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Care UK – Wycombe Minor Injuries and Illness Unit Good

Inspection Summary


Overall summary & rating

Good

Updated 8 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Care UK – Wycombe Minor Injuries and Illness Unit on 13 December 2016. The overall rating for the service was requires improvement. Specifically the service was rated good for provision of effective, caring and responsive services and requires improvement for provision of safe and well-led services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Care UK – Wycombe Minor Injuries and Illness Unit on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 26 September 2017 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 13 December 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 overall with provision of both safe and well-led services re-rated to good.

Our key findings were as follows:

  • Reception staff had been trained to undertake initial assessment of priority for walk in patients and followed an assessment protocol. Clinical staff were available to support the assessment process when needed. The provider was in the process of recruiting clinical navigators to support initial assessment and the recording of baseline clinical measurements for walk in patients.
  • Information about how to make a complaint was carried in the vehicles used to carry staff to home visits.
  • Prescribing of high risk medicines followed the providers prescribing policy and there were checks in place to ensure this happened.
  • Performance in relation to national quality requirements was improving.
  • Blank prescriptions were held safely and there was a system to track them through to issuing.
  • A system was in place to monitor the training and appraisals of sub-contracted staff. The system also gave the provider assurance that staff maintained their professional registrations and updated their Disclosure and Barring service (DBS) checks. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 November 2017

The service had taken appropriate action and is now rated as good for the provision of safe services.

  • Reception staff had been trained in assessing the priority of walk in patients and support from clinical staff was available when required.
  • Prescriptions were stored securely and monitored to point of issuing.
  • There was a system to ensure all staff working at the centre were appropriately registered and received mandatory training and appraisal.

Effective

Good

Updated 20 April 2017

The provider is rated as good for providing effective services.

  • Data showed the National Quality Requirements (performance standards) for GP out of hours services and Key Performance Indicators for the Minor Injuries and Illness Unit were monitored and reviewed and improvements implemented to ensure patient needs were met in a timely way. For example, data from November 2015 to October 2016 showed that 100% of patients defined as in need of ‘urgent’ face to face assessment had been assessed within 20 minutes.
  • However, the provider was required to further review and improve face to face consultations within two hours after the definitive clinical assessment for those patients classified as ‘urgent’.
  • The minor injuries and illness unit data showed that they were performing above targets. For example 99% of patients classified as routine were seen within four hours.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. There was a consistent focus on ensuring staff had completed mandatory training. There were appraisals and personal development plans for staff.
  • There was an effective system to ensure timely sharing of patient information with the relevant support service identified for the patient and their GP.

Caring

Good

Updated 20 April 2017

The provider is rated as good for providing caring services.

  • Feedback from patients about their care and treatment through our comment cards and collected by the provider was very positive. Patients were positive about their experience and said they found the staff friendly, caring and responded to their needs. Some patients felt that the wait to be seen at the Minor Injuries and Illness Unit was too long, however, there was no evidence that the wait was over the recommended four hours.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Patients were kept informed with regard to their care and treatment throughout their visit to the service.
  • The provider was mindful and respectful of the needs of patients, and their carers, receiving end of life care and, where necessary, provided them with a direct telephone number so that they were able to access clinician’s out-of-hours directly.

Responsive

Good

Updated 20 April 2017

The provider is rated as good for providing responsive services.

  • The service engaged with the NHS England Area Team and local clinical commissioning groups to secure improvements to services where these were identified.
  • The service had systems in place to ensure patients received care and treatment in a timely way and according to the urgency of need. However, the pathways used to assess patients who attended the Minor Injuries and Illness Unit were not always fit for purpose. The reception staff using the pathways had not had clinical training in how to use them and they were not always used appropriately.
  • The service had good facilities and mobile vehicles were well equipped to treat patients and meet their needs.
  • Information about how to complain was available at High Wycombe hospital base and easy to understand. Evidence showed the service responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 8 November 2017

The service had taken appropriate action and is now rated as good for the provision of well-led services.

  • Governance systems were operated consistently.
  • There were appropriate arrangements in place to identify, assess and manage risks.