This service is rated as Good overall. (Previous inspection December 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Derby Urgent Care Centre on 12 December 2018. This inspection was planned and undertaken as part of a wider inspection of the provider (One Medicare Ltd). The provider had agreed to contribute to our Primary Care at Scale project.

At this inspection we found:

• From 1 November 2018, the centre had operated under a nurse-led model and GPs no longer provide input on site. However, there was a GP at provider level who was accessible for clinical escalation. We found that this transition had been managed effectively and this had not affected the continuity of the service.
• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated people with compassion, kindness, dignity and respect. Patient interviews and feedback received through CQC comment cards supported our observations.
• Patients could access care and treatment from the service within an appropriate timescale for their needs. The provider had consistently met targets on waiting times set by the commissioners.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• At our previous inspection in December 2016, we highlighted an area where the provider should make an improvement. This recommended formal training for reception staff participating in the streaming process. At this inspection, we found this had been completed and reception staff had received appropriate training to support this element of their role.

We saw the following area of outstanding practice:

• Two members of the team had completed safeguarding training at level four (GPs and safeguarding leads within primary care are usually trained to level three). The local authority safeguarding leads attended team meetings on site. These two factors helped embed the awareness and responsiveness to safeguarding concerns.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derby Urgent Care Centre on 6 December 2016. Overall the service is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events. Staff were encouraged to record incidents. A tracker system was used to monitor progress and share learning.
• Risks to patients were assessed and well managed.
• Patients’ care needs were assessed and delivered in a timely way according to need. The service met the National Quality Requirements. These areminimum standards for all out-of-hoursGPservices established by the Department of Health.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• There was a system in place that enabled staff access to patient records, and the urgent care centre staff provided appropriate services (for example the patient’s GP or the hospital) with information following contact to ensure continuity of care.
• The service managed patients’ care and treatment within the four- hour wait time agreed with commissioners. They had triaged and prioritised 81% of children within 15 minutes over a three month period.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Improvements were made to the quality of care as a result of complaints and concerns.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate, and improved the patient experience. For example, they had widely advertised the services of the centre and explained to patients when they should attend the unit, rather than the accident and emergency department.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice;

• The provider had introduced a Support and Advice Hub (S&AHs) as a source of information and signposting to local service provision. They provided advice on health and wellbeing issues that did not require clinical discussion. For example, once a patient had been diagnosed with diabetes they could access further information on diabetes and lifestyle. The patient advisers within the S&AHs were able to provide this information and give resources for the patient to take away.

There was one area where the provider should make improvement;

The provider should implement a formal training and supervision programme for receptionists participating in the patient streaming system, to ensure staff have the skills and support to undertake the role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice