Walk in Centre

We carried out an announced focused inspection at the Walk in Centre, which is situated in the emergency department (ED) at Dewsbury and District Hospital, on 12 April 2022. This inspection was carried out as part of our national programme of urgent and emergency care inspections.

At this inspection, only those key lines of enquiry designed to support the focused inspection of the walk in centre within the key questions of safe, effective, caring and well-led were examined. Therefore, there are no ratings associated with this inspection.

A summary of CQC findings on urgent and emergency care services in West Yorkshire

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for West Yorkshire below:

West Yorkshire

Provision of urgent and emergency care in West Yorkshire was supported by multiple provider services, stakeholders, commissioners and local authorities.

We spoke with staff in services across primary care, integrated urgent care, community, acute, mental health, ambulance services and adult social care. Staff continued to work under sustained pressure across health and social care and system leaders were working together to support their workforce and to identify opportunities to improve. System partners worked together to find new ways of working, linking with community services to meet the needs of their communities; however, people continued to experience delays in accessing care and treatment.

During our inspections, some staff and patients reported difficulties with providing and accessing telephone appointments in GP practices. Some of these issues were caused by telephony systems which were being resolved locally. We found inconsistencies with triage processes in primary care which could result in people being inappropriately signposted to urgent and emergency care services. However, a number of staff working in social care services reported good engagement with local GPs.

We visited some community services in West Yorkshire and found these were generally well run. Service leaders were working collaboratively to identify opportunities to improve patient pathways across urgent and emergency care. These improvements focused on meeting the needs of local communities and alleviating pressure on other services. There were strong partnerships with social care and community teams, so patients had the right support in place on discharge.

However, we inspected one intermediate care service and found it could only take referrals from an acute trust, which meant there were no step-up facilities for patients in the community. The service struggled for ward space to deliver therapeutic activities and there were no communal spaces for patients to meet together or engage in group therapy. Plans were in place to provide additional facilities and to reconfigure the existing layout to provide communal spaces.

The NHS111 service was experiencing significant staffing challenges and were in the process of recruiting a high number of new staff. Staff working in this service had experienced an increase in demand, particularly from people trying to access dental treatment although a system was in place to manage the need for dental advice and assessment. Due to demand and capacity issues, performance was poor in some key areas, such as providing a call back to patients from a clinician.

The ambulance service had an improvement programme in place focused on performance and staffing. Whilst we saw improvement in the ambulance response times and handover delays, performance remained below target. We identified impact on other services due to the availability of 999 responses; for example, a maternity service had to close temporarily to keep women safe, due to system escalation and because ambulance responses could not be guaranteed in an emergency. Staff working in social care services also experienced lengthy delays in ambulance response times which further impacted on their ability to provide care to their residents.

We inspected some mental health services in Wakefield which were delivering person-centred care and responded to urgent needs in a timely way. Staff worked in multi-disciplinary teams and collaborated with system partners.

People’s experiences of emergency departments were varied depending on which service they accessed. Some emergency departments had long delays whilst others performed relatively well. In services struggling to meet demand, patient flow was a key factor. Poor patient flow was primarily caused by delays in discharge with a high number of people fit for discharge unable to access community or social care services.

Staff working in some social care services reported significant challenges in relation to unsafe discharge processes, this included a lack of information to support their transfer of care and we were told of examples when this resulted in people having to return to hospital. Local stakeholders had a good understanding of this problem and were looking to improve pathways and discharge planning.

Staffing and capacity issues in both care homes and domiciliary social care services have at times impacted on timely and safe discharge from hospital.

We found services were under continued pressure and people experienced difficulties accessing urgent and emergency care services in West Yorkshire. System and service leaders across West Yorkshire were working together to seek opportunities for improvement by providing services and pathways to meet people’s needs in the community; however, progress was needed to demonstrate significant improvement in people’s experience of accessing urgent and emergency care.

At the inspection of the Walk in Centre we found:

• Safeguarding and safety systems, processes and practices had been developed, implemented and communicated to staff to manage risk and ensure patient safety.
• Recruitment records were maintained in line with guidance and staff had access to induction, training and development.
• Infection prevention and control was appropriately managed to help safeguard people from a healthcare associated infection.
• The provider had access to appropriate clinical equipment in place to enable assessment of patients including emergency resuscitation equipment and medicines.
• Despite facing challenges with staffing the service had continued to maintain safe staffing levels with an appropriate skill mix of staff. The service had maintained face-to-face appointments during the COVID-19 pandemic.
• Systems were in place to respond to incidents and to ensure learning was identified and cascaded so improvements could be made when necessary.
• Clinical records viewed provided evidence that care and treatment was provided safely and effectively and in accordance with evidence-based guidelines.
• Staff had the skills, knowledge and experience to deliver effective care.
• Performance was routinely monitored, and data indicated that the service was performing well against key performance indicators. The service had paused some of their quality improvement activity, including clinical audit, during the COVID-19 pandemic but told us these were about to re-commence and demonstrated their 2022/23 schedule.
• We observed staff to treat patients in a respectful and considerate way and patient feedback reviewed was very positive.
• The provider had an effective governance system in place that enabled ongoing monitoring and scrutiny of the operation and performance of the services provided.
• Leaders demonstrated they had the capacity and skills to deliver high-quality, sustainable care.
• The provider engaged with patients and staff to improve the service.

The areas where the provider should make improvement are:

• Deliver the planned audit schedule for 2022/23.
• Improve and develop staff awareness of the nominated Freedom to Speak Up Guardian and the duty of candour to ensure all staff are aware of these.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care