Shakespeare Walk in 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

We looked for evidence that people were protected from abuse and avoidable harm. Overall, we found that patient safety was effectively managed. At the last inspection the service was in breach of legal regulation in relation to a lack of formal clinical supervision for clinical staff, ineffective communication with staff, which included poor access to guidance and information, and poor locum staff induction processes. At this assessment we found that these issues had been addressed. Processes were in place for formal clinical supervision, communication with staff had been improved through the use of a staff engagement platform and daily meetings, and staff now had good access to guidance and information. Staff induction, which included the induction of locum/agency staff had been improved and was comprehensive. However, we also identified that there were still some areas which required improvement, this included concerns regarding traffic management onsite, and infection prevention and control issues regarding the waste storage area, and the condition of the building.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 72 (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 had a proactive and positive culture of learning to support safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. We heard from staff that managers encouraged staff to raise concerns when things went wrong. They felt that the culture of the organisation was open, and shared with us examples of when they had raised concerns, and these had been investigated and dealt with. The provider had processes for staff to report incidents, near misses and safety events. Between 1 January 2024 and 28 February 2025, the service had recorded 79 significant incidents. Thematic analysis of these by the provider showed that the main issues included, incidents of poor patient behaviour, health and safety concerns, issues related to the premises, and information technology related problems. We saw that these had been investigated, and when necessary, actions had been taken to improve the service and prevent recurrence. For example, following concerns relating to cleaning they worked with the landlord and cleaning company to improve standards. There was a system to record and investigate complaints, and when things went wrong. Between April 2024 and March 2025, the service had received 19 complaints. Themes related to these included staff behaviour and issues with consultations. The provider had investigated these, and had made changes to prevent recurrence, such as improving information given to patients to better manage their expectations. These learning and service improvement opportunities were supported by a programme of audits, staff development, and ongoing training. Staff confirmed that they were made aware of learning from incidents, complaints and audits in a number of ways, which included daily briefings (huddles), at more formal meetings and via email.

The provider had established detailed processes for managing pathways and transitions of patients through their care and treatment journey. Patients were triaged and treatment prioritised accordingly. The provider used a standardised referral process when patients required services outside that of the walk in centre, such as x-rays. The service was able to access patient information for both walk in patients and for those referred via NHS 111. If the presenting patient required urgent referral the service used the Primary Care Advice Line (PCAL), a telephone service in Leeds that provides immediate access to local hospital consultants, and which acts as a gateway for urgent referrals, alternatively the service can in emergency circumstances use 999 services. The provider closely monitored patient flows through the walk in centre via 3 hourly updates, when they assessed demand and capacity. If demand pressures were identified the service used the national OPEL (Operational Pressures Escalation Levels) framework to manage these instances (the OPEL framework identifies 4 levels, 1 which indicates the service is coping, ranging to 4 which indicates the service is compromised and cannot meet demand, and which may put patient safety at risk). Whilst the service had escalated their OPEL status on a number of occasions in the previous 12 months, we saw that it had only needed to escalate to level 3 (the service was operating under major pressure, and demand exceeded capacity) on 13 occasions. The walk in centre did not accept new patients after 8pm, but staff remained on duty until 9pm. This allowed for final safe review of patients still to be seen. The service was looking to convert to urgent treatment centre status, and care pathways were being developed to support this.

The service had effective measures and processes in place which kept patients safe. Staff we spoke with were clear on how to recognise and raise a safeguarding concern. Staff told us that they had received safeguarding training appropriate to their role, and this was corroborated when we checked staff training records. The provider had appointed a senior staff member to act as the safeguarding lead for children and adults across One Medicare Ltd, and an individual lead had been put in place at the location. Safeguarding policies were in place and available to staff, as were the contact details of the local safeguarding authority. We heard how staff in the past had raised concerns quickly and appropriately when required. We saw that the provider had undertaken audits in respect of children and young people’s safeguarding to assess that necessary information had been recorded when a child or young person presented for treatment. For example, an audit noted that in September 2024 37.5% of records audited had not indicated that safeguarding had been mentioned or discussed during the consultation. After raising awareness with staff on the importance of this, a reaudit showed that incidents of this had fallen to 5% in November 2024.

The service worked with people to understand and manage risks. They provided care to meet people’s needs that was safe, and supportive. The service had processes in place to triage patients when they booked in, and used this to prioritise need and identity treatment requirements. This included processes for dealing with acutely unwell and deteriorating patients. We heard from staff, and saw evidence to support this that they had received regular mandatory training in the identification of deteriorating patients, as well as basic life support training, and they knew of the action they needed to take in such circumstances. Staff gave us examples of when they had identified acutely unwell patients and taken immediate action. Emergency equipment and medicines were available, and these were subject to regular checks. We saw emergency equipment had been maintained, and that stock levels of emergency medicines were satisfactory.

The service did not always detect and control potential risks in the care environment, and did not always make sure facilities supported the delivery of safe care. Whilst the provider had in place risk assessments and controls for many areas of activity, this was not comprehensive. For example, it was noted that there was no risk assessment for the safe operation of the car park at the health centre which housed the service. Furthermore, it was noted that the area around the building, and the waste storage area had an active rodent infestation. There was no risk assessment associated with the infection risk to staff in relation to this. We saw that following our visit to the site that the provider had raised the pest control risks with the premises landlord, and immediate and long-terms plans had been developed to tackle the issue, and actions were due to be implemented. Another issue linked to personal safety and security involved a non-functioning light leading to the patient entrance doorway. Notwithstanding the issues noted above we saw that staff had received required health and safety training, this included fire training, and measures were in place to ensure other potential risks such as legionella were controlled. The provider had developed a business continuity plan which was in place, and which was monitored and had been reviewed.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. There was a range of clinical and non-clinical roles within the service which included advanced care practitioners, triage nurses, non-clinical managers and care navigators. We saw that training for these staff was up to date. The provider had processes in place which ensured the learning and development needs of staff were managed, and that staff were working within their agreed areas of competence. Staff records were comprehensive, and we saw that good recruitment practices were followed. Induction processes were in place for new staff. We saw since the last inspection of the service in 2023 that substantive staff numbers had increased, and the reliance on locum or agency staff had decreased. For example, at the last inspection the clinical service was delivered by 3 advanced clinical practitioners, this had been increased to 4 on duty for the full opening hours of the service, along with a dedicated triage clinician. The provider had detailed clinical supervision and appraisal processes in place, which were supported by a programme of clinical audits, assessments of consultations, and observed practice. Staff told us that they felt that induction processes were supportive, and that senior staff were available should they require additional advice or help. The provider had recently introduced a practice educator role who worked with clinicians to improve compliance and sustain improvements in clinical care. We saw that as the service moved towards urgent treatment centre status that clinical staff, when required, were to be upskilled in areas such as the treatment of injuries. Staff had received the necessary Disclosure and Barring Service checks appropriate to their role, and clinical staff had their professional registrations verified on a regular basis by the provider.

The provider generally had in place measures to manage infection prevention and control (IPC). However, at the time of our visit we identified some minor concerns which required improvement. The fabric of the building was very tired in areas, and whilst some remedial repair and decorative works had been undertaken there were still areas which were non-compliant with good IPC standards. These included areas of damaged plasterwork and paintwork, damaged areas of sealant around public wash hand basins, rusting chair legs to a seat in the triage room, and evidence of poor high-level cleaning in the triage room. Members of the management team and staff told us that in the past there had been issues related to poor drainage in the premises, but that this had recently been rectified. It was also raised by managers and staff that on occasion cleaning standards had been below that required, and that whenever this had occurred it was raised with those responsible. Following our onsite visit, we saw that the provider had discussed the issues regarding IPC with the premises landlord and improvement measures were planned.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, and helped them understand how to take medicines they had been prescribed safely. As the service was not the regular GP provider to patients who attended, prescribing was limited to that associated with presenting conditions, and therefore actions such as medicines reviews were not routinely undertaken. Staff in the walk in centre had received regular training, and were competency assessed on medicines optimisation. Staff managed prescription stationery appropriately and securely, and we saw that prescription usage was actively monitored. We saw that processes were in place to keep clinical staff up to date with medicines related issues such as medicines safety alerts. For example, these were shared with clinicians via daily briefings (huddles), via the provider’s online staff engagement platform, and from emails and minutes of clinical meetings. The provider had developed prescribing protocols for certain medicines such as opioid painkillers to safely manage prescribing and prevent abuse or overuse. Due to the nature of the walk in service, the provider told us that they had measures in place to verify the identity of patients. To support good practice, clinical supervision processes were in place for prescribers, and this approach was supported by a programme of clinical audits. We examined a number of audits submitted to us and saw that these had led to improvements in prescribing performance. For example, an audit of the use of benzodiazepine to treat musculoskeletal presentations showed a reduction in usage over a four-month period, and that usage was now more in line with guidance. A review of a sample of clinical records was undertaken by the Care Quality Commission GP specialist advisor, these reviews indicated no concerns regarding the consultations and subsequent prescribing decisions made by clinicians. We were told that safety netting advice was given to patients which informed them of what to do and who to contact if their condition did not improve, or if they experienced any unexpected symptoms.