Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the Urgent Care Centre on 28 November and 1 December 2016. The overall rating for the service was requires improvement with good for providing effective, caring and responsive services and requires improvement for safety and being well-led. The full comprehensive report on the previous inspection can be found by selecting the ‘all reports’ link for the Urgent Care Centre on our website at www.cqc.org.uk.

This inspection was carried out on 24 September 2017 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the service is now rated as good.

Our key findings were as follows:

• The provider had reviewed the systems in place to minimise risks to patient safety. In particular, all relevant staff had now completed the chaperone training and a self directed training pack had been developed to support the online learning.  There was a system in place to ensure equipment was maintained to an appropriate standard and in line with manufacturers’ guidance.

• The provider had a process to check agency, bank and sessional staff met recruitment requirements.

• Staff interviewed demonstrated they understood their responsibilities regarding safeguarding, who the leads were and were trained to the relevant level.

• The provider had reviewed the arrangements for managing medicines at the service, including availability of emergency medicines and storage of vaccines to ensure they were stored correctly and available when needed. Blank prescription forms and pads were now securely stored and there were systems in place to monitor their use.

• There were arrangements in place to to keep staff informed and up-to-date.The provider reviewed how updates and alerts were shared with all staff and implemented a web-based risk management database to record all risk management activity, including incidents, complaints and queries.

• There was a clear leadership structure and staff were aware who the  leads were. The service had a number of policies and procedures to govern activity and held regular governance meetings.The service proactively sought feedback from staff and patients, which it acted on.

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 the Urgent Care Centre on 28/11/2016 and 01/12/2016. 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.
• Most risks to patients were assessed and well managed with the exception of those relating to medicines management.
• Patients’ needs were assessed and managed in a timely way.. The service met the National Quality Requirements.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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 to communicate patient information with other relevant services e.g. the patient’s own GP.
• 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.
• 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. The vehicles used for home visits were clean and well equipped.
• 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 areas where the provider must make improvement are:

• Ensure all those who act as chaperones are trained for the role and chaperone information is available to patients.
• Ensure stocks of medicines are regularly checked, appropriately disposed of and prescription pads are tracked through the service.
• Ensure the arrangements for accessing controlled drugs from midnight to 7am are appropriate and staff know how to access these. Ensure the stock lists for controlled drugs are updated so staff know which drugs are kept in each area.
• Review driver checks in place to ensure they are fit for their role.
• Review the process for DBS checks for sessional or agency staff and if the medical performers list is used, take steps to assure that the checks are adequate from other agencies such as NHS England.
• Ensure the system in place to ensure equipment is maintained and calibrated is effective.
• Ensure staff have access to all the policies and procedures as required.

The areas where the provider should make improvement are

• Emergency care practitioners should have Level 3 training in child safeguarding:
• Review local leadership arrangements to engage local staff.
• Review arrangements for briefing agency staff who work regularly at the service so staff are up to date with changes to policies and procedures and are aware of who the service leads are.
• Review how information is cascaded about lead roles e.g. infection control

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice