Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Shropshire Walk In Centre on 29 September 2016 as part of our regulatory functions. The service was rated as requires improvement for providing effective and well led services. The inspection report on the 29 September 2016 can be found by selecting the ‘all reports’ link for Shropshire Walk In Centre on our website at www.cqc.org.uk.

An announced focused inspection was carried out 15 May 2017. We found improvements had been made and the overall rating for the service was good with requires improvement in providing a well led service. The follow up inspection report on the 15 May 2017 can be found by selecting the ‘all reports’ link for Shropshire Walk In Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 January 2018 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 15 May 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

This service is rated as Good overall.

At this inspection we found:

• The Walk In Centre had implemented a system to assess, monitor and improve the quality and safety of the services by ensuring receipt of all appropriate patient safety and medicine alerts to enable appropriate action to be taken.

• There was an effective system in place for the management and security of prescription stationery.

• A system was in place to document learning from events including positive events and these were shared internally and wider for organisational learning.

• There was a strong focus on continuous learning and improvement at all levels.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Shropshire Walk-In Centre on 29 September 2016. Overall, the service was rated as requires improvement but good for providing a safe, responsive and caring service. The full comprehensive report on 29 September 2016 inspection can be found by selecting the ‘all reports’ link for Shropshire Walk-In Centre on our website at www.cqc.org.uk.

We undertook a focussed follow up inspection on 15 May 2017 to check that improvements had been made. The practice is now rated as good overall with requires improvement in providing a well led service.

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.
• 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.
• 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.
• The service managed patients’ care and treatment in a timely way.
• 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 service had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The service had not ensured receipt of all appropriate patient safety and medicine alerts to enable appropriate action to be taken.
• They had not implemented a system, which follows NHS Protect Security of prescription forms guidance.

The areas where the provider must make improvement are:

• Assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity by ensuring receipt of all appropriate patient safety and medicine alerts to enable appropriate action to be taken.

• Ensure a system is in place to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity by ensuring they implement a system that follows NHS Protect security of prescription forms guidance.

The areas where the provider should make improvement are;

• Document learning from events including positive events.

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 Shropshire Walk-In Centre on 29 September 2016. Overall, the service is rated as requires improvement and good for providing a safe, responsive and caring service.

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

• Feedback from patients about their care was consistently positive.
• The service was co-located within the local hospital A&E department with good facilities and was well equipped to treat patients and meet their needs.
• The service reviewed complaints and how they were managed and responded to, and made improvements as a result, however, there was no complaint literature about Shropshire Walk In Centre readily available for patients.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However, we found there were no trend analysis which involved all clinical staff.
• Patients were triaged by A&E qualified nursing staff as a failsafe process to ensure patients attended the most appropriate service to meet their needs. The triage process had changed in July 2016 and it was part of a pilot entitled, ‘Patient Streaming.’ Patients could not simply choose to attend the Walk In Centre.
• Patients were not informed of the waiting times to be seen by a clinician.
• 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.
• Patient outcomes were hard to identify as little or no reference was made in terms of auditing clinical care and treatment.
• There were no provider information leaflets, complaint leaflets, or posters about the pilot streaming protocol or about patient choice, as the local hospital had determined that the provider should not locate these in the shared waiting area within the A&E department.
• Patients spoken with were confused as to what the Urgent Care Centre/Walk-In Centre or minor injuries unit was and of the service they provided.
• The Walk In Centre manager and others within the organisation met regularly with stakeholders, such as the Clinical Commissioning Group and local hospital. They discussed the service provided and attended meetings held with the local hospital and their involvement with the Emergency Care Improvement Programme (ECIP). We found service’s vision and strategy lacked the involvement of some Walk In Centre clinical staff.

• The Walk In Centre did not have a local clinical lead GP and there was a lack of clinical leadership governance arrangements for example, clinical audit.

There were areas of the Walk In Centre where the provider must make improvements:

• Ensure quality improvement activity and monitoring of prescribing which is specific to the Walk In Centre service.

There were areas of the Walk In Centre where the provider should make improvements

• Carry out quality improvement activity to improve patient outcomes and ensure improvements have been achieved which include monitoring of the newly implemented triage system called the ‘Patient streaming protocol.’
• Ensure there is clinical leadership capacity to deliver all improvements.
• Implement formal significant event/complaint trend analysis with Walk In Centre clinical staff.
• Ensure that safeguarding policies fully reflect the procedures staff follow.
• Consider an accident book/documentation for Shropshire Walk-In Centre’s own staff.
• Provide patient literature about the service including, complaint literature and information on the triage system in place.
• Engage and communicate the service’s vision and strategy with staff involvement.
• Consider measures to inform patients of anticipated waiting times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice