Archived: Care UK - Wycombe Minor Injuries and Illness Unit

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Care UK – Wycombe Minor Injuries and Illness Unit on 13 December 2016. The overall rating for the service was requires improvement. Specifically the service was rated good for provision of effective, caring and responsive services and requires improvement for provision of safe and well-led services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Care UK – Wycombe Minor Injuries and Illness Unit on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 26 September 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 13 December 2016. 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 overall with provision of both safe and well-led services re-rated to good.

Our key findings were as follows:

• Reception staff had been trained to undertake initial assessment of priority for walk in patients and followed an assessment protocol. Clinical staff were available to support the assessment process when needed. The provider was in the process of recruiting clinical navigators to support initial assessment and the recording of baseline clinical measurements for walk in patients.
• Information about how to make a complaint was carried in the vehicles used to carry staff to home visits.
• Prescribing of high risk medicines followed the providers prescribing policy and there were checks in place to ensure this happened.
• Performance in relation to national quality requirements was improving.
• Blank prescriptions were held safely and there was a system to track them through to issuing.
• A system was in place to monitor the training and appraisals of sub-contracted staff. The system also gave the provider assurance that staff maintained their professional registrations and updated their Disclosure and Barring service (DBS) checks. (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).

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 Care UK-Bucks Out of Hours (OOH) service and the Minor Injuries and Illness Unit (MIIU) at Wycombe General Hospital on 13 December 2016. The out of hours service operates from a single call centre and headquarters in Aylesbury. The MIIU operates from the Wycombe General Hospital. Overall the service is rated as requires improvement.

Specifically, we found the service to require improvement for the provision of safe and well led services. The service is rated good for providing effective, caring and responsive services.

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

• There was an effective system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• The provider had systems in place to identify, assess and manage risk but the systems were operated inconsistently. Some risks associated with the process of initial assessment (of walk-in patients) carried out by a reception staff at the MIIU had not been managed effectively. The patient who was assessed as a ‘routine’ by a reception staff could wait up to four hours before a first contact with a clinician.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The National Quality Requirements (NQRs) standards for the OOH service and the Key Performance Indicators for the MIIU service were monitored and reviewed to ensure that if any improvements were required they would be identified and implemented’
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, the provider did not have a systematic approach to assure themselves that all GPs not directly employed by the Care UK had completed training relevant to their role and that sub-contracted staff covering the minor injuries service had completed mandatory training and had regular appraisals.
• There were safeguarding systems in place for both children and adults at risk of harm or abuse as well as palliative care (care for the terminally ill and their families) patients who accessed the service.
• There was a system in place that enabled staff at the out of hours service to access patient records, for example the local GP and hospital, with information following contact with patients as was appropriate.
• The service proactively sought feedback from staff and patients, which it acted on.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience.
• The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
• The service managed patients’ care and treatment in a timely way.
• Information about services and how to complain was available at the out of hours centres. Improvements were made to the quality of care as a result of complaints and concerns.
• There was a clear leadership structure. Communication channels were open and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Respond to and mitigate the risk associated with the process of initial assessment, carried out by a receptionist and first patient contact with clinicians to ensure that patients are accessing the appropriate service, transferred in a timely fashion to alternative services and to mitigate unnecessary risk associated with waiting times.
• The provider must review, assess and monitor the governance arrangements in place to ensure and improve the quality and safety of the services provided.
• Ensure all GPs not directly employed by the Care UK had completed training relevant to their role and that sub-contracted staff covering the minor injuries service had completed mandatory training and had regular appraisals.

The areas where the service should make improvements are:

• The provider should make sure that prescribers follow the prescribing policies for recording the supply of medicines.
• Review and improve the national quality standards relevant to the face to face consultations both at an out of hours base and at patients place of residence within two hours of assessment for those patients classified as ‘urgent’.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice