Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Dudley Urgent Care Centre on 28 June 2016. The overall rating for the practice was good with requires improvement for providing a safe service. The full comprehensive report on the 28 June 2016 inspection can be found by selecting the ‘all reports’ link for Dudley Urgent Care Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the areas identified at our previous inspection on 28 June 2016. This report covers our findings in relation to those requirements.

Our key findings were as follows:

• A system had been implemented to ensure that learning from significant events was communicated to all staff as well as to external stakeholders and healthcare professionals.
• The reporting process for significant events had been improved to make it more readily available to all staff.
• The lead nurse was the appointed lead for infection prevention and control. External auditors were used to monitor standards and best practice.
• A formalised process had been implemented to ensure that controlled medicines required for a palliative care patient during the out of hour’s period were easily accessible to staff.

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 Dudley Urgent care centre on 28 June 2016. Overall the service is rated as good.

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

• The service had clearly defined and embedded systems, processes and services in place to keep people safe and safeguarded from abuse. There were effective arrangements in place to the support processes for identifying, recording and managing risks.

• Although evidence demonstrated that the service effectively managed incidents and significant incidents, we found that regular meetings with front line staff such as receptionists and clinicians were not in place. Although staff felt valued and supported we found that they were often reliant on the lead GP and lead nurse to when dealing with incidents. This highlighted that staff were not always following a formal reporting process to identify and manage incidents and general concerns and that learning from significant incidents and incidents was not shared widely enough to prevent incidents from recurring.

• We observed the premises to be visibly clean and tidy. We found that the service was in the process of appointing a named infection control lead for staff to report infection control concerns to and seek best practice advice and guidance from.

• Some medicines management protocols were in place which covered prescribing responsibility between secondary and primary care. However, the service did not have a licence to stock controlled drugs and we found that there was not a formal process in place for obtaining controlled drugs within the out of hours service for example, to support end of life care patients.

• The service complied with the National Quality Requirements. A programme of continuous case audits and prescribing reviews was in place, findings were used to monitor quality and to make improvements.

• We saw that staff treated patients with kindness and respect, and maintained confidentiality. Completed comments cards and patients we spoke with during our inspection described the service as excellent and efficient.

• We saw clear signposting in place to direct people on where to find the urgent care centre and how to access the out-of-hours service. The urgent care centre was easily accessible to patients with mobility difficulties, including wheel chair access. There were hearing loop, translation services and baby changing facilities available.

• The process for managing complaints reflected recognised guidance and contractual obligations. Records demonstrated that complaints were satisfactorily handled and responses demonstrated openness and transparency.

The areas where the provider should make improvements are:

• Ensure that learning from significant incidents and general incidents are shared widely enough to prevent incidents from recurring.

• Ensure formal reporting processes are fully embedded in the service so that staff feel confident to formally report concerns when things go wrong.

• Ensure a lead is in place to manage infection control concerns and promote best practice infection control standards.

• Ensure key processes are formalised and easily accessible to staff in the event that controlled drugs are required for a palliative care patient during the out of hours period.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This service is rated as Good overall. (Previous inspection October 2017 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

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 Dudley Urgent Care Centre on 20 and 21 March 2019.This was in response to concerns raised by the hospital inspection team during an inspection in February 2019.

At this inspection we found:

• 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.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The area where the provider must make improvements as they are in breach of a regulation is:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Further improve the layout of the waiting area to provide segregation for children.
• Complete the planned programme of mandatory training for all staff.
• Review the programme for auditing to introduce benchmarking for those staff who audit clinicians.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care