Garston Urgent Treatment Centre

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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 staff involved people in decisions about their care and treatment and provided them with advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had effective tools in place to triage, prioritise and assess people. The provider used nationally recognised tools to triage people with a range of presenting conditions, to safely identify clinical priority to ensure people with the most immediate needs were seen first. People were categorised for risk using a red, amber, yellow, green stratification and staff across the service could therefore readily identify those patients who were assessed as requiring more urgent attention. There was a process to determine when observations of people were to be repeated whilst they waited for a full assessment and treatment and to ensure any immediate care and treatment, such as pain relief or temporary dressings were given.

During times of increased pressure when demand exceeded staffing capacity the service stepped down to a triage only service to support and maintain peoples safety. The triage only service ensured that staff reviewed the patient’s condition, took their vital observations, assessed their clinical issue and provided some initial treatment if required. People who were assessed as acutely unwell or vulnerable continued to be prioritised for a comprehensive assessment following triage. If a person was a low priority for assessment and deemed safe to wait, they were either signposted to an alternative service or asked to return for an assessment the next day. These people were provided with any relevant patient information leaflets and informed what to do if their condition deteriorated.

The service used a nationally recognised scoring system NEWS2 (National Early Warning Score 2) to facilitate early identification of sepsis, and these patients were managed accordingly.

Staff reported incidents when the service implemented the escalation process which allowed the leadership team to review the reasons for this and if possible, make changes to service provision.

The clinical team had access to people’s in-hours GP notes to assist with assessing needs. The UTC had established a collaborative working relationship with the local hospital and a number of other services to ensure people received appropriate care and treatment. Where people’s needs could not be met by the service, staff redirected them to the appropriate service for their needs.

The provider had systems in place to ensure staff were up to date with national guidance, evidence-based good practice and required standards. Clinical staff had access to guidelines from the National Institute for Health and Care Excellence (NICE) and used this information to ensure that people’s needs were appropriately met. Audits took place to ensure guidance was adhered to, for example, audits of antibiotic prescribing and clinical record keeping.

The provider had a training and development programme that was tailored to different staff roles and responsibilities. There was a system of annual appraisal. A trust wide process was in place for annual review of each nurse prescriber and monitoring of prescribing took place to ensure competence.

Leaders had a clear understanding of the performance of the service against key performance indicators; they regularly discussed performance at senior management and board level.

Leaders and staff worked closely with colleagues and relevant stakeholders to meet urgent need and support the wider system.

People who were the most clinically vulnerable were prioritised and the service worked with other healthcare professionals to deliver care and treatment when required.

Staff had access to the information needed to plan and deliver care and treatment. The service worked with other services to ensure continuity of care and shared records and information where relevant. An electronic record of all consultations was sent to the patients’ own GP. Staff communicated promptly with registered GPs so that they were aware of the need for further action and continuity of care for their patients.

The UTC had formalised systems with the NHS 111 service with specific referral protocols for patients referred to the service.

The UTC had developed referral and treatment pathways and had also developed effective links with local services such as the local emergency department, paediatrics, orthopaedics, burns unit, ophthalmology and mental health services. The service could also refer patients directly into other services.

The service supported people to live healthier lives and manage their health and wellbeing. People who used the UTC were referred or signposted to relevant services for care and treatment; information, education, advice and support linked to their needs.

Members of the clinical team provided people with information and support to manage their health, care and wellbeing where possible. People were provided with information to support them to make healthier choices, to promote and maintain their health and wellbeing and prevent deterioration.

The service identified people who may be in need of extra support. Risk factors, were identified and their normal care providers made aware so additional support could be given. Where peoples’ needs could not be met by the service, staff redirected them to the appropriate service to meet their needs. People could be referred to a social prescribing service for support with issues impacting on their health such as social isolation.

Leaders demonstrated that monitoring and improving outcomes for patients was important to them and they used information and data to drive improvement.

Leaders used information relating to incidents, complaints, patient feedback and other healthcare professional feedback to inform performance, safety and effectiveness and to identify and drive improvements.

The provider demonstrated they had clear evidence of action taken to change and improve patient care following significant incidents. The provider reviewed protocols and standard operating procedures in order to improve outcomes for people who used the service where they had recognised a need to improve.

Data was collected and used to identify achievement against performance indicators and drive improvement were required. Performance reports showed that a range of data was monitored, this included: the severity of a person’s condition and the urgency with which they needed medical care, the average daily, weekly and monthly number of attenders, peak times and the average length of waiting times.

The provider undertook an external quality assurance review commissioned by the trust board. The overall objective of the review was to provide assurance that systems and processes were in place to accurately report performance against the service key performance indicators. The results of the review indicated its overall assurance was rated as high, especially for how performance was mapped up to the trust board.

There was a system to monitor non-medical prescribers in relation to the assessment of patients, the prescribing of medicines and associated outcomes for people who used the service.

Clinical audit was undertaken by the provider to monitor and improve outcomes for people. There was a clear system of regular audit in place that included monthly reviews of antimicrobial prescribing, the triage system, infection prevention and control, medicines management and clinical documentation. We noted that low volumes of data were collected as a proportion of total clinical activity.

The provider had systems and processes to ensure people were provided with information about their care and treatment to enable them to make an informed decision. Staff understood the importance of ensuring that people understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment. Staff had undergone training in the Mental Capacity Act to enable them to understand the requirements of legislation and guidance when considering consent and decision making.