Background to this inspection
Updated
23 November 2017
Nestor Primecare Services Ltd t/a Primecare - East Kent is the registered location for the out-of-hours (OOH) GP and NHS 111 service provided by Nestor Primecare Services Limited.
Nestor Primecare Services Limited is a commercial enterprise that provides primary healthcare services across the UK. These services include: GP practices, walk-in centres, dentistry, OOH, NHS 111 and healthcare in secure settings. Nestor Primecare Services Limited is part of a larger group, Allied Healthcare. Allied Healthcare is in turn owned by Aurelius UK, a pan-European investment group.
Nestor Primecare Services Ltd t/a Primecare - East Kent provides urgent medical care and advice out-of-hours for patients across East Kent. It provides the NHS 111 service to the same community. It serves four clinical commissioning groups (CCG) namely: NHS Ashford, NHS Canterbury and Coastal, NHS South Kent Coast and NHS Thanet CCGs
There is a single contract to provide OOH and NHS 111 services.
The East Kent call centre and management are based at Canterbury. They provide primary medical services outside of usual working hours (OOH) when GP practices are closed, this includes overnight, bank holidays, weekends and when practices are closed for training. The Canterbury call centre closes at midnight, after this time calls are handled and clinicians dispatched from other call centres, based in Cardiff or Birmingham. They provide NHS 111 services 24 hours a day 365 days a year. The provider covers a population of approximately 700,000 patients.
Most patients access the out-of-hours service via the NHS 111 telephone service. Patients may be seen by a clinician, at a local primary care centre (PCC) often located adjacent to a hospital Accident and Emergency (A&E) facility, or patients may receive a telephone consultation or a home visit depending on their needs. The provider employs various clinicians including GPs, nurses (with various skill levels such as diagnosis or prescribing) and emergency care practitioners. Clinicians are engaged as locum or agency staff, or on a consultancy agreement. They are supported by drivers and receptionists who are employees of the provider. Some patients access the primary care centres by walking in or are referred from the hospital A&E departments or other urgent care centres.
The health of people in Kent is generally better than the England average. Deprivation is lower than average, however about 17.6% (48,300) of children live in poverty. Life expectancy for both men and women is higher than the England average.
The out-of-hours service, for East Kent, is provided from all the sites shown below.
The inspectors visited the following sites:
Nestor Primecare locality office and call centre
Charter House
St Georges Place
Canterbury
Kent
CT1 1UQ
Primary Care Centres
Fracture Clinic
William Harvey Hospital
TN24 0LZ
Fracture Clinic
Margate
QEQM
Ramsgate Road
CT9 4BF
Fracture Clinic
Canterbury
Kent & Canterbury Hospital
Ethelbert Road
CT1 3NG
Dover
Buckland Hospital
Coombe Valley Road
CT17 0HD
Folkestone
Royal Victoria Hospital
CT19 5BN
The inspectors did not visit the following sites:
Herne Bay
Queen Victoria Memorial Hospital
King Edward Avenue
CT6 6EB
Deal
Victoria Hospital
London Road
CT14 9UA
New Romney
New Romney Health Centre
Station Road
TN28 8LQ
Updated
23 November 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Nestor Primecare Services Ltd t/a Primecare - East Kent on 9, 10 and 11 May 2017. Overall the provider was rated as inadequate. The full comprehensive report on the 9, 10 and 11 May 2017 inspection can be found by selecting the ‘all reports’ link for Nestor Primecare Services Ltd t/a Primecare - East Kent on our website at www.cqc.org.uk. As a result of that inspection the service was placed in special measures. Additionally we served Warning Notices under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulations 12, 17 and 18;:
We undertook this announced focused inspection on 27 September, to check that the provider had followed their action plan for the warning notices and to confirm that they now met the legal requirements. The provider was not rated as a consequence of this inspection, as they are in special measures. It will be inspected again, with a view to assessing the practice’s rating when the timescale for being placed into special measures has passed.
Our key findings were as follows:
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The system for reporting significant events had improved. Any staff member could raise a significant event. Investigation of events was more thorough
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There had been some improvement to the management of medicines
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Data showed the provider was not meeting the National Quality Requirements, particularly for face to face consultations.
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Data showed the provider was not meeting the National Minimum Data set requirements, particularly for telephone answering times.
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Compliance with mandatory training had improved
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Complaints were managed to a high standard
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The service had addressed many of the leadership and governance issues, with the introduction of improved systems. But evidence of the effectiveness of the new systems was weak.
There remain areas where the provider must make improvements.
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Ensure care and treatment is provided in a safe way to patients.
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Establish effective systems and processes to help ensure good governance in accordance with the fundamental standards of care.
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Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
Following the inspection we took enforcement action against the provider namely the service of two warning notices:
The provider remains in special measures. Services placed in special measures will be inspected again within six months of the date of the publication of the initial comprehensive inspection. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we may take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice