Guy's Hospital

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 safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of 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.

The service had a positive culture of safety and learning. The organisation listened to concerns about safety and investigated and reported safety events. There was a no blame approach which empowered staff to report any issues without fear of negative consequences. Staff understood their responsibilities to raise and record safety incidents, concerns and near misses, and were encouraged to do so by senior leaders. Staff reported incidents through an electronic system which could be accessed by all staff. In the 12 months prior to the inspection there were no reported serious incidents. All recorded incidents resulted in either no or low harm. Incident themes from data we reviewed included inappropriate transfers and delays in treatment or acting on observations.

The service ensured that lessons were learned, and improvement was made when things went wrong. Learning from incidents was shared with staff and teams through meetings and emails. As leadership and team worked across both the Guy’s urgent care centre (UCC) and St Thomas’ Emergency Department (ED), we saw evidence that learning was shared across both sites.

Staff we spoke with were generally able to explain the duty of candour. Although there had been no incidents where duty of candour was applicable, when things went wrong, staff understood their responsibility to apologise to people and offer honest information and suitable support.

Staff told us the teaching environment was positive and supportive, and they were encouraged to participate in training opportunities. Emergency Nurse Practitioners (ENP) had access to monthly teaching sessions and yearly study days which covered a range of topics applicable to their roles. Staff said that the service encouraged discussion, reflection, and shared problem-solving. They described strong peer support, and opportunities for development.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had strong and well-functioning systems to manage risk, ensure safe patient flow, and support effective clinical decision-making. The service was open between 8am and 8pm. The urgent care centre (UCC) only treated adults and children over a year old with minor injuries and illnesses who self-presented or were referred from 111 or their GP.

On arrival at the UCC, patients were initially verbally assessed by an assessment nurse before registration by receptionist. Once booked in, patients were triaged by an assessment nurse using a triage tool based on a nationally recognised triage system. Patients who required redirection to an emergency department would be assessed prior to a streaming decision. Staff were knowledgeable about alternative community pathways, nearby GP hubs, and operating hours for associated services, allowing them to redirect people safely. The Royal College of Emergency Medicine (RCEM) recommends all patients are triaged within 15 minutes of arrival. We saw the service achieved 75.5% compliance with this standard over the previous 12 months.

Observations of triage and care pathways showed that staff assessed people quickly and transferred them promptly when more specialist care was required. Staff used the electronic patient record system to monitor waiting times and identify people who might need escalation, and they demonstrated clear understanding of pathways for mental health and medically unwell patients. These systems worked well in practice, supporting safe transitions of care.

After triage, patients waited in the waiting area until they were seen by an ENP or a General Practitioner (GP). Receptionists and the assessment nurses had oversight of the waiting area. The ENP in charge was in the nearest consultation room to the waiting to allow for timely escalation if needed. Data showed that between February 2025 and January 2026 97.2% of patients were seen treated or referred within 4 hours, which was above national targets. There was a television screen which kept people updated on current wait times. However, this was out of order for most of our inspection, although we observed attempts being made to fix it.

The service used an electronic patient notes system. This meant staff could instantly access a patient’s previous notes when assessing a patient and allowed the service to instantly share notes with other services. The computer system had an effective flagging system. Patients who had special notes on their patient records, were flagged and prioritised, for example frequent attenders and people with a learning disability.

The hospital had an onsite x-ray department that was open for most of the UCC opening hours. Outside of these hours patients needed to attend a neighbouring accident and emergency department, or if clinically stable, could return the next morning.

The service was able to undertake basic point of care testing such as urinalysis. The service did not have an onsite pathology service; therefore, any blood tests were required to be undertaken at other services, and results followed up by the patient’s GP. If staff identified patients may require a blood test at triage they would be redirected to nearby services.

The service had a transfer of care policy for patients who required higher level or more urgent treatment at an emergency department. The site also had a critical response team available for inpatient areas, who would attend the UCC if support was required for a critically unwell person.

We observed that complex and deteriorating patients were identified quickly and moved to the holding bay when required. Staff followed clear pathways for emergency transfer to St Thomas’ Hospital, liaising directly with receiving teams and ambulance services. Records showed that staff recorded NEWS2 scores (a standardised clinical scoring system used to identify and monitor patients who were at risk of clinical deterioration), administered first-line treatment such as analgesia or aspirin when needed and kept people under observation until transfer. The detailed record of managing a cardiac patient we reviewed demonstrated timely escalation, coordinated handover, and safe onward transfer.

Staff worked effectively to maintain safe flow. They explained how they stopped further bookings when capacity was exceeded and how they redirected people to other sites safely. Staff also used triage screening to ensure people were streamed to GP, ENP or emergency pathways appropriately.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding systems, processes and practices meant that people’s human rights were upheld, and they were protected from discrimination, abuse and neglect. There was a strong understanding of safeguarding and how to take appropriate action. Staff described how safeguarding alerts appeared on the electronic patient record system and how new concerns were escalated to GPs or ENPs for further assessment. They were confident in describing processes for domestic abuse, use of risk assessment tools, and pathways for transferring children or vulnerable adults to specialist teams. Observations showed staff were aware of warning signs in a patient’s condition during assessment and acted quickly where concerns were identified.

Staff knew how to identify people at risk of abuse, and most had completed the required level of safeguarding training for their role. There was a commitment to taking immediate action to keep people safe from abuse and neglect. Any children or adults deemed as vulnerable were prioritised and seen promptly. Staff demonstrated awareness of safeguarding pathways for people with mental health needs, pregnant women, and children. They described how they contacted St Thomas’ Emergency Department (ED) directly when a child or adult required specialist review and how they ensured safe transfer. They also referred to using dedicated safeguarding sections in the clinical system to record concerns clearly.

People were supported to understand their rights, including their human rights, rights under the Mental Capacity Act 2005 and their rights under the Equality Act 2010. Staff completed Mental Capacity Act training which was incorporated into the safeguarding training modules.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There was a balanced and proportionate approach to risk that supported people and respected the choices they made about their care. People were risk assessed for their suitability to attend the unit at triage based on clear criteria. Patients who did not meet the criteria were advised about the appropriate service for their injury or illness and redirected. There was also a programme set up to monitor and safeguard frequent attenders of the service. Reviews were performed to assess the drivers of attendance, where possible with as much input from patients as possible.

Staff used a nationally recognised tool to identify deteriorating people and escalated them. Observations of vital signs were recorded by staff, and the national early warning score was calculated. These were recorded electronically. The service had a clear escalation policy for the deteriorating patient, including the transfer of their care to an emergency department. Patient assessments comprised of a brief history and basic observations, and bloods and X-rays or ECGs if appropriate. Staff were able to assess a patient's suitability for the service at the point of triage and redirect patients to other healthcare providers when necessary. All patients were directed to the most appropriate place for their clinical needs including where this may have been outside of the UCC e.g. ED, children's ED and external redirection, e.g., pharmacies, own GP, GP hubs, sexual health services etc. Typically, when patients were advised to attend St Thomas’ Emergency Department, staff arranged taxi transport for them.

Staff described how they considered people’s preferences, language needs, and health literacy. They supported people to understand their symptoms and treatment options, and they involved those accompanying children or adults where appropriate. Staff gave safety-netting advice routinely and communicated timeframes for review or expected recovery. Staff also adapted care for people with additional needs, such as those with dementia or learning disabilities. Feedback from patients indicated they felt listened to and involved in decisions about their treatment. People were confident that their individual needs had been appropriately assessed and were fully understood. Assessments considered the person’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People were cared for in safe environments and facilities were available to meet their needs. The UCC environment was well laid out and visibly clean and tidy. We saw evidence that cleaning audits were completed to ensure good standards of cleanliness. The service had 7 consultation rooms and a holding bay used in the event a patient becomes critically unwell. The waiting area was within the line of sight of the reception desk for direct observation and monitoring by the reception or nursing staff while patients waited for their turn to be attended to.

The service did not have a separate, secure paediatric waiting area in accordance with Facing the Future standards. Nevertheless, one of the consulting rooms could be utilised as a waiting area for children if required. The trust's play therapy team provided a selection of toys to help create a more welcoming and child-friendly environment for young patients waiting to be seen. This felt a proportionate response considering the patient demographic. Data we reviewed showed paediatric attendances made up between 7%-9% of all the UCC attendances in the last 12 months. On the first day of our inspection the UCC saw a total of 93 patients, 2 of which were children or young people.

Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care. The service had a resuscitation trolley equipped with both paediatric and adult equipment available to use in an emergency. Staff completed daily checks of resuscitation equipment. All equipment reviewed had safety checks in date.

An on-site security team was based nearby and was available during the unit’s opening times. Staff felt confident contacting the security team if they were needed.

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.

The service planned and regularly reviewed staffing levels and skill mix to ensure people received safe care and treatment.

A team of ENPs staffed the UCC alongside GPs from an external provider. Nursing and admin staff worked on a rotational schedule between the Urgent Care Centre (UCC) and the ED at St Thomas' Hospital. This provided staff with valuable experience in caring for patients presenting with more complex or severe health needs. As a result, staff were able to further develop their clinical skills and confidence, enabling them to identify and care for patients who were more acutely unwell than the typical patient demographic seen in the Urgent Care Centre. Staff received training appropriate to their role. Staff told us all ENPs received immediate life support training and paediatric immediate life support training. New staff to the trust received an induction, which included mandatory training; the UCC overall compliance for mandatory training was 89.7%, was slightly below the trust target of 90%. Staff training needs were also discussed as part of annual appraisals. Compliance with completing appraisals was 100%.

Staffing levels were generally safe. Rosters showed that the service usually had the correct number of ENPs, assessment nurses and GPs in line with its staffing model. Gaps in nursing and admin staff were often filled by redeploying staff from other sites, and both staff and leaders reported that the unit rarely operated with low staffing levels, with occasional bank staff use from the service’s own substantive staff. During our assessment we did not observe any staff shortages. There was a good skill mix of staff on duty, and we observed that staff worked well together.

GP cover was provided by an external primary care GP service operating under a Service Level Agreement (SLA) with the trust. This service was not part of the trust we were inspecting, but we saw that GPs and ENPs worked well together. In the event of a GP absence reception staff would escalate this to the primary care GP service. We were told that this worked well and that problems were rare. This was demonstrated by a 97.4% GP shift fill rate, indicating that the service was rarely understaffed with medical personnel.

The service vacancy rate was below the trust target at 9.2%. Most staff we spoke with told us they enjoyed working at the service. The service had a low staff turnover rate of 9.4%.

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.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. All areas were visibly clean, had required furnishings and were well-maintained. Staff were seen cleaning equipment after patient use, demonstrating adherence to infection control principles.

Personal protective equipment (PPE), hand sanitisers, and hand-washing facilities were readily available in all areas of the unit and good hand hygiene was promoted. All staff were bare below the elbow. They washed their hands and wore appropriate PPE when caring for patients. Audits consistently demonstrated good hand hygiene and environmental cleanliness compliance.

Waste management was handled in line with national standards, with different colour coding for general waste and clinical waste. All clinical bins were seen to be operated with pedal lids and were not overfilled. We saw that sharps were managed safely in line with national guidance, with correct disposal and secure containers in place.

Most staff had completed infection prevention and control training with infection prevention training compliance for clinical staff at 81.8%. Cleaning processes after infectious patients were appropriately described by staff, and housekeeping teams were contacted for deep cleans when needed.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Medicines were generally managed safely, with appropriate storage and security. Staff stored medicines in locked cupboards and ensured that medicines requiring refrigeration were managed safely. Staff followed Patient Group Directions (PGDs) where authorised, and systems were for GPs and ENPs to prescribe and administer first-line treatments.

The systems and arrangements for managing medicines, including medical gases, emergency medicines and equipment generally minimised risks. Medicines were provided through prescriptions, PGDs, and supplies to take away. Typically, patients collected their medications from the hospital pharmacy; however, if the pharmacy was closed or for patients with limited mobility, medicines could be provided from the service’s to-take-out (TTO) cupboard. PGDs used to supply medicines by non-prescribing clinicians were reviewed regularly. Staff told us they could seek medicines advice from the pharmacy department when needed.

Stock medicines were stored in locked cupboards in consultation rooms. However, we observed that some medicines in the TTO cupboard had been opened and used as stock. These medicines also did not have a label indicating when they were opened or when it should be discarded. This creates a risk that staff may unknowingly be providing medicines that are no longer safe or effective. We raised this during the inspection and staff rectified this immediately.

The service used an electronic prescribing system. Emergency medicines could be accessed in the event of an emergency, which were regularly checked. Lockable fridges were available for those drugs needing refrigeration. Processes for monitoring medicines fridge temperatures were in place. Record logs confirmed that fridge and room temperatures were checked regularly.

People were appropriately involved in decisions about their medicines. We saw that patient’s allergy status was accurately documented in patient’s notes.

The service undertook safe and secure handling of medicines audits, including controlled drugs, temperature monitoring, and medicines security, which showed good compliance within the UCC and did not identify any actions for improvement.