Urgent Care Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination.
At our last assessment, we rated this key question as good. At this assessment, the rating has changed to Requires Improvement.
 

This service scored 57 (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 tried to make sure people were at the centre of their care and treatment choices and how to respond to any relevant changes in people’s needs.
We saw that as the number of patients had increased at the UTC, there was also an upward trend in significant events or incidents, and an upward trend in breach times for call handling and triage. Staff told us that key performance indicator breaches were a regular occurrence, and reporting data supported this too.
Some patients commented via Friends and Family data that they felt listened to and that staff were professional, understanding and excellent in their roles. Some patients commented that clinicians were not good at explaining things, they were sometimes condescending, that communication about information relating to their presenting condition was lacking.
We saw that changes had been implemented as a result of incidents. For example, a process for immune-suppressed patients was introduced as a gap in person-centred care had been identified.
 

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.
There was a dedicated safeguarding inbox that all staff could use to ensure they had escalated social care concerns in addition to meeting the health needs of patients in the UTC. There was evidence of communication and information sharing with GPs, NHS111 and the ambulance service.
 

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.
Information was not available in a range of languages. The practice had access to interpreter services, including British Sign Language via a digital application. Information provided by the service did not meet the Accessible Information Standard. Patients were not informed as to how to access their care records.
 

The service encouraged people to share feedback and ideas, or raise complaints about their care, treatment and support through the NHS Friends and Family test. They investigated complaints and told the complainant what had changed as a result.
We saw complaints were managed in line with the practice’s policy. Staff received individual direct feedback regarding compliments and complaints. However, wider learning was limited, and not all staff were able to identify changes made as a result of patient feedback, including complaints. The provider was involved in patient safety investigation following serious incidents and they told us they tried to disseminate this learning across staff, the service and the wider system. There was a lack of systems of assurance that the information was read, understood, and changes made at staff level, as a result of this dissemination.
 

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.
Treatment rooms were available on the ground floor, and a ramp and automatic door had been fitted to the entrance. The distance from the ‘front door’ to the UTC was long, which could potentially adversely impact those with pain, injury, mobility problems or acute illness.
Patients arriving in the UTC with a pre-booked appointment tended to be seen ahead of those who had used a ‘walk-in’ approach. This did not necessarily take account of acuity or urgency; however, all patients were awarded a disposition at check-in (which indicated the seriousness of their presenting condition). Patients arriving at busy times were not able to be seated in the waiting room and had to wait in corridors where signs of deterioration could not safely be observed. If very long waiting times occurred or were predicted, staff told us that rota lines were increased to deal with the additional workload. However, this did not mitigate the burden on the physical environment. We observed patients becoming frustrated and leaving the department without being seen, on several occasions during our assessment. These patients were added to the ‘failed consultation list’ for a call back, but the list was long, and it took significant manpower to administer this leading to delays in contacting these patients.
 

Staff and leaders listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.
Feedback provided by people using the service, both to the provider as well as to CQC, was mixed. Staff treated people equally and without discrimination. Staff understood the importance of providing an inclusive approach to care and made adjustments, where they could, to support equity in people’s experience and outcomes. The provider had processes to ensure people could receive care and treatment at the service, including those in vulnerable circumstances such as homeless people and Travellers. Staff used appropriate systems to capture and review feedback from people using the service, including those who did not speak English. However, digital triage technology was only available in English which created barriers to equitable access. We did not see any systems of communication for people who may experience barriers to health care.
 

People were supported to consider their wishes for their end-of-life care, including cardiopulmonary resuscitation when clinicians had access to this information. This information was shared with other services when necessary.