Bay Urgent Care

Updated 20 July 2022

Bay Urgent Care provides out-of-hours primary medical services to patients in the Morecambe Bay area when GP practices are closed. The service is located the Queen Victoria Centre, Thornton Road, Morecambe, Lancashire, LA4 5NN. We inspected this location on 25 April 2022. The service is registered to provide the following regulated activities:

Diagnostic and screening procedures,

Treatment of disease, disorder or injury,

Transport services, triage and medical advice provided remotely.

Bay Urgent Care provides a GP out-of-hours (OOH) service to 165000 people living in and around the Morecambe area. The service is contracted by the NHS Morecambe Bay clinical commissioning group (CCG) to provide OOH primary medical services to registered patients and those requiring immediate and necessary treatment in Morecambe and the surrounding area when GP practices are closed. This includes overnight, during weekends and bank holidays.

Patients access the out-of-hours service by calling NHS 111. The OOH service operates a total telephone triage service and the patients receive a call back from a clinician in accordance with the triage process.

The service is open seven days a week (including bank holidays) from 6.30pm to 8am each day and at weekends when GP practices are closed.

This service is delivered by a multidisciplinary team of clinical and non-clinical staff. This team includes GPs, Advanced Nurse /Clinical Practitioners and are supported by receptionists, car drivers and a management team. The service provides approximately 2000 to 2500 appointments each month.

The registered provider for the service is FCMS (NW) Limited which is a not for profit Social Enterprise Company Limited by Guarantee. FCMS (NW) Limited provide a range of services from several registered locations: They provide:

• Twenty-four hour, 365 day call taking, prioritisation and signposting of patients for unscheduled health or social care needs.
• Primary Care clinical telephone consultations, advice and treatment.
• Face to face primary care clinical consultations, advice and treatment either in a surgery setting or in the home environment.
• Extended access services.

Bay Urgent Care in Morecambe is one of nine locations. The other locations are:

Morecambe Urgent Treatment Centre

Urgent Care Centre Blackpool

Urgent Care Centre Doncaster

Doncaster Same Day Health Centre

Rossendale Minor Injury Unit

Fleetwood Urgent Treatment Centre

West Lancs GP out of hours service

PDS Planned Care Diagnostics

Updated 20 July 2022

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Bay Urgent Care on 25 April 2022. This was the first inspection of this Out of Hours (OOH) under this registered provider. Overall, the service is rated good.

A summary of CQC findings on urgent and emergency care services in Lancashire and South Cumbria.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Lancashire and South Cumbria below:

Lancashire and South Cumbria.

Provision of urgent and emergency care in Lancashire and South Cumbria was supported by services, stakeholders, commissioners and the local authority.

We spoke with staff in services across primary care, integrated urgent care, acute, mental health, ambulance services and adult social care. Staff felt tired and continued to work under sustained pressure across health and social care.

We found demand on urgent care services had increased. Whilst feedback on these services was mostly positive, we found patients were accessing these services instead of seeing their GP. Local stakeholders were aware that people were opting to attend urgent care services and were engaging with local communities to explore the reasons for this.

The NHS 111 service which covered the all of the North West area, including Lancashire and South Cumbria, were experiencing significant staffing challenges across the whole area. During the COVID-19 pandemic, the service had recruited people from the travel industry. As these staff members returned to their previous roles, turnover was high and recruitment was particularly challenging. Service leaders worked well with system partners to ensure the local Directory of Services was up to date and working effectively to signpost people to appropriate services. However, due to a combination of high demand and staffing issues people experienced significant delays in accessing the 111 service. Following initial assessment, and if further information or clinical advice was required, people would receive a call back by a clinician at the NHS 111 service or from the clinical assessment service, delivered by out-of-hours providers. The NHS 111 service would benefit from a wide range of clinicians to be available such as dental, GP and pharmacists to negate the need for onward referral to other service providers.

People who called 999 for an ambulance experienced significant delays. Ambulance crews also experienced long handover delays at most Emergency Departments. Crews also found it challenging managing different handover arrangements. Some emergency departments in Lancashire and South Cumbria struggled to manage ambulance handover delays effectively which significantly impacted on the ambulance service’s ability to manage the risk in the community. The ambulance service proactively managed escalation processes which focused on a system wide response when services were under additional pressure.

We saw significant delays for people accessing care and treatment in emergency departments. Delays in triage and initial treatment put people at risk of harm. We visited mental health services delivered from the Emergency Department and found these to be well run and meeting people’s needs. However, patients experienced delays in the Emergency Department as accessing mental health inpatient services remained a significant challenge. This often resulted in people being cared for in out of area placements.

We found discharge wasn’t always planned from the point of admission which exacerbated in the poor patient flow seen across services. Discharge was also impacted on by capacity in social care services and the ability to meet people’s needs in the community. We also found some patients were admitted from the Emergency Department because they couldn’t get discharged back into their own home at night.

Increased communication is needed between leaders in both health and social care, particularly during times of escalation when Local Authorities were not always engaged in action plans.

At this inspection of Bay Urgent Care we found:

• There was an established leadership team who prioritised a safe and effective service that supported the local emergency department and other primary care services.

• The provider ensured staff were supported by accessible leadership and good communication networks, training and development. A staff “Wellbeing” agenda was in place. Team members spoken with demonstrated a commitment to deliver a quality service.

• There were clearly defined and embedded systems to minimise risks to patient safety. Incidents, complaints and patient feedback were viewed as opportunities to learn and to improve processes. A learning log was in place which offered an overview of improvements implemented in response to issues and this log also included compliments received which were also shared.

• A comprehensive cycle of continuous quality improvement with supporting business plans was underpinned by the service strategy and this reflected the provider’s vision and values.

• The culture of the service was to work in partnership with local community health and social care services to deliver a person-centred responsive approach to people living in the local area.

• Staff involved and treated people with compassion, kindness, dignity and respect.

• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

The areas where the provider should make improvements are:

• Adapt the patient survey report to provide a service specific feedback report for each of the Urgent and Emergency Care services that patients are commenting on.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care