Lymington Urgent Treatment Centre

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed and inspected against two quality statements, Involving people to manage risks and Safe and effective staffing. We found that the service provided care in a way that kept patients safe and protected them from avoidable harm. Staff recognise and respond appropriately to changes in the risks to people who use services. Risks to safety from changes or developments to services are assessed, planned for and managed effectively. Staffing levels and skill mix are planned, implemented and reviewed to keep people safe at all times. Any staff shortages are responded to quickly and adequately. Where relevant, there are effective handovers and shift changes to ensure that staff can manage risks to people who use services.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Leaders told us how they had developed clinical audits and supervision in line with best practice guidelines. Patient safety staff and leaders discussed learning from incidents and outcomes from audits. Leaders showed us examples of clinical audit activity to improve service provision. For example, the service completed an audit on Revaxis, a medicine used to immunise against diphtheria, tetanus and poliomyelitis. The service reviewed 10 clinical completed case records from June 2023, following a report of high number of Revaxis used monthly. The service identified a 92% compliance rate, showing an under use of Revaxis, mainly with patient cases of burns; limited records on tetanus status, or patients with prone risk. Clinicians were sent an update as a reminder by the service to use best practice guidelines with the use of the Green Book and to consider burns as a clinical indicator, and the appropriate recording of clinical documentation.

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. Medicines were managed appropriately. Emergency medicines were available as well as some stocks of medicines for doctors to prescribe when necessary. Systems were in place to audit, for example, prescribing, patient records, referrals and cleanliness. Action was taken when improvements were required. Audits were developed in response to identified risks. We saw evidence of 100% compliance rates to completed audits in relation to safeguarding, controlled drugs, waste management, clinical documentation and reception call observations. Where audit compliance rates were below 100%, the service took action to improve performance. For example, in relation to infection prevention and control training and with Personal Protective Equipment (PPE), this was monitored and re-audited. The service worked with the local commissioners to review inappropriate patient referrals from GP providers or 111 and identified 68 cases in 2023. Feedback was given to GP providers and call handlers within the 111 service to help reduce inappropriate referrals and mechanisms were in place for the service to report issues. There were safe systems to ensure patients were clinically assessed and treated in a timely way. The service developed systems and clinical pathways to ensure staff had clear protocols to treat patients and where required referred to external healthcare partners. The service had developed relationships with local organisations to ensure there was end to end feedback on referrals and case reviews for learning. Patient feedback was positive about the treatment they received. This included the introduction of patient advice information sheets as a safety mechanism following treatment.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Leaders told us they had reviewed and updated their interview processes to ensure staff were recruited to match people specification standards for new and developing roles. This included competency and skillset for a growing organisation. Training was prioritised to ensure staff were equipped with the latest treatment guidance and clinical updates. Staff were encouraged to take part in further training that was of the individual practitioner's interest whilst in scope of urgent care. Leaders and staff confirmed that staff welfare and wellbeing was supported. The service provided us with examples to demonstrate this.

There were arrangements for planning and monitoring the number and mix of staff needed. The rotas were managed to ensure staff did not work too many hours. Capacity and demand were worked out several weeks in advance to ensure appropriate staffing levels. The provider operated a safe recruitment process that had been further improved to include wider staff involvement at interview stage. We reviewed 4 staff files on assessment and found that recruitment procedures were followed in line with the provider's policy. Staff had the skills, knowledge and experience to carry out their roles and were provided with training and supervision to ensure they met patients’ needs. There was an induction programme where staff were supernumerary and supported by experienced staff. The service had developed its own development pathway for clinical practitioners, with competencies and academic qualifications in conjunction with the University Hospital Southampton Trust. This unique and innovative approach had helped meet increasing levels of patients attending the service through improving the opportunities for clinicians to be upskilled. The approach was implemented as a measure to reduce the impact of staffing demands across the sector. As a result, the service had initiated a ‘see and treat’ process to identify patients who could be treated quickly after an initial assessment. We saw evidence of performance data from the past 12 months to show that a high level of patients were initially assessed and treated within targeted timeframes, above national averages.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.