Archived: Slough Walk in Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Slough Walk-in Centre on 9 August 2016. Overall Slough Walk-in Centre is rated as requires improvement. Specifically improvements are required in providing safe, effective and well-led services.

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

• There was a system in place for reporting and recording significant events. Reviews of complaints, incidents and other learning events were thorough
• Risks to patients were mostly assessed and well managed. However, we found one fridge containing vaccines was not monitored properly and we identified temperatures outside ranges required for storage of vaccines.
• Staff assessed patients’ ongoing needs and delivered care in line with current evidence based guidance.
• Walk in patients often waited more than an hour to be seen by a clinician. There was no system to identify patients with more serious conditions, other than a receptionist asking what their medical problem was. On the day of our visit here were waits of approximately two hours for some patients using the walk in centre without a clinical assessment.
• Children were prioritised through the walk-in service.
• National data from 2015 suggested clinical care for patients with long term conditions was not always in line with best practice. However, in 2016 national indicators for the centre improved significantly.
• The monitoring of overall patient care was not always appropriate in terms auditing clinical care and treatment.
• The system for reviewing patients on repeat medicines was appropriate.
• Staff were trained in order to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Slough Local Healthwatch undertook a study which identified that the centre was valued by local groups of people who may be unable to register at GP practices, such as refugees.
• Screening for HIV, TB and Hepatitis was offered and referrals were made where required.
• Coding on the computer record system meant vulnerable patients were not always listed or easily recognisable to staff, including carers, learning disabled patients and those with mental health problems.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patient feedback regarding access showed registered patients were usually able to make an appointment.
• The centre had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The centre proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was a focus on continuous learning.

Areas the provide must make improvements are:

• Ensure the proper and safe management of medicines. Specifically ensure fridges are appropriately monitored if storing medicines.
• Develop a plan to assess and do all that is necessary to mitigate risks related to low achievement in performance data to improve patient outcomes. For example, correct and accurately apply the coding on the patient record system to ensure that patients’ needs are assessed and care is monitored appropriately. This includes registers of carers, mental health patients and clinical care recording.
• Improve the monitoring of patient care to ensure any risks are identified and improvements planned where required. For example, through clinical audit.
• Review the risks associated with the process of initial assessment and first patient contact with clinicians to ensure that patients are accessing the appropriate service, transferred in a timely fashion to alterative services and to mitigate unnecessary risk associated with waiting times.

Areas the provide should make improvements are:

• Review how significant events are communicated to staff.
• Continue to identify ways to improve patient experiences, particularly as regards telephone contact with the centre.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice