Overall, we rated this service as good, although safety was rated as requires improvement. Although staff told us that there were usually sufficient staff to meet the need of the patients, there were high levels of staff sickness at the urgent care centre at Peterlee Community Hospital. Long-term sickness was being managed and agency staff were occasionally used to cover at Peterlee, with cover at other sites being provided by staff working longer hours or staff from other centres covering vacant shifts. Several staff from Bishop Auckland urgent care centre had recently left the service due to the uncertain future of the service. Staff teams usually consisted of GPs, urgent care practitioners and healthcare assistants. Staffing levels in centres were much higher during the day than at night and often, at Shotley Bridge urgent care centre, a single member of staff could be left to work in the department if a GP was called away. In one centre, the urgent care practitioner also held the second crash pager for the whole community hospital, to support the Advanced Nurse Practitioner within the hospital. Incidents of violence and aggression towards staff had been reported by staff and a security alert had been raised at Peterlee urgent care centre when a member of staff had felt threatened at night. A risk assessment had subsequently been carried out.
Staff were confident in reporting incidents and safeguarding concerns and we saw from staff meeting minutes that incidents and learning from incidents were discussed regularly. There was a child protection lead practitioner in the team. Documentation was correctly and consistently completed. Staff knew the procedure to follow if a patient’s condition deteriorated and transfer to the emergency department or admission to the acute site was required.
We saw some evidence of assessment tools in use. There was audit undertaken to monitor quality and people’s outcomes Multidisciplinary team meetings were held quarterly in each centre and included a range of staff (e.g. GP/Reception/Practitioner/HCA). Cross Centre Clinical Governance meetings were held monthly. Across all centres there were good relationships with local GP practices. Information was available via the electronic records system and discharge information was available electronically to other users of the system, such as local GPs.
Staff were competent in their roles and attended regular quarterly team meetings. They discussed best practice and changes in guidelines. Staff competency documents and supervision notes were unavailable during our visit. There were a number of care pathways in use, which demonstrated good patient outcomes. Staff told us that trust guidelines and National Institute for Health and Care Excellence (NICE) guidance were followed across all centres. They also explained that they frequently used their own clinical judgement and relied on professional integrity and responsibility.
Patients and their relatives or carers were treated in all interactions with dignity, respect and care was provided in a compassionate way. They were provided with relevant verbal information, emotional support and explanations about their care and staff checked patients’ understanding of the care planned and provided.
Radiology was available during the day at Shotley Bridge, Bishop Auckland and Peterlee centres. Patients attending Seaham urgent care centre would need to be transferred to Peterlee urgent care centre for radiology services. Premises were accessible for patients with limited mobility and peoples’ individual needs were well met by the delivery of patient-centred care. All services worked well together and coordinated within and across sites to ensure the best possible care was given. There was good access for staff to refer to the mental health team, who would attend the unit if called. There were clear criteria for ensuring all babies and pregnant women were seen by a GP, as well as patients returning to the centre on two or more occasions.
Governance structures were clear to both staff and managers. Learning from incidents was shared via the urgent care clinical governance group, which also discussed peer support and reviews. The management and leadership of urgent care had changed and a relatively new postholder was managing services across the stand-alone urgent care centres (Bishop Auckland, Shotley Bridge, Peterlee and Seaham). The culture within the service was mostly positive and confident and was actively looking at ways to improve. All the staff we spoke with were positive about the contribution they made to patient care and were very positive about the teams they worked in. Staff felt supported by managers, despite experiencing a prolonged period of transition and change, and reported effective team working. The changes were aimed at improving the services for local communities and ensuring sustainability.