Urgent Care Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.
At our last assessment, we rated this key question as good. At this assessment, the rating has changed to Requires Improvement.
 

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
Feedback from people using the service was mixed. People did not always feel involved in any assessment of their needs or feel confident that staff understood their individual and cultural needs.
Access to patients’ health information was somewhat limited. Front door clinicians had access to Yorkshire and Humber’s shared care record through its UTC clinical records’ system, but this was not available by default for all patients. Feedback from staff told us that they did not feel that they had all of the relevant information to make safe clinical judgements, for example, blood results and hospital letters.
The recently implemented triage system of having a clinician situated at the ‘front door’ was a potential effective method of streaming patients to the most appropriate place to receive care. Staff told us that this had implemented with no standard operating practices, no training and minimal communication about how this new system would operate. They told us they felt unsafe.
 

The service mostly planned and delivered people’s care and treatment with them, including what was important and mattered to them. They mostly did this in line with legislation and current evidence-based good practice and standards.
Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance. Clinical Guardian was the service’s clinical audit and quality assurance system, designed to provide structured oversight of clinical decision-making, and treatment provided across all professional groups. It ensured that some clinicians received regular feedback, supported reflective practice, and promoted continuous improvement in patient care. We saw data from the preceding 12 months which categorised clinical cases as ‘not safe’, ‘safe but not best practice’, ‘needing reflection’ and ‘safe’. On average 80-85% of cases reviewed were deemed to be safe by the clinical guardians. The provider was endeavouring to continue a positive trajectory by ensuring all staff were following clinical guidelines and safety netting appropriately. However, we saw some significant events which outlined unsafe practice and posed risks to patients.
Health Care Assistants whose role it was to conduct initial triage, baseline observations, and National Early Warning Scores (NEWS) were not subject to clinical audit. The provider could not be assured that baseline observations were effectively recorded in a timely way by a healthcare assistant, because this process was not audited.
The provider did not have adequate systems in place to assess, monitor or improve the quality and safety of the service. They had not met any of their commissioned performance targets for any month in the previous 12 months. Only 59% of patients had been seen within 30 minutes of arriving at the urgent care centre. Urgent Treatment Centres must evidence that 100% of patients are provided with an initial assessment within 15 minutes as per the national standard.
 

The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.
Staff did not always have access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.
There were evident themes running through the provider’s incidents log which depicted regular disagreement between services as to the suitability of patients referred to different parts of the pathway (e.g. to an Emergency Care Practitioner rather than a GP, to the UTC from UEC, etc). During our site visits we observed tensions between different groups of staff. The provider told us that they were working hard to build better relationships between the teams and that the highly stressful environment of urgent and emergency care was a contributing factor.
 

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.
Safety netting was recorded in records and patients were advised how to escalate their concerns if their condition worsened. The service was involved in a project with the local authority and other partners to promote better self-care at home.
 

The service did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.
Although most clinicians had their individual care records audited by clinical guardians, there was not a service approach to improvement initiatives, undertaken by clinical staff. We did not see evidence of 2-cycle audits, accreditation schemes, research or trials during our assessment. Significant events were not proactively used to improve practice (but they were recorded and investigated by managers).
 

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.
Staff understood and applied legislation relating to consent. Capacity and consent were recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were mostly appropriate and were made in line with relevant legislation. The service had described and recorded a significant event where staff did not have access to up-to-date end-of-life care documentation. They had learned lessons from the incident and reflected that when these documents were not visible across services, it could delay appropriate decision-making, increase the risk of unnecessary hospital admission, and prevent care aligned with the patients’ wishes.