This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out this announced comprehensive inspection on 27 November 2018. We had previously carried out an announced comprehensive inspection on 26 September 2017. At that time the service was rated as requires improvement. It was rated as requires improvement for the safe, effective and well led domains and good for caring and responsive.

The areas where we said that the provider must make improvement were:

• Develop effective systems and processes to ensure safe care and treatment including, the storage and dispensing of medicines and ensuring that non-calibrated equipment is not stored where it might be used. The service should ensure that targets relating to the time taken to stream patients are met.
• Develop effective systems and processes to ensure good governance including ensuring streaming services are clear and understood by all staff. They should also ensure patient group directives are in place for nursing staff. The service should review that performance data meets national guidelines.

Since the last inspection the service no longer provided urgent care services, and was out of hours only.

At this inspection we found:

• The service had good systems to manage risk so that safety incidents were less likely to happen. The provider had taken steps to assure itself that incidents were not missed.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided.
• The service was below target levels for National Quality Reporting (NQR) standards in some areas, but not by a significant margin, and performance was improving since the last inspection.
• Audits were in place to monitor the performance of staff at the service.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• The service had a clear system for managing and learning from complaints.
• The service had an overarching governance framework in place, including policies and protocols which had been developed in conjunction with its partner organisations.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The service proactively sought feedback from patients to evaluate the quality of the service being provided.

The areas where the provider should make improvements are:

• Review which audits are undertaken to ensure that high risk, high cost and high dependency medicines are used in line with guidelines.
• Continue to review NQR standards to ensure that they are met.Inform all doctors that they should use only equipment provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Croydon Urgent Care Centre on 26 October 2017. Overall the service is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.
• Medicines management at the service met guidelines in some areas but not in the storage of vaccines, patient group directives (PGDs) and the management of out of hours prescriptions.
• The service had good facilities and was well equipped to treat patients and meet their needs. However, a defibrillator that was not suitable for use was kept in a room with emergency drugs.
• Some policies and procedures were in place at the service, but others, for example the streaming service, were unclear and staff were not aware of how the system worked.
• There was a clear leadership structure and some staff felt supported by management, although some staff commented that staffing was insufficient to meet the demands of the workload.
• The service met some of the National Quality Requirements and other targets specific to the urgent care centre, but in several areas the service had yet to meet targets.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• There was a system in place that enabled staff access to patient records, and the out of hours staff provided other services, for example the local GP and hospital, with information following contact with patients as was appropriate.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment, although some patients commented that waiting times could be long.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience.
• The vehicles used for home visits were clean and well equipped.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Develop effective systems and processes to ensure safe care and treatment including, the storage and dispensing of medicines, patient group directives and ensuring that non-calibrated equipment is not stored where it might be used. The service should ensure that targets relating to the time taken to stream patients are met.

• Develop effective systems and processes to ensure good governance including ensuring streaming services are clear and understood by all staff. They should also ensure patient group directives are in place for nursing staff. The service should review that performance data meets national guidelines.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice