Guy's Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment this key question was not rated. At this assessment this key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We did not look at Assessing needs during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The UCC had a team of experienced Emergency Nurse Practitioners (ENPs), General Practitioners (GPs) and assessment nurses who followed recognised pathways for minor injuries, wound care, and common urgent conditions. Clinical records showed structured documentation, and appropriate escalation to St Thomas’ Hospital for people requiring further investigation or specialist review, such as cardiac patients or people needing imaging not available on site for example CT and MRI scans. These practices aligned with national urgent care pathways.

Staff at Guy’s Urgent Care Centre (UCC) generally carried out prompt initial assessments. Observations during our inspection showed that people were usually triaged quickly, with waits as short as two minutes, and assessment nurses used a brief but structured approach to identify whether people needed GP review or treatment by an emergency nurse practitioner. When someone needed privacy, staff moved them into a separate room. We observed that assessment nurses demonstrated kindness and professionalism when obtaining people’s histories and observations.

Policies and treatment guidelines were stored electronically and accessible to all staff. They were based on best practice from the National Institute for Health and Care Excellence (NICE) and the Royal College of Emergency Medicine (RCEM) and were reviewed and updated. Although we found that certain folders within the UCC contained printed copies of policies that were no longer current. This presented a risk of staff inadvertently referring to outdated guidance, which could result in procedures not aligning with the most recent standards or best practice.

Staff used available diagnostic tools such as x-ray, and ENPs were trained in Ionising Radiation (Medical Exposure) Regulations to request imaging where clinically indicated. Oversight arrangements ensured ENP x-ray interpretations were cross-checked with formal radiology reporting to maintain diagnostic accuracy in line with best practice.

People consistently reported receiving thorough examinations, clear clinical explanations, and effective treatment plans. Many described the care as “excellent,” “professional,” and “very thorough,” reflecting that staff delivered care in line with good clinical standards. Most medicines were appropriately prescribed or supplied, and although some delays in pain relief were observed when an assessment nurse was unable to administer medicines under PGDs, staff mitigated this by ensuring a second nurse or GP assessed pain relief where required. Staff also used age-appropriate pain assessment tools, which meant that people’s pain was accurately identified and managed according to their individual needs, supporting better overall outcomes during their care and treatment.

Staff assessed and met patient’s needs for hydration. A water dispenser was available in the department. There were nearby hot drink and food outlets open at all times the UCC provided service. As patients were not typically in the UCC for longer than four hours, food provision was not required. Where patients had specialist nutrition or hydration needs, staff ensured these were met.

The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff described good working relationships between ENPs, GPs, and assessment nurses, and this was reflected in observed handovers and patient flows. Rosters showed that when assessment nurse cover was short, the service drew on staff from St Thomas’ Emergency Department (ED) to ensure safe staffing levels. This flexibility supported continuity of assessments and helped maintain safe waiting times.

Clinical staff undertook clinical consultations dependent upon their skill set. For example, the ENPs generally saw patients with minor injuries while the GPs saw the minor illnesses. The team had access to support and advice from a range of specialists to meet the needs of patients using the service, such as from mental health teams and pharmacists.

There were effective processes for transferring people to St Thomas’ Hospital when they needed specialist review, such as mental health assessment, paediatric care, or further diagnostics. Staff used a clear system to alert teams at St Thomas’, arranged taxi or ambulance transfer based on clinical need, and ensured people remained monitored in the holding bay when unwell. Observations showed staff stayed with people until safe handover occurred.

Information was shared between teams and services to ensure continuity of care. We saw systems and processes for multidisciplinary cross site discussions regarding people highlighted as having safeguarding concerns, and those that frequently reattended to the emergency services across the trust.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. The hospital’s electronic health record system facilitated the sharing of patient information necessary for planning and delivering care. Information about people’s episode of care was accessible to peoples GP in a timely manner. Access to a citywide electronic patient record system meant different professionals could see key information about patients to ensure their care was planned and transition between services was managed.

We did not look at Supporting people to live healthier lives during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People who used the service consistently experienced positive outcomes. The service met the national emergency waiting time outcomes. Reattendance rates were low with an average of 6.3% over the 12 months prior to the inspection. We saw systems and processes for multidisciplinary cross site discussions regarding people that frequently reattended the emergency services across the trust and a multidisciplinary team was to support this.

The service gathered and reviewed extensive patient feedback. Friends and Family Test data showed consistently high levels of positive experience, with around 88% of people rating the service as good or very good. Comments highlighted fast assessments, compassionate staff, and efficient treatment. Themes were analysed and shared with staff, helping the service identify what worked well and where improvements were needed.

Information was displayed which supported health promotion, including posters advising against the unnecessary use of antibiotics. Leaflets were available with information, that provided practical guidance and information on managing their conditions. However, we noted that many patient information materials featured dates from several years ago and lacked a review date. We brought this to the attention of staff during the inspection, and they confirmed that a review of patient information was underway.

The service’s performance was monitored daily to ensure they met the 15-minute initial assessment and 4-hour seen and discharged national targets. Breach reports were produced each day to identify causes for not meeting the standards. Local audit activity was often shared with the St Thomas’ ED. While certain audits for the UCC were carried out, such as tracking the number of dressings applied, there was a lack of evidence to demonstrate routine monitoring of care and patient outcomes at Guy’s Hospital UCC. Following the inspection, the trust provided evidence that demonstrated spot auditing of deep vein thrombosis (DVT), which highlighted opportunities to improve the assessment process and potentially prevent some patients from being placed on the DVT pathway. While the DVT service was based in the UCC on the St Thomas’ site, the skills were used across both Guy’s and St Thomas’. Staff explained that peer reviews of ENP practice had previously taken place, but these were not ongoing at the time of inspection. Following the inspection the trust provided evidence that Emergency Practitioners and Advanced Practitioners completed annual multi-professional enhanced, advanced and consultant level practice assurance reviews which included reflective practice and self-declarations of competence.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service obtained consent to care and treatment in line with legislation and guidance. Staff understood the requirements of legislation and guidance when considering consent and decision making. They supported patients who lacked capacity to make their own decisions or when experiencing mental ill health. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care, including young people.

Staff demonstrated a clear understanding of consent and decision‑making for children and young people. They recognised the role of those with parental responsibility and appropriately involved parents or carers in consent processes, while also respecting the rights of children and young people to be involved in decisions about their care. Staff communicated with them using age-appropriate explanations, adapting their approach to reflect the child’s level of understanding. Staff understood when and how to assess Gillick competence and were able to support competent young people to consent to their own care where appropriate.

Staff used plain language and checked understanding, and we saw examples where clinicians discussed risks and benefits in a calm and respectful way. This ensured people understood what would happen and could ask questions.

People’s views and wishes were considered when their care was planned. There were systems and practices to ensure that people understood the care and treatment being offered or recommended. This helped them make an informed decision. People received information about care and treatment in a way they could understand and had appropriate support and time to make decisions.