Urgent Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

SAFE: People felt able to raise concerns. Managers investigated incidents and had begun to use this to inform wider learning and drive improvements. People were protected and kept safe. Staff understood and managed risks, but they did not always feel that escalation of those risks resulted in positive changes. The facilities and equipment mostly met the needs of people; the environment was clean and well-maintained. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training, appraisals and competency checks. Medicines were well managed.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Since our last assessment, FCMS NW Ltd had taken steps to improve the way it managed risks. This included introducing an additional quality assurance measure to its complaints handling process so that all complaint responses were subject to a tripartite peer review. The clinical manager had introduced weekly incident meetings with stakeholders (including the ambulance service, urgent and emergency care department and paediatrics department) to discuss and escalate all relevant concerns. The provider was in the process of trying to streamline its clinical assessment service to further strengthen safe and effective care for patients.

The provider was following the Patient Safety Incident Response Framework (PSIRF) which sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents. The purpose of this is to maximise learning and improve patient safety. Adaptations to the risk management software system used by the provider had offered better oversight and delegation ability that we had not previously seen at our last assessment.

A ‘failed encounter' policy had been created so that clinicians had an effective standard operating procedure for the safe closure of cases, where this was needed. The clinical manager had developed a ‘what matters this month’ newsletter to identify pertinent themes for discussion around risk management. In addition to this, they had identified themes from incidents and used these as a springboard for wider clinical auditing of records. This meant that the provider could be more assured as to whether incidents were due to unavoidable occasional human error or identified a systemic gap in training or operational procedures.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Improvements had been made to ensure safe and effective staffing since our last assessment. We saw that the provider had introduced a system to regularly assess clinical competence for all clinical staff which now included health care assistants working within the urgent care centre. We saw that there was also new monthly clinical supervision in place for all clinical staff. Although not mandatory, the provider told us this was well attended with high levels of engagement by clinicians. The provider had held frank conversations with staff about listening to them and trying to positively affect the workplace culture. Surveys had been designed and circulated to capture the voices of staff working in the department. A daily safety huddle had been introduced every day at 10am. Staff had the opportunity to attend this in a face-to-face format, or via a digital meeting. The improved system of clinical audit provided assurance that health care assistants (in addition to all existing clinical groups) were now working within their scope of practice. Emergency Care Practitioners were acting as volunteer mentors to health care assistants which offered additional safety and oversight of clinical practice. One-to-ones were hosted by managers for all staff every 6 weeks. The provider told us that morale was starting to shift and improve.

Since our last assessment, an infection prevention and control (IPC) lead had been appointed, and they had 4 hours of protected time per week aside from their usual clinical duties to ensure optimum compliance with the IPC systems. We saw that the environment was visibly much cleaner and was free from clutter - there were no longer discarded specimens lying around and equipment had mostly been wall mounted (with the exception of some sharps bins). Privacy curtains were now dated and changed regularly, if needed. The infection control policy had been updated to reflect the process to be followed if clinicians attended for duty with an acute infection.

Regular audits were being carried out and leads and managers held staff to account where standards fell slightly short, for example, with nail care or jewellery. Around 84% of staff had achieved compliance with IPC training. This would rise to 100% if the percentage adjustment for new starters was made.
 

The service had systems in place to manage medicines safely and support safe storage. Systems were in place for the oversight of stock, storage and monitoring processes, supported by clear leadership and governance.

The service had improved how it managed FP10 forms (NHS prescription forms), including better monitoring, electronic tracking and stronger controls. These improvements increased oversight. However, these arrangements were not fully embedded at the time of inspection. We found gaps in record keeping and tracking, including missing entries and a lack of final checks when forms were returned.

Staff reported incidents and concerns and took action, which showed a positive approach to safety. Leaders supported staff to learn and improve practice.

Medicines were stored securely in clean and organised areas, with access limited to authorised staff. Stock was well managed; stock levels were regularly checked to avoid overstocking. The service had effective systems for ordering and monitoring medicines, supported by regular checks, audits and handovers.

Staff carried out temperature monitoring and recorded results clearly. However, the medicines policy did not include clear guidance for emergency medicines stored outside the main medicines room, such as those held in reception.

Some processes were not always applied consistently. For example, we found expired medicines in a sealed emergency drugs bag that had been recorded as having been checked. This showed that checks were not always carried out effectively.