Queens Urgent Treatment 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.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed to Good. This was because the organisation had made improvements and had responded to the findings of the previous assessment. This included staffing, clinical guardianship and delays in referral to emergency care.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The organisation listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The organisation had started implementing a new NHS incident reporting system, Patient Safety Incident Response Framework (PSIRF) in August 2024. Leaders had daily and weekly meetings to review all the incidents reported that day and week, to promptly identify serious incidents and any immediate learning for implementation. This was additional to the governance team’s review and oversight of incidents.

Learning from incidents was shared with staff by emails, the rota system and a quality and safety bulletin issued monthly. The integrated governance committee report from April 2025 found the themes as delayed blood test results from secondary care, inappropriate referrals to the organisation, clinical assessment concerns and staff punctuality issues. Learning from incidents was shared between the organisation and the trust.

The organisation had a system in place to manage the receipt and response to Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts. The response to the alerts was monitored through organisation's sub-committees, and information was cascaded to staff through the quality and safety bulletins.

The service worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

Patients who attended the UTC registered at the reception area, once registered they had an initial clinical assessment (streaming) by a clinician within 15 minutes of registration. The assessment comprised of a brief history and observations, and bloods and x-rays may be requested. All patients were then directed to the most appropriate place for their clinical need. Where patients were directed to the UTC, they were told to wait in a specific zone and wait for the clinician to call them. The zones were monitored by the clinical staff to identify any patients who were deteriorating; staff signed a form each hour to demonstrate this had been carried out. However, although we observed clinical staff calling new patients in the zones and checking patients’ welfare, we found the forms were not always completed.

Clinical staff had new adult and children’s streaming guidance to follow, which included the escort guidance and exclusion criteria.

The organisation's staff worked closely with the trust staff to improve services for patients. Staff said the relationship with the trust had improved and the transfer of patients to the accident and emergency department was better and quicker.

At the previous assessment where patients with potentially serious symptoms were being delayed when directed to the emergency department, the issue was not being flagged as an incident, at this assessment we found all incidents were recorded, monitored and discussed at regular meetings with the Trust.

The organisation had identified and monitored areas that could affect their service, such as any delays in providing blood results, and x-ray requests.

The time for patients to wait before they were initially clinically assessed and treated was monitored by the operational managers to ensure they met their targets. At the time of the assessment 99% of patients were seen within 15 minutes for their clinical assessment and 98% of patients were seen and discharged within 4 hours.

Patients who had special notes on their patient records, were flagged and prioritised, for example the elderly and people with a learning disability.

Safeguarding systems, processes and practices were developed, implemented and communicated to staff. There was active and appropriate engagement in local safeguarding processes.

Information demonstrated staff actively referred patients to the safeguarding teams when appropriate and recorded their actions. The staff always had access to a member of the leadership team for advice and support. The safeguarding lead reviewed the safeguarding referrals to provide advice and identify regular attendance, any themes and improvements monthly. All their findings were fed back to staff in the quality and safety newsletter; cases were discussed in staff supervisions. Most staff were trained to appropriate levels for their role.

The organisation and the local integrated care board met to discuss assurance issues relative to safeguarding.

Any children or adults deemed as vulnerable were prioritised and seen promptly.

In line with the local hospital, the organisation followed the operational pressure escalation levels, a framework used by the NHS to assess and manage operational pressures in healthcare settings.

Daily meetings were held to ensure that staff resources were sufficient. The newly appointed operational managers were onsite and dealt immediately with the staffing resources to ensure patients were seen within 15 minute and 4-hour targets. Staff said the operational managers being onsite and covering 24/7 had improved the management of staff resources.

Staff used the hospital’s emergency number for patients who had a cardiac arrest or a medical emergency. The emergency equipment was checked by PELC staff but maintained by the hospital.

We reviewed the check lists and found one indicated an automated external defibrillator, and a suction unit should be present, which they were not. The operational manager agreed to review the checklist.

Sepsis information was displayed in the initial assessment room.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The service was located in a local hospital who allocated the area of the premises and had the responsibility for the upkeep of the building.

The service had a new combined entrance for the emergency department, the same day emergency care unit, and the UTC. This enabled patients with urgent conditions to be quickly moved to the emergency department. Following the initial assessment patients were sent to the main atrium of the hospital where they waited in clearly marked areas for either minor injury or illness. Although this was a walk from the initial assessment area, we were told porters mostly were available, and the hospital had clear signage about where to go and where to wait. In addition, there was a separate area for children.

The service maintained equipment according to manufacturers' instructions. However, we noted there was no signage on the door where the oxygen was stored to inform staff of a possible danger.

The organisation had the necessary recruitment checks and induction for the different staff contracts and roles in the service, which included references and Disclosure and Barring Service (DBS) checks.

All staff had to complete competency training as part of their induction.

The organisation had an effective system in place to monitor and ensure all staff completed the appropriate mandatory training. Information submitted by the provider demonstrated over 85% of staff had completed their mandatory training with the exception of the staff who were self-employed and worked in the minor injury unit. Directly employed clinical staff had access to a monthly focus learning group covering different health conditions.

At the previous assessment we found the organisation employed a number of doctors who were not GPs, and it was unclear how the organisation had determined that the training undertaken by non-GPs was sufficient for the role, in the absence of GP validation. At this assessment we found a system was in place to monitor this.

At the previous assessment we found the organisation was not up to date with clinical guardian audits at the site. (Clinical guardian audits were the routine audit of clinical consultations to assess the quality of clinical practice against established standards.) At this assessment we found from January to March 2025 the service was up to date with the audits and had carried out 2.2% audits of all the consultations. Most of the audits found the patient consultation records were satisfactory with the exception of the initial clinical assessment staff, (streamers) where 50% were found to need to reflect their work.

The service had implemented a workforce planning document to determine the staffing requirements, and the managers met each morning to discuss staff cover for the service. In addition, we found staff were allocated to most of the available hours on the rota. Where there were insufficient staff, this was raised as an incident. Leaders told us they had recruited a significant number of doctors and clinical streamers

A new system was in place for monitoring clinical supervision of directly employed staff (streamers). However, the supervisions were not always occurring three monthly as recommended in the organisation's policy.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We visited the service and found appropriate standards of cleanliness and hygiene were being met. The organisation had leads for infection control, and they carried out quarterly infection prevention and controls audits of the premises and improvements were discussed and actioned. The leaders provided examples of staff learning across the organisation, such as the management of a recent patient who had an infectious disease and staff members not being bare below the elbows.

The cleaners followed daily cleaning schedules and staff carried out daily checks of the rooms they worked in.

Most of the organisation’s staff had completed infection prevention and control training with the exception of the staff who were self-employed and worked in the minor injury unit, where 67% of staff had completed their training.

At a previous assessment regular hand wash audits were not taking place, at this assessment we found the hand wash audits were taking place monthly.

Although, the organisation followed the immunisation against infectious disease (green book) for clinical staff, we were told this was not followed for non-clinical staff.

The most recent Infection control audit report was completed 19/12/2024, where the service scored 92% for governance, 100% for vaccine management, 73% clinical environment and 62% decontamination. The service had an action plan in place to ensure improvements were made.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The systems and arrangements for managing medicines, including medical gases, emergency medicines and equipment, and vaccines minimised risks. Medicines, including controlled drugs were ordered, recorded, stored and disposed in line with national guidance and legislation. Medicines were supplied via prescriptions, patient group directions (PGDs), and to take away supplies.

Whilst most prescriptions were usually sent electronically via the electronic prescribing service (EPS), the EPS had been out of service since earlier in the year. The service managed supplies with paper FP10s prescriptions. There was a clear auditable process for the ordering, storing and distribution of the paper prescriptions. They were kept secure and accessible by only authorised staff.

Patient group directives (PGDs) used to supply medicines by non-prescribing clinicians were reviewed regularly. The organisation had recently worked with the neighbouring emergency department to develop new PGDs which would ensure consistency in the care people received. The new PGDs were not embedded at the time of the assessment. However, it was not clear from the PGDs for antibiotics if there had been appropriate specialist advice from a microbiologist when developing them.

The service had a pharmacy team who supported staff with managing medicines. Staff spoke positively about the support from the pharmacy team.

Staff had access to emergency medicines and these were regularly checked.

The service had a system to audit and review staff’s consultation records each month. This review included ensuring that medicines were being supplied and recorded in line with national guidance and local policy. We saw an example of a prescriber being supported to improve as a result of the audit.