Primary Care/Urgent Care Centre

We carried out an announced focused inspection at the Primary care / Urgent Care Centre on 21 March 2022. This inspection was carried out as part of our national programme of Urgent and Emergency Care inspections.

At this inspection, only those key lines of enquiry designed to support the focused inspection of an Urgent Treatment Centre within the key questions of Safe, Effective, Caring and Well-led were examined. Therefore there are no ratings associated with this inspection.

We undertook this focused inspection at the same time as CQC inspected a range of urgent and emergency care services in Lancashire and South Cumbria. To understand the experience of these providers and people who use these services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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 we found:

• There was an established leadership team who prioritised a safe and effective service that supported the wider system.
• The provider had an effective governance system in place that enabled ongoing monitoring and scrutiny of the operation and performance of the services provided.
• Quality and performance was routinely monitored and records indicated that the service was performing well against key performance indicators.
• Clinical records viewed provided evidence that care and treatment was provided safely and effectively and in accordance with evidence-based guidelines.
• Despite facing many challenges with staffing the service had continued to maintain safe staffing levels with an appropriate skill mix of staff.
• Safeguarding and safety systems, processes and practices had been developed, implemented and communicated to staff to manage risk and ensure patient safety.
• Systems were in place to respond to incidents and to ensure learning was identified and cascaded so improvements could be made when necessary.
• Staff spoken with confirmed they had access to policies, procedures and guidance relevant to their role and responsibilities including clinical protocols.
• The provider had appropriate clinical equipment in place to enable assessment of patients including emergency resuscitation equipment and medicines.
• Records required under schedule 3 of the Health and Social Care Act were maintained and staff had access to induction, training and development.
• Infection prevention and control was appropriately managed to help safeguard people from a healthcare associated infection.
• There were processes in place to manage the flow of patients and to coordinate, monitor and respond to the presenting clinical needs of patients.
• Patients spoken with confirmed they were treated in a respectful and considerate way and patient feedback reviewed was generally very positive.
• Staff reported that there was a positive, inclusive and supportive culture and that they were supported by leaders within the organisation.
• There was a focus on continuous learning and improvement at all levels of the organisation.

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

Overall system summary will be inserted here once finalised

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care