Trust Headquarters Also known as NHS 111 Service

Updated 22 July 2022

The provider, North West Ambulance Service (NWAS) NHS Trust, serves more than 7.5 million people across the communities of Cumbria, Lancashire, Greater Manchester, Merseyside and Cheshire.

The service covers 23 local authority areas and the following integrated care systems (ICS):

• Cheshire and Merseyside
• Greater Manchester Health
• Lancashire and South Cumbria
• North Cumbria as part of the North Cumbria and North East ICS
• Glossop as part of the Derbyshire ICS

The NHS 111 service is based at two call centres in Bolton and Liverpool and some clinicians work from home.

The NHS 111 service responded to 1.96 million telephone calls and online contacts in 2021.

The provider’s vision is to be the best ambulance service in the UK, providing the right care, at the right time, in the right place; every time for patients accessing its urgent and emergency (999) care service, non-emergency patient transport service and NHS 111 service. The NHS 111 service is available 24 hours 7 days a week.

NWAS sub-contracts approximately 15% of calls to NHS 111 to Fylde Coast Medical Services (FCMS) out-of-hours service. The subcontractor provides a NHS 111 service on specific days and at specific times as agreed with NWAS. The leadership, management and responsibility for the contract to provide NHS 111 in the North West lies with NWAS who has developed a partnership approach to delivering NHS 111 services in the North West.

The service employs call handlers (health advisors and service advisors), clinicians and various other leadership and managerial roles.

NWAS NHS 111 was last inspected in May 2016 and rated good overall and for all key questions.

Updated 22 July 2022

Letter from the Chief Inspector of General Practice

We inspected the NHS 111 service which is provided by North West Ambulance Service NHS Trust (NWAS) on 23, 24, 25 and 26 May 2016. This inspection was undertaken as part of a joint inspection of the whole Trust with the CQC hospital team.

NWAS is the contract holder for the NHS 111 service in the North West and sub-contracts approximately a 20% share of the service to two GP Out-of-Hours (OOHs) providers, Fylde Coast Medical Services (FCMS) and Urgent Care 24 (UC24). Both FCMS and UC24 are registered with the CQC as GP OOHs providers. Blackpool Clinical Commissioning Group (CCG) is the lead commissioner for the NHS 111 service in the North West and holds the contract for the full service with NWAS.

We carried out this announced inspection of NWAS NHS 111 as part of our comprehensive approach to inspecting NHS 111 services. We did not undertake inspections of FCMS and UC24 NHS 111. However as part of the NWAS NHS 111 inspection we visited the two subcontractors call centres in the evening at peak activity times.

Overall NWAS NHS 111 is rated as good.

Our key findings were as follows:

• NWAS worked closely with the lead CCG who commissioned the NWAS NHS 111 service on behalf of all 33 CCGs in the North West.
• NWAS NHS 111 provided a safe, effective, caring, responsive and well-led service to a diverse population spread across the whole of the North West of England.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• All opportunities for learning from internal and external incidents were discussed to support improvement. Information about safety was valued and used to promote learning and improvement.
• Risk management was embedded and recognised as the responsibility of all staff.
• Staff took action to safeguard patients and they were aware of the process to make safeguarding referrals. Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including calls from children and frequent callers to the service.
• Staff had been trained to ensure they used the NHS Pathways system safely and effectively. (NHS Pathways is a Department of Health approved computer based operating system that provides a suite of clinical assessments for triaging telephone calls from patients based on the symptoms they report when they call). Once trained there were comprehensive systems in place to monitor staff usage of NHS Pathways including call auditing. An effective action plan was in place to ensure all call audits were undertaken in accordance with NHS Pathways licence.
• The service was monitored against National Minimum Data Set (MDS) and Key Performance Indicators (KPIs). Due to significant staff attrition in late December 2015 NWAS NHS111 struggled to meet the service KPIs. Effective action was implemented to improve their performance in achieving the key performance indicators and this included the recruitment and training of staff. The service met regularly with the commissioner of the service who was kept up to date about performance.
• Patients using the service were supported effectively during the telephone triage process. Consent to triage was sought and their decisions were respected. We saw that staff treated patients with compassion, and responded appropriately to their feedback.
• The service responded effectively to complaints and to patient and staff feedback.
• The leadership within the NHS 111 service was accessible and visible. There was a culture of support, continuous improvement and development of the service.
• All staff spoken with at all four call centre locations were enthusiastic and committed to providing a safe quality service. Staff said they felt supported directly with on the job supervision and support and indirectly with access to online training and guidance.

The areas where NWAS NHS 111 should make improvement are:

• Continue with the implementation of the staff recruitment and training plan to ensure the service is staffed to full capacity.
• Continue with the implementation of the call auditing improvement plan.
• Continue to implement the planned programme to complete staff annual appraisal.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice