The Care Quality Commission
  • Doctor
  • Urgent care service or mobile doctor

King George's EUCC

Overall: Requires improvement read more about inspection ratings

Barley Lane, Goodmayes, Ilford, Essex, IG3 8YB (020) 8970 8426

Provided and run by:
Partnership of East London Co-operatives (PELC) Limited

All Inspections

6, 7, 20 and 22 June 2023

During a routine inspection

This service is rated as requires improvement overall.

The service had previously been inspected on 20 and 21 October, and 7 November 2022. In this inspection the service was rated as inadequate, and found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008. The service was rated inadequate, conditions were issued and the service was placed into special measures.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for King George’s EUCC on our website at www.cqc.org.uk

We carried out an announced comprehensive inspection of King George’s EUCC on 6, 7, 20 and 22 June 2023. We found that some of the breaches of regulation from the previous inspection had been fully addressed, but for others whilst progress had been made there was more to do. Following this inspection, the key questions are rated as:

Are services safe? – Requires improvement.

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

At this inspection we found:

  • The rating of the service had improved from inadequate to requires improvement. Significant work had taken place to address the breaches identified at the previous inspections, however in a few areas whilst there was progress there was still more improvements needed.
  • The service had begun to monitor more effectively the safety of the care it provided, and its performance was improving, but was still not meeting requirements specified by NHS England. Systems were now in place to monitor the time taken for patients to have their initial clinical assessment. However only 67% of patients were having this assessment within the 15-minute target. This meant there was an ongoing risk of patients needing urgent medical attention not being identified in a timely manner. An action plan was in place to continue to make improvements in meeting this target.
  • Patients were not consistently able to access care and treatment at the service in a timely way. The service had a target to provide treatment and discharge the patient within 4 hours. The service was meant to achieve this for 95% of patients but the average was 75-85% so below the target.
  • Staffing at the service was not in line with the rotas that workforce planning exercises had deemed necessary. The rotas showed that there was a gap of at least 15% for the urgent care practitioners during the day each month, and in some cases no cover at all overnight. This meant there were times when there were not enough staff working, and there were 277 instances in the last six months where patients had to be referred to another urgent treatment centre due to a lack of suitably qualified staff.
  • The service was not consistently monitoring the effectiveness of the work of individual clinicians. Not all the clinicians were receiving consistent regular and high-quality clinical supervision. In addition, the audits of clinicians notes were not taking place as robustly as needed to ensure all clinicians were delivering appropriate clinical care.
  • The service did not yet have formal mechanisms to engage with patient groups.
  • Whilst governance processes had improved, there was still scope for these to be further strengthened, particularly in terms of ensuring staff performance was adequately monitored.

However, the following areas had been addressed:

  • The service had improved the management of incidents and complaints, and mechanisms were in place to share learning.
  • Leaders now had the capacity and skills to deliver high-quality, sustainable care.
  • The service had developed a clear vision and credible strategy to deliver high quality care.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

The areas where the provider should make improvements are:

  • Review the detail required in the review of clinical competencies.
  • Review storage of medicines at the service.

I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

20 and 21 October, and 7 and 9 November 2022

During a routine inspection

This practice is rated as Inadequate overall. The service had previously been inspected on 30 March 2017 at which point the service was rated as good overall, and in all five key questions.

We carried out an announced comprehensive inspection of King George’s EUCC on 20 and 21 October, and 7 and 9 November 2022.

This inspection was part of a follow up on our previous system wide review of urgent and emergency care services across the North East London (NEL) integrated care system that was carried out in November 2021. At that time, we identified issues with flow in and through the urgent and emergency (UEC) pathway and had significant concerns regarding the impact of this on safety and quality of care. Due to ongoing concerns regarding the UEC pathway and patient safety, during November 2022 we inspected all four urgent treatment centres (UTC) provided by the Partnership of East London Cooperatives (PELC), and both emergency departments (ED) and medical care provided by Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT). Subsequent to significant concerns that were identified at these locations, the Commission found that the challenges these services faced were also complicated by wider challenges within the health and social care system. A Quality Summit with NHS England and system wide partners was convened to devise an action plan to address the concerns identified.

Following this inspection, the key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Inadequate

Are services well-led? – Inadequate

At this inspection we found:

  • The service could not be assured that it was providing safe care to patients attending the service, particularly those with potentially serious conditions.
  • There were insufficient procedures and processes in place to ensure learning from incidents and complaints. There were not clear systems in place to demonstrate improvements when things went wrong.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, the service was not meeting the targets specified by its commissioners.
  • The organisation did not have sufficient procedures in place to ensure that effective staffing was being provided.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Patients were not able to access care and treatment at the service in a timely way.
  • Leaders did not have the capacity and skills to deliver high-quality, sustainable care.
  • There were some clear responsibilities, roles and systems of accountability to support good governance and management. However, line of accountability and designated decision-making authority were unclear.
  • The service did not have a clear vision and credible strategy to deliver high quality care and promote good outcomes for patients.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of safe care and treatment.
  • Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good governance.
  • Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good staffing.

The areas where the provider should make improvements are:

  • Review compliance with infection protection and control guidance at the site.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

14 March 2019

During a routine inspection

This service is rated as Good overall (Previous inspection April 2018 – Inadequate).

We carried out an announced comprehensive, follow up inspection at King George’s Emergency Urgent Care Centre (EUCC) on 14 March 2019.

CQC previously inspected the service on 5 April 2018 and asked the provider to make improvements because although the care being provided was responsive, it was not being provided in accordance with the relevant regulations relating to safe, effective, caring and well led care. Specifically, we found the provider had breached Regulation 12 (1) (Safe care and treatment) and Regulation 17 (1) (Good governance) of the Health and Social Care Act 2008. This was because of an absence of appropriate clinical equipment and systems to safely assess and monitor patients. We also noted a lack of appropriate systems for sharing learning from safety incidents and for ensuring governance arrangements operated effectively.

Two Warning Notices were served and the service was placed into Special Measures. Shortly thereafter the service wrote to us to tell us what they would do to make improvements. We undertook this comprehensive inspection to check the service had followed their plan and to confirm they had met the legal requirements.

At this inspection, the key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? – Good

At this inspection we found:

•Action had been taken since our last inspection such that leadership and governance arrangements now supported the delivery of high-quality and person-centred care.

•Action had been taken since our last inspection to ensure that when safety incidents happened, learning was shared internally with relevant people. For example, a monthly Governance Committee had been established to learn from safety incidents and improve safety; and a staff bulletin established to share this learning.

•Action had been taken since our last inspection to improve how the service assessed and monitored patients. This included availability of appropriate clinical equipment and introduction of new protocols and training to support how clinicians ‘streamed’ or assessed patients. However, we noted the new protocols did not record how long patients waited in the queue or include formal arrangements for prioritising patients who were frail or acutely ill.

•Action had been taken since our last inspection to improve the service’s physical layout and make it more conducive to maintaining patients’ privacy, although we noted conversations in the service’s new initial assessment room could be overheard. We saw that staff involved and treated people with compassion, kindness, dignity and respect.

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

The areas where the provider should make improvements are:

•Continue to liaise with it’s NHS Trust Landlord to further improve how the physical layout ensures patients’ privacy.

  • Continue to further develop queue management arrangements, so as to more precisely measure how long patients wait in the queue.

•Take action to ensure electronic patient feedback terminals are available in languages other than English.

•Take action to ensure appropriate filing systems are in place for staff pre-employment checks and training records.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

5 April 2018

During a routine inspection

This service is rated as Inadequate overall (Previous inspection 30 March 2017– Requires Improvement).

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at King George’s Emergency Urgent Care Centre (EUCC) on 5 April 2018. The service is co-located with the Emergency Department of King George’s Hospital and is open 24/7. Patients are initially assessed by a nurse and then “streamed” or directed for treatment by the most appropriate clinician: for example at the hospital’s Emergency Department or at the EUCC.

This inspection was to confirm that the provider had carried out their plan to meet the legal requirements in relation to breaches in regulations that we identified in our previous inspection on 30 March 2017. At that time the service was rated as requires improvement for effective, caring and well led services; and rated overall as requires improvement. This report covers our findings in relation to those requirements and also in relation to additional findings made since our last inspection.

At this inspection we found:

  • The provider’s clinical streaming process did not safely assess, monitor or manage risks to patients.

  • Although we saw evidence that the provider learned from safety incidents and improved its processes, we could not be assured that learning included all relevant people.

  • The delivery of high quality care was not assured by the governance arrangements in place. For example, nursing staff induction documents were not readily available and medicines audits lacked a clear process for managing clinicians who persistently breached local prescribing expectations.
  • We also noted that clinical meetings were informal and infrequent.

  • Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

  • Action had been taken since our last inspection such that clinical audit was now being used to drive quality improvements.

  • Staff treated patients with compassion, kindness, dignity and respect. However, there was no system to seek patient’s feedback. Three of the eight CQC comment cards completed by patients in the weeks leading up to the inspection indicated patients did not always feel they were treated with respect upon arrival at the centre.

  • Records confirmed that the provider’s NHS Trust landlord was shortly due to commence reception area building improvement works in response to privacy and confidentiality concerns highlighted at our last inspection. Shortly after our inspection we were sent evidence confirming that the works had commenced.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Review its medicines management protocols relating to checking expiry dates, prompt access to emergency medicines and also relating to clinicians who breach local prescribing expectations.
  • Review the training needs of non clinical staff in response to patient feedback.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

30 March 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at King George’s emergency urgent care centre (EUCC) on 30 March 2017. The service is operated by the Partnership Of East London Cooperative Ltd (PELC) and based at King George’s Hospital in Goodmayes, Essex.

Patients are assessed upon arrival by a “streaming nurse” who determines the urgency of the presentation and the service best placed to provide care and treatment. Overall, the service is rated as requires improvement.

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

  • We looked at the personnel records of five clinical streaming staff but could not find confirmation that staff had completed the provider’s prerequisite streaming training. We also noted other gaps in training and that some staff had not had annual appraisals.

  • The premises were accessible but due to a lack of space, when patients arrived at reception, privacy and confidentiality were not maintained. The premises were also inappropriate for streaming in that they lacked sufficient space to enable initial patient assessments to be conducted in private.
  • Governance arrangements did not always work effectively in that infection risks to patients were not well managed and we saw limited evidence that clinical and internal audit was being used to drive quality improvements.

  • There was an open and transparent approach to safety and an effective system in place for recording, and learning from significant events.

  • Data indicated that patients’ care needs were assessed and delivered in a timely way according to need. The service met most targets which were specific to the urgent care centre.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

  • Staff demonstrated that they understood their responsibilities and had received training on safeguarding children and vulnerable adults 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.
  • We saw that reception staff were kind and compassionate.
  • 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 provider was aware of and complied with the requirements of the duty of candour.
  • We noted that the provider had recently come through a period of organisational change; resulting in the Medical Director currently also serving as interim Chief Executive. Staff spoke positively about how the interim Chief Executive provided visible leadership and promoted a culture of collective responsibility.

The areas where the provider must make improvement are:

  • Ensure that there are appropriate arrangements in place to assess, monitor and improve the quality and safety of the services provided (including two cycle audits and internal audits), so as to drive improvements in patient outcomes.

  • Introduce reliable systems to ensure that staff are appropriately trained in line with its protocols and ensure that all staff receive an annual appraisal.

  • Develop effective systems and processes to ensure that the dignity and respect of patients is maintained, by ensuring that all stages of the consultation process take place in a confidential setting.

The area where the provider should make an improvement is:

  • Consider undertaking refresher infection prevention and control refresher staff training.

  • Introduce reliable systems to ensure that staff are appropriately trained in line with its protocols and ensure that all staff receive an annual appraisal.

  • Review the layout of its reception and waiting areas, to see where improvements can be made to arrangements for maintaining patients’ privacy, confidentiality and dignity.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice