Archived: Croydon Urgent Care Centre

Updated 12 November 2015

Croydon Urgent Care Centre provides a service for the treatment of minor to moderate illnesses or injuries which do not require treatment in the emergency department. The centre is led by seven GPs with a staff grade doctor, seven emergency nurse practitioners, three staff nurses, two health care assistants, 13 reception and four managerial staff. At the time of our inspection, there were eight vacant positions at the centre. The service is available to all people with an urgent health need 24 hours a day 365 days a year. They see approximately 4,000 patients each month. The service is provided by Virgin Care Wandle LLP on behalf of the Croydon Clinical Commissioning Group. Virgin Care LLP is a subsidiary of Virgin Care which operates a large number of health and social care services across the country. The provider operates the urgent care centre and the GP out of hours service from the one location, they are registered to provide the regulated activities of diagnostics and screening procedures, treatment of disease, disorder or injury, surgical procedures and for the out of hours service transport services, triage and medical advice provided remotely. This inspection focused on the urgent care centre. The Urgent Care Centre is situated in the emergency department at Croydon University Hospital and all patients for both services are seen initially by reception staff working at the urgent care centre.

We inspected the service for the first time in February 2013; the five outcomes inspected were compliant. A further inspection was carried out in July 2013; this identified three issues where the service was not meeting the essential standards of quality and safety. Patients were not treated with consideration and given information and support about their treatment; patient’s health and safety was not protected and patient’s privacy and dignity was not maintained. We also found the streaming for patients on arrival at the centre was carried out by non-clinical staff. Compliance actions were made and the provider sent an action plan detailing the improvements they would make to become compliant.

We carried out a responsive inspection in September 2013 following concerns raised during the inspection of Croydon University Hospital earlier the same month. This inspection identified continued concerns regarding patient privacy not being maintained and there had been no changes to the streaming of patients when they initially attended the centre.

We carried out a follow up inspection in July 2014 to check the progress the provider had made with meeting the Regulations and found improvements had been made, although there were still issues with patient’s privacy not being maintained. There had been the addition of a Vital Early Warning Score (ViEWS) assessment (completed by a health care assistant) to the streaming of patients when they initially attended the centre. We made a compliance action regarding the design and layout of the building not adequately protecting patient’s privacy and dignity.

Updated 12 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Croydon Urgent Care Centre on 17 June 2015. Overall the practice is rated requires improvement.

Specifically, we found the service to require improvement for providing safe, effective and well led services. It was good for providing caring and responsive services. The provider operates an out of hours service from the same location which was not inspected during this visit.

Our key findings were as follows:

• Patients said they were treated with respect and did not raise concerns regarding privacy. However the reception and waiting area is open so conversations can be overheard and while treatment rooms have curtains, they provide minimal privacy;
• Patients were generally happy with the care and treatment they received, although they were not always satisfied with the time they had to wait to receive treatment;
• Information about how to make a complaint was available to patients and suitable arrangements were in place to deal with complaints;
• The provider and the centre had systems in place to seek feedback from patients about the services it provided;
• The urgent care centre is open 24 hours a day 365 days a year and accessible to all who attended;
• Staff understood their responsibility to raise concerns and report incidents, although there were limited opportunities for meetings to discuss learning;
• While audits had been carried out there was not a completed cycle and they did not demonstrate improvements made;
• The service had developed a range of policies and procedures to govern activity, although some staff reported they did not have good access to them;
• Staff recruitment practices were generally in line with requirements;
• New staff received an induction to ensure they had the information they needed to carry out their role;
• Systems were in place for staff to receive annual appraisals.

There were areas of service where the provider needs to make improvements.

Importantly, the provider must:

• Ensure the process for reporting and recording incidents is improved so the system is accessible to all staff and that lessons learnt are discussed and shared with relevant staff;
• Ensure GPs are trained to the required Level in child protection;
• Ensure a record is maintained of the fridge temperatures on a daily basis;
• Ensure the details of any cancelled prescriptions are recorded in line with the provider’s policy and guidance;
• Ensure there are clear and effective systems in place to assess, monitor, mitigate risks and improve the quality and safety of the service through the completion of clinical audit cycles, learning from incidents and complaints and engaging with staff.

In addition the provider should:

• Look at ways to improve privacy for patients, at reception and in treatment areas;
• Ensure staff record checks made of clinical trolleys and any actions required or taken;
• Be able to assure themselves that those tasks being carried out by hospital trust staff are being done to the appropriate standard. This included cleaning of communal areas and testing of electronic equipment;
• Continue to recruit to vacant staff posts to reduce the reliance on locum staff;
• Consider providing specific training for staff relevant to working in an urgent care centre.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice