Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northwick Park Urgent Care Centre on 14 September 2016. Overall, the service is rated as Requires Improvement.

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

• Risks to patients who used services were assessed and well managed.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events; however significant events are not formally discussed with all staff.
• There were systems and processes in place to keep patients safe and safeguarded from abuse; however not all staff had undertaken safeguarding training relevant to their role.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment; however, we observed that clinicians did not always maintain patients’ dignity and confidentiality.
• Information about services available for patients was limited and was not easily accessible to service users. The service had no hearing loop to help patients with hearing impairments and translation services were not widely advertised for patients.
• The service understood the needs of the changing local population, increased demand on local health services and had planned services to meet those needs.
• Patients’ care needs were assessed and delivered in a timely way according to need and in line with current evidence based guidance.
• Appraisals for many clinical staff were overdue and not all staff had undertaken basic life support, infection control, fire safety and information governance training relevant to their role.
• The service had an effective streaming pathway in place; children under two years were triaged by a GP within 15 minutes of arrival and urgent patients were usually seen within 15 minutes of arrival by an emergency nurse practitioner. This pathway also ensured that all patients with life threatening conditions received the most appropriate response.
• There was a system in place that enabled staff access to patient records. The information provided to the GPs following contact with patients was appropriate.

• Information about services and how to complain was available. 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 service had a vision and a strategy but not all staff were aware of this and their responsibilities in relation to it. Service specific policies were implemented and were available to all staff; however, we were not assured that all staff were aware of these policies.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure all staff undertake safeguarding, basic life support, infection control, fire safety and information governance training relevant to their role.
• Ensure regular appraisals are undertaken for all members of staff.

In addition, the provider should:

• Review systems in place to ensure there is a clear system in place to monitor the implementation of medicines and safety alerts.
• Ensure service users are always treated with privacy and dignity.
• Consider improving communication with patients who have a hearing impairment and ensure translation services were made available for service users.
• Improve staff knowledge of and involvement in the vision and strategy of the service.
• Consider improving joint working between the management team of the Urgent Care Centre (UCC) and the Emergency Department (ED) and improve communication within the management team.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice