Queens Urgent Treatment Centre

Updated 15 August 2023

Queens Urgent Treatment Centre (QUTC) is an urgent treatment service available to anyone living or working in Romford and the surrounding areas in the London Borough of Havering and Barking and Dagenham in North-East London. The service provides treatment of minor injuries and illnesses, and provides a streaming service in order that patients are transferred to the right service either within the Urgent Treatment Centre or elsewhere. The streaming service is also the first point of contact for patients attending the emergency department of the hospital at which the centre is based.

The service is co-located on one level with the emergency department of Queens Hospital based at Rom Valley Way, Romford, Essex, RM7 0AG and is accessible to those with limited mobility.

The service is delivered by Partnership of East London Cooperatives (PELC) which is a not-for-profit social enterprise delivering NHS integrated urgent treatment services (including GP Out of Hours and Urgent Treatment Centres), to more than two million people across East London and West Essex.

The urgent treatment centre is a 24/7 NHS service for patients who walk-in, self-refer, or are referred by the NHS 111 service.

PELC provides doctors and streaming staff to the service. Other clinical staff are provided by North-East London NHS Foundation Trust who subcontract nurse and health care support worker staff to PELC. Most of the clinical staff working at the service for PELC are either self-employed, bank staff (those who are retained on a list by the provider) or agency staff.

The urgent treatment service is open 24 hours a day. The service sees approximately 5,000-6,500 patients per month

CQC registered the provider to carry out the following regulated services at the service:

• Treatment of disease, disorder or injury
• Diagnostic and screening procedure

The service’s website address is http://www.pelc.nhs.uk

Updated 15 August 2023

This service is rated as requires improvement overall.

The service had previously been inspected between 25 March and 15 April 2021, with a follow up inspection taking place between 10 November and 8 December 2021 The latter inspection rated the service as requires improvement overall and in the safe, effective and well led key questions. The caring and responsive key questions were rated as good. The service was found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008, and requirement notices were served. A further inspection was carried out on 20 and 21 October, and 7 November 2022. In this inspection the service was again found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008. The service was rated inadequate, conditions were issued and the service was placed into special measures.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Queens Urgent Treatment Centre on our website at www.cqc.org.uk

We carried out an announced comprehensive inspection of Queens Urgent Treatment Centre on 6, 7, 20 and 21 June 2023. We found that some of the breaches of regulation from the previous inspection had been fully addressed, but for others whilst progress had been made there was more to do. Following this inspection, the key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

At this inspection we found:

• The rating of the service had improved from inadequate to requires improvement. Significant work had taken place to address the breaches identified at the previous inspections, however in a few areas whilst there was progress there was still more improvements needed.
• The service had begun to monitor more effectively the safety of the care it provided, and its performance was improving, but was still not meeting requirements specified by NHS England. Systems were now in place to monitor the time taken for patients to have their initial clinical assessment. However only 76% of patients were having this assessment within the 15 minute target. This meant there was an ongoing risk of patients needing urgent medical attention not being identified in a timely manner. An action plan was in place to continue to make improvements in meeting this target.
• Patients were not consistently able to access care and treatment at the service in a timely way. The service had a target to provide treatment and discharge the patient within 4 hours. The service was meant to achieve this for 95% of patients but the average was 70-80% so below the target.
• Staffing at the service was not in line with the rotas that workforce planning exercises had deemed necessary. The rotas showed that there was a gap of up to 20% for the urgent care practitioners each month, meaning there were times when there were not enough staff working.
• The service was not consistently monitoring the effectiveness of the work of individual clinicians. Not all the clinicians were receiving consistent regular and high-quality clinical supervision. In addition the audits of clinicians notes were not taking place as robustly as needed to ensure all clinicians were delivering appropriate clinical care.
• The service did not yet have formal mechanisms to engage with patient groups.
• Whilst governance processes had improved, there was still scope for these to be further strengthened, particularly in terms of ensuring staff performance was adequately monitored.

However, the following areas had been addressed:

• The service had improved the management of incidents and complaints, and mechanisms were in place to share learning.
• Leaders now had the capacity and skills to deliver high-quality, sustainable care.
• The service had developed a clear vision and credible strategy to deliver high quality care.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

The areas where the provider should make improvements are:

• Review the detail required in the review of clinical competencies.
• Review the physical patient pathway from initial clinical assessment to the Emergency Department.

I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care