Archived: Primecare - Primary Care - Northampton

Updated 27 July 2017

Nestor Primecare Services Limited is the registered provider for Primecare Primary Care – Northampton (Primecare). Primecare provides community end of life care for patients over 18 years in Northamptonshire. The service is commissioned by Nene and Corby Clinical Commissioning Groups (CCG) to provide dedicated care and support to patients, who are registered with a Northamptonshire GP and are thought to be in the last eight weeks of life and wish to die in their own home or in a care home. The service works alongside existing NHS care providers, the local acute NHS hospitals, district nursing service, GP’s, voluntary patient support organisations and the local NHS ambulance trust and is an integral part of the Northamptonshire multi-agency end of life pathway.

There are two distinct aspects to the service:

• Advanced nurse practitioners, based at the two local acute NHS hospitals, provide discharge planning and support for patients who are nearing the end of life and wish to be cared for at home or in their own care home.
• Advanced nurse practitioners and healthcare assistants also provide a rapid response between 8am and 1am to people who are receiving end of life care in their own home or care home and are experiencing symptoms.

The service registered 1,309 patients between April 2016 and March 2017. The service had supported over 1330 patients to receive their end of life care in their chosen place of care from March 2016 to March 2017. The numbers of people receiving the care from the service changed daily as patients used the service when they required urgent relief of their symptoms. The rapid response community nursing service provided 6,418 visits to patients from March 2016 to March 2017. This was a 15% increase in patient visits from the previous year.

From March 2016 to March 2017, the service consistently met their key performance indicator (KPI) set by the CCG of supporting 700 people per year to die in their own home or care home as preferred place of care. The service was able to demonstrate 961 patients were supported to die in their preferred place of care or death. This was a 5.83% increase from the previous year.

Care Quality Commission (CQC) registered Primecare to carry out the following regulated activities:

• Nursing Care
• Personal care

Primecare has been registered with CQC since 1 October 2010.

The date of last CQC inspection visit was 18 May and 4 June 2015, where the service was found fully compliant in all areas inspected.

The service has a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is managed. The registered manager understood their responsibilities and demonstrated this by managing all aspects of the service to provide high quality care.

Updated 27 July 2017

This announced inspection took place on 18 May and 4 June 2015. Primecare Primary Care - Northampton provide dedicated support to people who are nearing the end of their lives and wish to die in their own home or in a care home.

Primecare Primary Care - Northampton provide dedicated care and support to patients who are registered with a Northamptonshire GP, are thought to be in the last eight weeks of life and wish to die in their own home or in a care home.

The service dovetails with existing NHS care providers; Northampton and Kettering General Hospitals, District Nurses, GP’s, Marie Curie, Hospice At Home, Northamptonshire out of hour’s medical service, Macmillan and East Midlands Ambulance Service and is an integral part of the Northamptonshire End of Life Pathway.

There are three distinct aspects to the service; Advanced Nurse Practitioners based at Northampton and Kettering General Hospitals provide discharge planning and support for patients who are nearing the end of life and wish to be cared for at home or in their own care home. Advanced Nurse Practitioners and healthcare assistants provide a rapid response to people who are in their own home or care home and require support or treatment. People can contact the Primecare Care Coordination Centre 24 hours a day. Between 08:00and 01:00 the call regarding that person is passed immediately by the centre to the Primecare Rapid Response community nursing team. Out of these hours the referral is passed to directly Northampton’s out of hour’s medical service.

At the time of our inspection the service supported more than 90 people, and had supported over 650 to receive their end of life care in their chosen place of care. The numbers of people receiving the care from the service changed daily as people used the service when they required urgent relief of their symptoms.

At the last inspection in July 2013 we asked the provider to make improvements on the assessment of people’s needs to ensure the planning and delivery of care met their individual needs. These improvements had been completed.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager understood their responsibilities and demonstrated this by managing all aspects of the service to provide a high quality service.

People were involved in choosing where they received their end of life care. When people were being discharged from hospital staff listened to what people wanted and arranged care based around their wishes and need; this included arranging equipment and care at home to ensure a persons safety and comfort.

The service was easily accessible everyone who required the end of life care. Staff responded rapidly to requests for support for people receiving end of life care at home or in a care home. People who used the service valued the caring relationship with the staff, who ensured that people received care in a dignified and respectful way. Staff were flexible in the length of time given at each visit to meet the needs of people who used the service and their relatives.

The service worked in partnership with the local end of life providers. Staff kept health professionals informed about the care that people had received to ensure that people received continuity of care.

People were protected from avoidable harm and abuse as staff understood how to recognise and report any concerns. Staff understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There were sufficient numbers of skilled and experienced staff to meet people’s needs. All of the staff had undergone rigorous recruitment processes to ensure they had the required skills and experience to provide care to people at end of their lives. The Advanced Nurse Practitioners who prescribed medicines were qualified to practice as a Non-Medical Prescribers and attended regular professional development updates.

All staff received mandatory training, role specific training and regular updates. Staff received regular supervision and feedback on how well they were doing and how to improve their practice. Complaints were dealt with promptly and changes had been made to improve the service. Quality monitoring and people’s feedback was used to monitor and improve the service.

Updated 27 July 2017

• There were effective systems in place to keep patients safe. Staffing levels were maintained in line with national guidance to ensure patient safety. Nursing staff levels met the needs of patients. Effective processes were in place for the provision of medicines.

• There was evidence of strong national and local leadership, with accessible and responsive managers. All staff and patients were positive about the service.

• We observed a strong, person-centred culture. Staff treated patients with compassion, kindness, dignity, and respect. Staff were committed to providing compassionate care not only to patients but also to their families.