Medway Community Healthcare C.I.C

On this page

• 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

Are community urgent care services effective? This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question as requires improvement. At this assessment the rating had improved. We rated effective as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 service assessed people’s needs when they attended the service. Triage was either done at the emergency department if they came to the acute hospital or at the unit for those who had a prebooked appointment.

Staff completed comprehensive assessments in a timely manner, which considered people’s physical and mental health, risks, personal circumstances, preferences, care, wellbeing and communication needs. For example, staff used the National Early Warning Score (NEWS2), a physiological tool to assess the degree of illness of a patient, including those with sepsis, and used this to trigger critical care interventions.

For patients who had complex health care needs, staff ensured that they involved relevant professionals to ensure assessments reflected a full understanding of the patient.

Staff involved patients in discussions about their care and treatment. They worked with patients to ensure care and treatment reflected patients’ views, wishes and goals, and supported shared decision‑making.

Staff developed care plans that met the needs identified during assessment particularly for people who presented with deep vein thrombosis (DVT) and cellulitis. Care plans were personalised, holistic and recovery oriented.

Staff reviewed peoples care and treatment and updated them, particularly when people’s needs changed, to ensure care remained appropriate and effective. Following assessment and treatment at the urgent treatment centre, when required, staff referred people back to their GPs to ensure continuity of care.

The service planned and delivered people’s care and treatment in line with current legislation and evidence‑based good practice, taking account of what mattered to people. Staff worked with people to ensure care and treatment decisions reflected their needs, preferences and goals.

The service ensured that care and treatment pathways were underpinned by up‑to‑date policies, national guidance and recognised best practice. Staff demonstrated an understanding of how to apply evidence‑based approaches to support safe, effective and consistent care across the service. For example, staff offered patients who suffered from cellulitis oral antibiotics before intravenous injections (IV) antibiotics in line with national best practice. Staff monitored the effectiveness of the treatment and made recommendations.

The service had up to date British National Formulary (BNF) which is a practical evidence-based information for health professionals who prescribe, dispense and administer medicines. Clinicians ensured that they worked in accordance with the BNF.

Handover and multidisciplinary discussions considered people’s psychological, emotional and physical needs, supporting continuity and coordinated delivery of care. Staff with the right skills, knowledge and experience contributed to care delivery, ensuring treatment was safe and effective.

The service used audit and review activity to monitor practice and support learning, helping ensure care and treatment remained aligned with evidence‑based standards. Where learning was identified, this informed improvements in care delivery.

While most patients reported that staff assessed them for pain, some patients felt that staff did not also ensure that their pain was well managed while they waited to be seen by a clinician.

Staff referred patients for mental health assessments when they showed signs of mental ill health. Staff protected the rights of patients subject to the Mental Health Act.

Staff held regular and effective multidisciplinary meetings to discuss patients and improve their care. The team had daily huddles to discuss patients' care.

The service worked collaboratively with other teams and services, both within the provider and externally, to meet people’s needs. This supported timely referrals, coordinated care planning and smoother transitions between services when required.

Patients had their care pathway reviewed by relevant clinicians. Staff, teams and services worked well together to deliver coordinated and joined‑up care, supporting positive experiences and outcomes for people using the service.

Staff from different professional backgrounds communicated effectively and shared relevant information to support decision‑making and continuity of care.

Handover processes and team discussions enabled staff to understand people’s needs, risks and progress, reducing the likelihood of gaps or duplication in care.

Multidisciplinary team (MDT) working was embedded into routine practice. Relevant staff were involved in care reviews and planning, ensuring decisions were informed by a range of perspectives and professional expertise. This helped ensure care was holistic and responsive.

Managers supported effective teamwork by providing opportunities for communication, reflection and shared learning, including access to team meetings and information when staff were unable to attend. This helped ensure staff remained informed and aligned in their approach to care delivery.

Staff supported patients to live healthier lives – for example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse.

Staff ensured that patients and visitors had access to drinks. There was a cold-water dispenser in the waiting area. People who attended the service could get food from the hospital cafeteria.

Clinicians enquired during consultations about people’s general health including their diet and nutrition. When necessary, staff made appropriate referrals to specialists such as dietitians and speech and language therapists for patients who needed support with eating and drinking.

The service had relevant information promoting healthy lifestyles. Staff assessed each patient’s health and gave advice when required on how to live a healthier lifestyle such as exercise, eating healthy and quitting smoking. Staff signposted people to other services where they could get support around living a healthier lifestyle.

There were a range of Information leaflets at the reception area about how patients and visitors could access help and support, for example, with quitting smoking and support with addiction.

The urgent treatment centre (UTC) routinely monitored people’s care and treatment to ensure outcomes were effective, safe and timely, and met national clinical guidance, local pathways and the expectations of people attending the service. Leaders used a range of outcome and performance information to understand how well the service was operating and to drive improvement.

Staff monitored clinical outcomes relevant to urgent and same‑day care, including re‑attendance, and escalation to emergency services where required. Records showed that clinicians assessed outcomes throughout people’s attendance and routinely reviewed whether treatment had been effective before discharge.

The service monitored ‘did not attend’ appointments. Staff made sure they followed up on missed appointments including contacting the person and the emergency department to follow up on the referral.

The service used audit, performance data and pathway monitoring to assess effectiveness. This included reviews of clinical decision‑making, adherence to clinical guidelines, timeliness of treatment, and the appropriateness of onward referrals. Audits were repeated over time to check whether actions had resulted in sustained improvement. Managers reviewed this information through governance processes and used it to identify risks, trends and priorities for action.

People’s experiences were considered alongside clinical outcomes when assessing effectiveness. Feedback from people using the UTC was reviewed by leaders and used to identify where care processes or communication could be improved, particularly around discharge advice, waiting times and onward referrals.

The service carried out a programme of repeated audits to check improvement over time. For example, the service audited the time clinicians spent with patients during consultation and the effectiveness of the consultation to ensure that people needs were being met.

Staff took appropriate steps to ensure people were involved in decisions about their care and were supported to make informed choices during their attendance at the urgent treatment centre.

Staff gained consent from people before delivering care and treatment and ensured this was done in line with legislation and national guidance. People were provided with relevant information about their condition, treatment options and any risks. Staff ensured that consent to treatment was clearly recorded.

Where people may have had impaired mental capacity, staff understood how and when to assess capacity and did so on a decision‑specific basis, particularly for significant clinical decisions. Records showed that where people lacked capacity, staff made decisions in their best interests, taking into account the person’s wishes, feelings, culture and history, and involving others where appropriate.

Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act 1983, Mental Capacity Act 2005 and the Children Acts 1989 and 2004 and they knew who to contact for advice.