Liverpool 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. We assessed all quality statements from this key question. At our last assessment in November 2018, we rated this key question as requires improvement. At this assessment the rating remains requires improvement and we have identified a breach for Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

This service scored 59 (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 established systems and processes to monitor and review safe care and treatment within a positive learning culture.

Staff across the wider organisation and at the service used a web-based patient safety system to report incidents and risks. Managers reported a high level of incident reporting at the service, which they used to monitor patient safety risks. Data shared with us highlighted incidents linked to high service demand, admissions and referrals, ambulance delays, and infection control issues. We reviewed several events that showed staff collaborated with external organisations to conduct reviews and investigations. These events often resulted in joint action plans. The service held monthly meetings with neighbouring emergency departments to discuss cross-sector incidents and share learning to prevent recurrence.

Staff said they understood their responsibility to raise concerns and report safety incidents, near misses, and risks both internally and externally when appropriate. However, we found that feedback after incident reporting was inconsistent. Some incident reports lacked detailed documentation of investigations, or any follow-up actions taken.

The provider had tested out their strategy for emergency planning when presented with such incidents as mass casualties and people exposed to suspected hazardous materials.

The provider collaborated with service users and healthcare partners to establish and maintain safe care systems.

The provider held regular meetings with local stakeholders and partners to develop standard operating procedures across organisations. The service had effective systems for sharing information with staff and external agencies to support safe care and treatment. For example, staff used timely and secure referral pathways to share information with patients own GPs, GP out-of-hours (OOHs) services, and secondary care.

Clinicians followed clearly defined care pathways for diagnosis, treatment, and referral to specialist services. During periods of extreme demand, the provider activated processes to redirect patients to alternative services. When patients required urgent or complex medical care, the local emergency department team could attend the service to provide immediate support. The service also had protocols in place to ensure smooth transfers to the emergency department when needed.

Staff maintained individual care records in a way that promoted patient safety. Commissioners and system partners did not raise any concerns about delayed referrals or the safety of care systems.

The service had appropriate systems to safeguard children and vulnerable adults from abuse.

All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns. Learning from safeguarding incidents was available to staff. The service had a centralised team who provided advice and support to staff so that they shared concerns quickly and appropriately. Alerts were added to the patient record system when there were safeguarding concerns about a patient so that all relevant members of the staff team could readily identify this. The service worked with partner agencies to share information to safeguard people. Policies and procedures were reviewed and up to date and were aligned with other local safeguarding teams. The service had a chaperone policy in place to maintain patient privacy during intimate examinations. Posters were displayed in all consultation rooms and waiting areas.

In accordance with the trust safeguarding responsibilities and the 0–19 service protocols, when a young person under the age of 18 leaves the service without waiting to be seen, the service follows a clearly defined and proactive process to ensure their safety and well-being.

Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention and had received appropriate training. They had been provided with training and support on how to identify and manage patients with severe infections. The reception team knew how to identify patients who were displaying life threatening symptoms.

In line with available guidance, people were prioritised appropriately for care and treatment, in accordance with their clinical need. This included patients being triaged by a clinician using national early warning tools for children and adults to help assess the severity of acute illness and the recognition of clinical deterioration. There was a target for patients to be triaged within 15 minutes of arrival, further clinical observations were repeated to monitor changes as required.

Systems were in place to manage patients who experienced long waits. Signage in the waiting area provided information such as anticipated waiting times. Staff made observations of people in the waiting area. Deterioration in a patient’s condition was escalated and responded to. Patients transferred to the emergency department had a copy of the consultation record and handover was provided to emergency department staff. Staff told patients when to seek further help and advised patients what to do if their condition got worse. Details of the attendance to the UTC were sent to the patients registered GP electronically, this was usually within 24 hours of attendance to ensure information was shared in a timely manner and patients were followed up as required.

The service actively identified and managed potential risks in the care environment. The provider maintained a clear infrastructure to govern health and safety, estates, and facilities. The provider established local service-level agreements with the premises' owners and held regular meetings to review risks and monitor contract performance.

However, staff reported that the landlord did not always respond promptly or effectively when they raised issues. For example, during the site visit, we noted that clinical waste bins were full and overflowing, making it impossible to secure or safely segregate them. Staff had reported this issue to the relevant department, but it had taken no action.

Dusty surfaces and environments, caused by the demolition of nearby buildings, posed significant risks for patients and staff. The service recognised these risks, conducted risk assessments, and implemented control measures to mitigate them.

The provider ensured that equipment, facilities, and technology supported the safe delivery of care. Staff conducted regular health and safety and fire risk assessments to identify, address, and monitor safety concerns related to the premises. However, despite staff carrying out a recent health and safety risk assessment prior to our visit, exposed electrical wiring remained fully accessible to the general public.

The provider maintained a business continuity plan to guide staff during major disruptions, such as an IT failure. They also performed regular safety testing on all equipment, supported by established systems.

The provider had systems to ensure there were enough qualified, skilled and experienced staff, who received support, supervision and development opportunities. The provider monitored patient demand for the service and reviewed staff capacity to meet anticipated demand. A new staffing structure had been introduced in March 2024 to better meet the needs of the service. The new structure indicated minimum and optimum staffing levels and required daily staff skill mix.

Risk assessments were in place to mitigate risks associated with staffing in terms of both numbers and skill mix. There were arrangements in place for covering staff sickness, absence and vacancies and the use of temporary staff. When patient demand and acuity outweighed the number of staff and resources, the provider had an escalation process to follow. This enabled the service to move to a triage only service but continue to manage and assess patients who required a fuller assessment and treatment.

Whilst arrangements were in place for planning and monitoring the number and skill mix of staff needed, staff told us that when the service had the minimum staffing levels this was not always sufficient to meet the needs of the service. They told us that the role of coordinator (person in charge) was demanding and was included in the minimum staffing levels. We reviewed the rotas for the last three months and found that from April to June 2025 there had been 273 shifts of which 93(34%) had operated on the minimum staffing levels. The provider told us that this had been as a result of sickness, compassionate leave or cancellation by temporary staff. At the time of the assessment the provider had not carried out a review of staffing, that included obtaining the views of staff and evaluating how many times the service had used the escalation process as a result of minimum staffing.

There were safe recruitment practices to make sure that all staff, including agency staff, were suitably experienced, competent and able to carry out their role. Processes were in place to ensure staff were fit to work at the service, for example when undertaking Disclosure and Barring Service (DBS) checks.

All new staff underwent a comprehensive induction programme and were required to undertake mandatory training within an appropriate timescale. The provider used competency frameworks to support staff to continuously learn and professionally develop. The provider monitored training undertaken and were taking steps to address any shortfalls. Work was taking place to improve the structure of on-going clinical training and ensure the timeliness of some training being completed. Staff told us they were supported to identify their training needs and were supported with their professional development, but they struggled to attend training sessions when staffing levels were low.

Interviews with staff confirmed that meetings took place with non-medical prescribers to review their prescribing practice, such as advanced nurse prescriber.

The provider had an effective system to manage infection prevention and control (IPC).

Infection prevention and control audits were carried out and reviewed, and actions taken where necessary.For example, the provider shared risks associated with hygiene issues that had occurred related to service proximity to building works at a neighbouring trust on the same site. The last IPC audit was undertaken in May 2025 and showed 87% compliance. An action plan was in place with recommendations for improvements.

Personal protective equipment was in sufficient supply and located appropriately around the premises. Procedures were in place to prevent the risk of infection and to report any notifiable IPC issues to the appropriate organisations. There were clear roles and responsibilities around infection prevention and control with dedicated lead staff. Staff had been provided with training in infection prevention and control.

The arrangements for managing waste, sharps and clinical specimens kept people safe.Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance, if relevant to their role. There was a system for the service to report infection-related concerns to the relevant agencies (e.g. notifiable diseases).

The service lacked full and reliable systems to ensure appropriate and safe handling of medicines at all times. We found that not all staff involved in immunisation had followed the guidance for proper vaccine storage and management. Staff recorded fridge temperatures daily for storing vaccines and cold-chain medicines. However, we found that a number of cold-chain incidents had occurred and the temperature had dropped outside the +2⁰C to +8⁰C range. Staff had not reported or responded to these breaches. We reported this issue to the management team on the day of the assessment. In response, the provider immediately investigated the incident and took action to prevent it from recurring.

We noted that Patient Group Directions (PGDs) (written instructions to supply or administer medicines to patients in planned circumstances for example, vaccinations) were in good order. However, it was reported to us that this involved duplication of entering medication dispensed in EMIS templates and in a paper-based system. We were told the management team were aware of this and were looking for a solution. The processes in place for the management of blank prescriptions and the issuing of medicines to patients was not robust and there was no effective audit trail for how this was being managed safely. We also saw staff were not reliably completing records of internal medication stock that could lead to discrepancies in what had been signed out and what was available.

The service was equipped to respond to medical emergencies (including suspected sepsis). Staff had access to emergency medicines and equipment including oxygen and a defibrillator, and they were suitably trained in emergency procedures. Emergency medicines were regularly checked for stock availability and to ensure they were in date. The medicines were stored securely. We identified that emergency seizure medication was not held on site. A policy and procedure for holding this medication at all relevant services operated by the Trust had been developedand there was a plan to implement the new process, including staff training, across the provider’s walk in centres and urgent treatment centres by end of July 2025.

Staff followed established processes to ensure that when people were prescribed medicines their GP was informed. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment. Reviews of non-medical prescribing practice had taken place. The provider had a system for recording and acting on safety alerts and medical recalls.

During the service site visit, we found there was an open vial of the medicine Lidocaine stored in one of the service fridges and the unused portion should have been discarded after initial use. This was removed at the time of the assessment visit.

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