Nottingham Urgent Care Centre was previously inspected on 12 May 2016 in response to concerns. We found that the service provided at the centre was not meeting legal requirements and we set two requirement notices in relation to:

• Regulation 17 HSCA (RA) Regulations 2014 good governance, as the provider did not have effective systems in place to monitor and manage risk by having sufficient cover to enable staff to triage and see patients in a timely manner.

• Regulation 18 HSCA (RA) Regulations 2014 Staffing, as the provider did not have effective oversight of staffing requirements in order to deploy sufficient numbers to meet demand and have a systematic approach to determine the correct number of staff and range of skills to meet patients’ needs.

We carried out an announced, comprehensive inspection on 28 November 2016 and we also followed up on the requirement notices, considering whether sufficient improvements had been made. This inspection took place as part of a provider wide inspection of Nottingham CityCare by our Hospitals team.

The provider had addressed the concerns raised at the previous inspection. Overall the provider is rated as good following this inspection.

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

• There was a clear leadership structure and the vision of the service had been established. Staff we spoke to were aware of the vision and told us recent workshops to develop rotas and future strategy had improved the relationship between management and staff and created a more supportive environment in which to work.

• The management team had taken steps to improve communication with staff by holding morning huddles. There was an open and transparent approach to safety and an effective system in place to support the reporting, recording and investigation of incidents.

• The centre had taken steps to ensure there was adequate clinical cover by increasing the number of staff on shift to meet patient demand. This had been achieved through increased use of agency cover in the short term and the recruitment of further clinicians for long term sustainability.

• Following the recent refurbishment and expansion of the centre, consultation and treatment capacity had increased and there were good facilities equipped to treat patients in a clean and safe environment.
• We saw evidence that there had been a steady improvement in the assessment time of patients following the inspection in May 2106. However, the provider had still not been able to meet the targets set by the clinical commissioning group (CCG). At the initial inspection 30% of patients were not assessed within the agreed 30 minutes of arrival, this had reduced to 13% of patients over the previous quarter and plans were in place to improve this further.

We also saw an area of outstanding practice:

• The medical director had developed an application which allowed staff to review an anonymised patient record, reflect on the notes and automatically produced a scoring system to highlight areas of good practice. This provided clinical staff with an effective way to self and peer review their decision making, treatment plans and record keeping.

This application had been introduced over the last six months and had been utilised voluntarily 42 times by staff (by some staff multiple times) and the final scoring could also be used in appraisals, for development and good practice was celebrated.

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 focused inspection on 12 May 2016 following concerns raised anonymously. These concerns focussed on the staffing levels at the centre as well as safety during the building works. We will be undertaking a full comprehensive inspection of this service in due course.

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

• There was a leadership structure and vision which the provider had established however staff told us there was a distance between the management and the clinicians which led to a feeling of isolation and in some cases a perceived lack of support for staff.

• There was an open and transparent approach to safety and effective systems in place to report, record and investigate incidents.

• The building had undergone significant development to enable the delivery of care. We saw evidence that steps had been taken to ensure patient and staff safety, during building work.  Staff told us there were times when the building work intruded on delivering a safe service to patients.

• There was evidence to show delays in initially assessing patients during peak times which could lead to sick patients not being identified and appropriate care implemented. In the previous three months 29.5% of patients waited over 30 minutes for initial assessment. This was an area the provider was looking to improve.

• Staff told us there were often days where staff struggled to meet patient demand. We saw evidence that on weekends the centre had been unable to cover clinical staff who were off sick, leaving remaining staff to cover the shortfall of up to 25 hours in addition to their normal working hours.

• The centre provided a range of care, treatment and diagnostic tests such as x-rays and the treatment of minor burns and head injuries and had adopted safeguards to ensure diagnoses were not missed.

There were areas where the provider must make improvements;

We found that the provider did not have effective systems to enable them to assess monitor and manage risks in relation to;

• ensuring there was sufficient cover to enable patients to be initially assessed in a timely way at peak times

• maintaining effective oversight of staffing levels to ensure these were appropriate and cover in emergencies could be arranged

• ensuring staff were supported to undertake their roles and responsibilities

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we last visited the location on 15 August 2014 we asked the provider to make some improvements. This visit was to check to see if those improvements had been made.

We found the provider had made improvements to the environment and equipment in use. There were also improved systems in place to ensure future monitoring and addressing of any issues of concern as they arose.

We saw the seating in the patient waiting area still required attention. However the provider was aware of this and plans to address this issue were in progress.

There had been a change in manager since our previous inspection and Ms Sarah Kirkwood was no longer working at the location.

We visited the location to carry out a scheduled inspection. However, we also carried out the inspection to check whether the provider had met the compliance action that we set at our previous inspection on 12 February 2013.

We spoke with six patients. They told us that the treatment process was explained to them and they felt able to make decisions about their treatment. They spoke positively about the treatment and advice they had been given. Patients had no concerns about the cleanliness of the environment. They told us that staff appeared well trained and confident when carrying out care. Patients were not aware of the complaints process but told us they would be happy raising concerns with staff.

We found that before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We also found that patients experienced care, treatment and support that met their needs and protected their rights.

We found that patients were not cared for in an environment that minimised the risk of infection. However, we also found that staff were supported to deliver care and treatment safely and that comments and complaints patients made were responded to appropriately.

We spoke with seven patients. They told us they received sufficient information and were provided with good care. They told us they felt safe and they felt that staff had appeared to be competent and well trained.

Patients were not aware of how they could provide feedback about the quality of service they had received. However, patients told us they felt that any comments or complaints would be taken seriously. One patient said, “Based on my experience today, they seem very professional so I’m sure they would deal with any comments properly.”

We found that patients were treated with dignity and respect and received care that met their needs. We found that patients were safe; however, there was not sufficient evidence to demonstrate that all staff received induction, supervision, appraisal and training. We also found that the provider took steps to assess the quality of the service being provided.