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

EFFECTIVE: Assessments took account of people’s communication, personal and health needs. Care was typically based on latest evidence and good practice. The initial triage process within the urgent care centre had improved, meaning that service users received the care and treatment they required, in a timeframe that was appropriate for their condition. There were still difficulties with the streaming pathway operated by the NHS trust, and we saw that FCMS NW Ltd (“the provider”) was working hard to positively improve the effectiveness of this process.

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.

Since our last inspection, operation and management of “The Front Door” has passed completely to Doncaster and Bassetlaw Hospitals NHS Trust. Undifferentiated walk-in presentations (where symptoms or conditions may point toward a general illness but without a specific diagnosis) are booked in by Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust emergency care navigators (receptionists) and each patient then receives a brief clinical assessment using a standardised clinical scoring system to quickly identify acutely ill patients, assess their illness severity, and detect signs of clinical deterioration including sepsis (known as a NEWS2 score but without a blood pressure recording). Children are awarded a Paediatric Observation Priority Score as appropriate, by an experienced nurse navigator. All patients are then streamed by the nurse to either the Urgent and Emergency Care department or Urgent Treatment Centre. Booking in with reception starts the clock for the purposes of emergency care data set reporting. A live dashboard of waiting times was now being used by managers to monitor waiting times.

On the day of the inspection there were 3 receptionists and a single nurse on duty at the front door. During the time spent at reception we observed all patients meeting the 15-minute target from booking in to initial assessment. However, we could not be assured that this performance could be maintained when the department was busy. Staff told us that at the busiest times, arrival to booking in time could exceed 30 minutes with patients needing to queue outside of the department.

Reception staff reported that when the time to triage exceeded 30 minutes management deployed an additional triage nurse to the reception area. Due to space constraints this resulted in one of the receptionists being displaced. Although this improved the time to triage, this then resulted in the queue shifting to un-booked patients who were invisible both to the clinical team and to emergency care data set reporting and this posed a clinical risk. Managers informed us that a receptionist was deployed to the waiting room in these circumstances with mobile technology to book patients in, but staff told us that the mobile device did not function as needed to allow them to do this.

Patient flow and timely assessment were additionally hindered by the environment in the waiting area of the front door. Poor signage resulted in all people reporting to the reception desk, not just patients requiring booking in. This meant that reception staff had to deal with general enquiries as well as booking in patients, delaying assessment of patients. There was a lack of clear instructions visible to arriving patients informing them of the requirement to book in on arrival, increasing the risk that patients could be waiting without the clinical teams being aware they were there and delaying initial assessment. Confidentiality was hard to maintain in the open environment of the reception desk. Two or three patients could be present at the same time when details of presenting complaints were discussed by both the receptionists and the navigator-nurse, and it was easy to overhear. We did not see signage informing patients that a confidential area was available if needed.

Once patients who were deemed suitable for the urgent care centre operated by the provider (FCMS NW Ltd) reached their destination, patients booked in via NHS111patients received an initial assessment within the required 30 minutes and those referred by the front door underwent an additional full NEWS2 assessment. There was a waiting room safety policy in place with regular supervision of waiting patients and non-medical staff had completed “recognising the deteriorating patient” training.

A digital clinical system was used to make patient notes, and we checked clinical entries from one of the clinicians on duty. Notes were comprehensive and of good quality, including patient observations, history, a clear formulation and disposal plan.

The use of clinical quality software provided additional assurance of the quality of medical records. All clinical staff were therefore subject to ongoing audit of their clinical records.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.