Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Walk in Centre, Dewsbury and District Hospital on 23 February 2017. The overall rating for the service was requires improvement and a breach of the legal requirements was found. The full comprehensive report for the February 2017 inspection can be found by selecting the ‘all reports’ link for Walk in Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 October 2017 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 23 February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the service is now rated as good.

Our key findings were as follows:

• The provider had implemented a system to assure themselves that all the appropriate checks were carried out by the employing agency on locum staff.
• The provider demonstrated quality improvement activity.
• The provider had taken steps to reduce risks to patients within the Walk in Centre by working to clarify arrangements and responsibilities for the monitoring and management of equipment and the environment.
• The service had decided not to see or treat children under two years of age until a protocol for the management of this age group was agreed with Mid Yorks Hospitals Trust (MYHT). We were shown evidence that work to achieve this protocol was underway. All staff we spoke with were aware of this and children were directed to the emergency department.

In addition the provider should:

• Continue to work with Mid Yorks Hospitals Trust to ensure the reduction of risks to patients through the continued review and formulation of written protocols and agreements for the area.
• Review their arrangements for carrying out fire drills in conjunction with Mid Yorkshire Hospital Trust in line with Government guidelines.
• Deliver on their plan to carry out a patient satisfaction survey in November 2017.

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 the Walk in Centre, Dewsbury and District Hospital on 23 February 2017. Overall the centre is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• Although some risks to patients were assessed, we found a lack of written protocols to support verbal agreements between the Walk in Centre and Mid Yorkshire Hospitals Trust (MYHT) which would clarify the arrangements and responsibility for the assessment, monitoring and management of the area and the reduction of risks to patients’ safety.
• The provider could not assure themselves that locum staff from the agency were Disclosure and Barring Service (DBS) checked or had suitable indemnity arrangements in place. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results showed that between February 2016 and February 2017 of 854 responses, 92% of patients would be likely or extremely likely to recommend the service to their friends and family. The service had not undertaken a patient survey.
• 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 could not evidence ongoing clinical audits or demonstrate quality improvement.
• 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.
• The provider was aware of the requirements of the duty of candour and there was a staff information booklet to support this. Staff were knowledgeable about this issue.
• Children under 12 months were directed to the emergency department and not seen in the walk in centre. However, a flow chart developed by the service and MYHT stated that children aged two or more could be directed to the walk in centre and it did not detail the pathway for children between 12 months and two years old. We were told there was another protocol for this age group but we did not see this on the day of inspection.

The areas where the provider must make improvement are:

• Introduce a system to assure themselves that all appropriate checks have been carried out by the employing agency on any locum staff used.

• The provider must be able to demonstrate clinical audits and assure themselves that they have considered the quality of care provided, reviewed the care provided in relation to current best practice guidance and made changes where necessary in order to improve.

• The service must be able to assure themselves of the arrangements and responsibility for the assessment, monitoring and management of the area and the reduction of risks to patients’ safety within the walk in centre.

The areas where the provider should make improvement are:

• The service should clarify the arrangements for the initial review of children aged between 12 months and two years of age and ensure that the joint protocol for assessment between MYHT and the Walk in Centre reflects this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with three people who told us they had never used the service before but were very happy with the care they had received. One patient told us "Every town should have a service like this, I have travelled twenty miles because my general practitioner (GP) could not give me an appointment." Another said "I am really impressed by the service."

People's health, safety and wellbeing was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider had developed robust written and agreed procedures with other providers. They had in place measures to regularly review those procedures in light of service changes.

People we spoke with told us the healthcare professionals they saw at the centre took time to explain things to them and they were able to ask questions. They told us they felt involved in decisions about their treatment.

Appropriate recruitment checks were in place prior to the employment of staff. This meant the provider had taken steps to ensure the staff they employed were of good character and suitable people to work with vulnerable groups.

The provider had a system to regularly assess and monitor the quality of service that people receive.

The Locala Walk-in centre gives access to local NHS services and can offer assessment, advice and treatment on a range of minor illnesses, ailments and primary care conditions.

On the day of our inspection we were unable to speak with people as there was no one using the service.

The procedures for care and treatment were carried out in line with up to date published research and good practice guidelines such as those from ‘The National Institute for Health and Clinical Excellence (NICE).’

The staff we spoke with were knowledgeable and showed a good awareness of the needs of the people who used the service.