Archived: Urgent Care Centre - Queen Mary's Hospital

Integrated Care 24 Limited (IC24) provide an urgent care centre service at Queen Mary’s Hospital, Sidcup. The service is an ‘out-of-hours’ primary medical service operating between 9.45pm and 8.00am, seven days a week including bank holidays. Sessional GPs and agency nurses are employed by IC24 to run this service. At all other times the centre is operated by Oxleas NHS Foundation NHS trust using NHS staff. The service is commissioned by Bexley Clinical Commissioning Group (CCG). There are other out of hours providers commissioned by Bexley CCG for use between 18.30 and 08.00. These include an NHS 111 service and accident and emergency departments. However, this report relates only to the out-of-hours service provided by IC24 at Queen Marys Hospital between the hours of 9.45pm and 8am.

During our site visit we spoke with four patients and five relatives who were using the out-of-hours service. We spoke with three members of the clinical and administrative staff. We also spoke with the Head of Operations, Operations Manager, head of medicines management and director of clinical services during a visit to the organisations head office in Ashford. The operations manager accompanied us on the site visit.

Patients were confident in the care they received. One patient said “everybody knows about this hospital. It’s got quite a good reputation.”

IC24 had good leadership and internal management structures. Communication within the organisation was effective especially regarding the communication of changes, updates and safety information.

Learning from feedback, incidents, accidents and complaints was handled effectively at the service. We found the service had effective clinical governance structure in place. This structure was instrumental in identifying where care had not been effective, understanding why this had happened, learning lessons from the issues and putting systems in place to reduce and prevent any recurrence.

Patients were cared for in a clean and hygienic environment.

Medicines were supplied readily. However, there was no robust audit trail for the supply of medicines given to people at the centre and there were not effective systems in place for the obtaining using, safekeeping, storing and supply of medicines.

The organisation had clear policies relating to recruitment and retention of staff, which included recruitment of sessional doctors, confirmation of eligibility to work in the UK and induction. However, we were not satisfied that systems were in place to ensure that evidence of these checks was held for some existing staff. We checked the recruitment file of one doctor and saw no evidence in the file that a criminal records check (Disclosure and Barring Service check) had been performed.

The recruitment of agency nurses was also based on assumptions that recruitment checks had been performed by the agency. There was no evidence the clinical competencies of agency nurses had been assessed. The induction process for agency nurses was poor resulting in gaps of essential knowledge.

We found the service was effective in meeting the wide ranging needs of patients that presented and the varying levels of demand that were placed on it. Care received by patients was audited and information shared with patient’s usual GP where the patient volunteered this information. There was no real evidence to show continuity of care between different providers as the service appeared to work in isolation.

Patients received a caring service. They told us that they were involved in discussions about the health care they received and gave consent before it was provided. We observed patients being treated with sensitivity and respect by staff. However, we found privacy was not always protected.

The service was responsive to the needs of patients. There were opportunities for patients to provide feedback about the care they had received. Staff had access to equipment, guidance and where possible information about the patient to support clinical decisions and effectively respond to those in urgent need. However, some emergency equipment and lack of training in its use meant that staff may not always be able to operate the equipment in any medical emergency that may arise.

Access to the premises was appropriate for patients with mobility difficulties.

We found appropriate information was provided for staff in the format of policies, procedures, intranet, staff handbook and email communication. Regular staff described the service as well-led and said they felt supported. Information was routinely shared with staff via email, telephone and the intranet. However, we found that there were limited opportunities for agency staff to formally discuss issues relating to their work. Performance was monitored through audits using set criteria with common themes but it was not always clear that this monitored clinical decision making.