Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hillingdon Urgent Care Centre on 17 March 2017. Overall the service is rated as good.

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

• Staff were open and transparent and fully committed to reporting incidents and near misses. The level and quality of incident reporting ensured a reliable picture of safety.
• Learning was based on a thorough analysis and investigation of any errors and incidents. Opportunities for learning from internal and external incidents were maximised.

• The centre had effective systems in place to manage risks to patient safety. The centre staff and managers gave high priority to safeguarding children and vulnerable adults from the risk of abuse.

• Staff were aware of current evidence based guidance. Staff had the skills and knowledge to deliver effective care and treatment.

• Patient feedback indicated that patients were treated with care and respect and were involved in decisions about their treatment.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• The service was accessible 24 hours every day. Patient feedback was positive about the ease of using the service and time taken to receive treatment.

• The centre had adequate clinical facilities but the children’s designated seating area was ineffective and patient confidentiality was compromised given the location of the clinical assessments. However, environmental improvements were in progress.
• There was a clear leadership structure and staff felt supported by management. The provider proactively sought feedback from staff and patients, which it acted on.
• The provider and staff had a good understanding of the centre’s performance against national and contractual targets. The provider worked with the clinical commissioning group and other health partners to improve the service.

The areas where the provider should make improvement are:

• The provider should develop a written role description for the local infection control lead for reference.

We saw several areas of outstanding practice:

• There was a holistic approach to assessing and delivering care. The urgent care centre used evidence based guidelines to support its ‘streaming decisions’ and prioritise patients on the basis of clinical urgency and need. There was a systematic programme of audit with some local discretion on clinical topic selection. The service used the weekly email ‘blog’ with staff to cascade learning back into the system. There was a focus on continuing improvement as the service worked to develop new and more effective local ‘pathways’ to services (such as the early pregnancy assessment unit).

• The service actively sought feedback from patients and took action as a result. This was a contractual requirement but we were impressed with the level of patient engagement and the high levels of patient satisfaction the service achieved.

• The staff team was committed to working collaboratively with hospital and community based colleagues and services (including the A&E department, specialties and safeguarding teams and primary care practices) to ensure patients received appropriately coordinated care. The service proactively shared learning from incidents and audits with stakeholders and was persistent in seeking coordinated solutions where appropriate.

• The urgent care centre staff recognised that some patients had longer term needs that were not best met in an urgent care setting. The ‘health coordinators’ initiative to direct patients to more appropriate services and support patient registration with primary care services had reduced the number of patients who attended the centre frequently. The urgent care centre was building on this work by developing better links with general practices.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice