Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Minor Injuries Unit on 10, 21 and 30 January 2017 and 14 February 2017.

We rated the service as requiring improvement, and there were breaches of legal requirements. In particular, we found that staff had not received training related to the Mental Capacity Act 2005 and safeguarding children to the expected level. There was insufficient governance and oversight to provide assurance recruitment processes were safe and that action was taken to address areas of known concern.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the above regulation.

This inspection was an unannounced focused inspection, carried out on 20 October 2017, to check whether the provider had taken steps to comply with the above legal requirements, and made other improvements we said they should since our last inspection.

Overall, the service is now rated as good.

The provider, Vocare Limited, provides urgent care for minor injuries and illnesses to residents in the Sunderland area from three centres. This report relates to one of these, Minor Injuries Unit at Washington Primary Care Centre. However, some data in the report relates to the overall performance across the three locations, where data was not available at location level. You can find the reports for the provider’s other locations by searching for Vocare Limited on our website at www.cqc.org.uk, and selecting the ‘all reports’ link for each location.

Our key findings were as follows:

• The service’s internal online training system had been redesigned and the sample of training records we looked at showed all clinical staff had recently carried out safeguarding training.
• The staff responsible for recruitment had been integrated into the human resource support team. This team supported regional and line managers with the administrative tasks associated with recruitment. The sample of recruitment records we looked at showed references had been obtained.
• Staff had completed training on safeguarding children (to the appropriate level) and the Mental Capacity Act. Arrangements were in place to contact GPs to request copies of training certificates where they had completed this externally to the service.
• Staff had received an appraisal within the last twelve months.
• The service had started to address cultural issues within the organisation. They recognised this was an ongoing challenge, and there was still further action needed to address staff morale and to promote a supportive culture.
• We found there were some instances where clinical staffing arrangements were lower than expected. There were short periods of time where, although other members of non-clinical staff were available, the clinical staffing level was at one member of staff.

At our previous inspection in January / February 2017, we said the service should review how they assess the needs of patients who attend in person to make an appointment to make sure risks to patients are assessed and well managed. At this inspection we found the service had not addressed this area. They had made no changes to the way they managed the risks to patients who attend in person to make an appointment.

Vocare Limited had produced a patient leaflet, which set out the types of minor illnesses and injuries patients could seek treatment for at the urgent care centres in Sunderland. This directed patients to inform reception if their symptoms changed or got worse whilst they were waiting for an appointment.

The areas where the provider should make improvements are:

• Review how they assess the needs of patients who attend in person to make an appointment to make sure risks to patients are assessed and well managed.
• Continue to make improvements in the way the service reviews, monitors and deploys the number, and mix of staff needed, to meet patients’ needs to demonstrate a safe environment is maintained for staff and patients.

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 Minor Injuries Unit on 10, 21 and 30 January 2017 and 14 February 2017. Overall, the service is rated as requires improvement.

The provider, Vocare Limited, provides urgent care for minor injuries and illnesses to residents in the Sunderland area from three centres. This report relates to one of these, Minor Injuries Unit at Washington Primary Care Centre. However, some data in the report relates to the overall performance across the three locations, where data was not available at location level. You can find the reports for the provider’s other locations by searching for Vocare Limited on our website at www.cqc.org.uk, and selecting the ‘all reports’ link for each location.

Our key findings 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.
• The most recent results of key performance indicators (October and November 2016) reported to commissioners showed the provider was meeting these requirements.
• Risks to patients were assessed and well managed.
• Patients’ care needs were assessed and delivered in a timely way according to need.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had mostly been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, there were gaps in some areas, such as training on the Mental Capacity Act and children’s safeguarding to the relevant level.
• Arrangements were in place for planning and monitoring the number and mix of staff needed to meet patients’ needs. However, we found there were some instances where clinical staffing arrangements were lower than expected. There were short periods of time where, although other member of non-clinical staff were available, the clinical staffing level was at one member of staff.
• There was a system in place that enabled staff access to patient records, and minor injuries units and out of hours staff provided other services, for example the local GP and hospital, with information following contact with patients as was appropriate.
• The service managed patients’ care and treatment in a timely way.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• There was a clear leadership structure in place, but there were mixed views from staff on the culture across all three minor injuries units. Although some staff reported they felt supported by management; others raised concerns with us about their experience of managers listening to, responding and addressing their concerns.
• The provider was aware of and complied with the requirements of the duty of candour

The areas where the provider must make improvements are:

• Ensure all staff receive training appropriate to their role including children’s safeguarding and in the Mental Capacity Act. Ensure all staff receive appropriate support, including regular supervision and appraisals.
• Ensure oversight and governance arrangements provide assurance that recruitment processes are safe and that action is taken to address areas of known concern, such as addressing gaps in provision of training requirements for staff, in a timely way.

In addition, the provider should:

• Continue to make improvements in the way the service reviews, monitor and deploys the number and mix of staff needed to meet patients’ needs to demonstrate a safe environment is maintained for staff and patients.
• Carry out fire evacuation drills in line with risk management strategies set out in the property fire risk assessments.
• Review how they assess the needs of patients who attend in person to make an appointment to make sure risks to patients are assessed and well managed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice