Archived: Urgent Care Centre North Staffordshire

This service is rated as good overall (previous inspection 04. 2018 – Inadequate).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection on 22 and 23 April 2018. Our overall rating for the service was inadequate and following discussions with North Staffordshire and Stoke Clinical Commissioning Groups, Vocare and The Royal Stoke Hospital, the provision of the streaming service was transferred to hospital staff until the required improvements could be made. We rated the service to be inadequate for providing safe, effective and well-led services; requires improvement for providing responsive services and good for providing caring services. We served warning notices for breaches in relation to Regulation 12: Safe Care and Treatment and Regulation 17: Good Governance. The hospital management team agreed to provide the service on a temporary basis until the provider could re-commence provision of the service. The transfer of the service back to the Urgent Care Centre North Staffordshire was completed on 10 September 2018.

At this inspection we found:

• Systems to safeguard vulnerable patients had been strengthened.
• There was a consistent approach for identifying risks, issues and implementation of mitigating actions.
• Processes to manage risks relating to shared learning from significant events and incidents were being used effectively.
• Emergency equipment and medicines were easily accessible to staff.
• Staff employed had the appropriate skills to treat patients accepted into the service.
• There was suitable pain relief medicine to treat acute pain.
• Clinicians were working to clear exclusion criteria; no inappropriate patients were found to have been accepted into the service.
• Prescriptions were securely stored and an effective system was in place that monitored their use.
• Patients’ care needs were assessed and delivered in a timely way and according to need.
• Systems and processes had been improved to enable the provider to effectively assess, monitor and improve the quality and safety of the services provided.
• The governance arrangements had been strengthened and covered permanent and temporary staff 24 hours a day, seven days a week.

The area where the provider should make improvements are:

• Refresh training for staff on the use of smartcards when using the computer system.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

This service is rated as inadequate overall. The service has not been inspected previously.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection on 22 and 23 April 2018. Our key findings from this inspection were as follows:

• Processes to manage risks relating to shared learning from significant events and incidents were not being used effectively. Staff had stopped reporting on significant events and incidents, or were reporting through the hospital system.
• Emergency equipment and medicines were not always easily accessible to staff.
• Staff employed did not always have the appropriate skills to treat some of the patients accepted into the service.
• There was a lack of suitable analgesia to treat acute pain.
• Patient Group Directions were seen to be contradictory and did not always include the dosage.
• Clinicians were not working to the exclusion criteria, inappropriate patients were being accepted into the service, resulting in delays to patients in need of urgent treatment.
• Prescriptions were securely stored but their use was not monitored effectively.
• Patients’ care needs were not always be assessed and delivered in a timely way and according to need.
• Systems to safeguard vulnerable adults were effective but the numbers referred were very low.
• Systems and processes failed to enable the provider to effectively assess, monitor and improve the quality and safety of the services provided.
• There was an inconsistent approach for identifying risks, issues and implementation of mitigating actions.
• The governance arrangements were not sufficient for permanent and temporary staff recruitment and training.

There were also areas of service where the provider needs to make improvements:

Importantly, the provider must:

• 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 provider should:

• Explore how patient feedback about the service can be improved.
• Develop a clearly defined strategy to deliver the vision for the centre.

For more information on these requirements, please refer to the enforcement action at the end of this report. On the day after the inspection, we took urgent action and the provider implemented an action plan to mitigate the immediate risks to patients.

I am placing this service into 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.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice