’s governance processes were comprehensive which included proactive risk assessments that enabled them to respond to patient risks quickly. This ensured they received appropriate care and treatment as part of a Real Time team and Clinical Delivery team process. This was where operational and clinical teams reviewed patients risk and the effectiveness and appropriateness of care and performance across the service live 24 hours a day, 7 days a week.
• The service continued to display a culture of learning, continuous improvement and innovation and this included:
  • Trialling the Pathways Clinical Consultation Support Tool (PaCCs). This was a patient assessment and clinical consultation tool designed as an alternative offered nationally to NHS Pathways (a triage software used throughout 111 services). PaCCs gave clinicians who used the software, more autonomy. The trial showed a positive impact of a reduction in referrals to 999 and Emergency Departments. This supported the other areas of the local healthcare economy.
  • Trialling GoodSAM (a video or image sharing technology which is a one-way video call). This allowed clinicians to see the patient and supported them to identify concerns quickly. Clinicians were very positive about the use of this tool, as it allowed them to make a more accurate diagnosis.
• The service had developed its own remote green button accessible to health advisors working remotely from home. It allowed advisors to easily access clinical support where a patient required cardiopulmonary resuscitation (CPR).

The organisation should continue to work closely with all system partners to tackle the capacity pressures on urgent and emergency care in the health and social care system in Gloucestershire

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care