The Care Quality Commission
  • Doctor
  • Urgent care service or mobile doctor

Harold Wood Urgent Treatment Centre

Overall: Requires improvement read more about inspection ratings

Gubbins Lane, Harold Wood, Romford, Essex, RM3 0FE

Provided and run by:
Partnership of East London Co-operatives (PELC) Limited

All Inspections

6, 7, 20 and 21 June 2023

During a routine inspection

This service is rated as requires improvement overall.

The service had previously been inspected between 10 November and 8 December 2021. The inspection rated the service as requires improvement overall and in the safe, effective and well led key questions. Caring and responsive were rated as good. The service was found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008, and requirement notices were served. A further inspection was carried out on 20 and 21 October, and 7 November 2022. In this inspection the service was again found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008. The service was rated inadequate, conditions were issued and the service was placed into special measures.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Harold Wood Urgent Treatment Centre on our website at www.cqc.org.uk

We carried out an announced comprehensive inspection of Harold Wood Urgent Treatment Centre on 6, 7, 20 and 21 June 2023. We found that some of the breaches of regulation from the previous inspection had been fully addressed, but for others whilst progress had been made there was more to do. Following this inspection, the key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

At this inspection we found:

  • The rating of the service had improved from inadequate to requires improvement. Significant work had taken place to address the breaches identified at the previous inspections, however in a few areas whilst there was progress there was still more improvements needed.
  • The service had begun to monitor more effectively the safety of the care it provided, and its performance was improving, but was still not meeting requirements specified by NHS England. Systems were now in place to monitor the time taken for patients to have their initial clinical assessment. However only 71% of patients were having this assessment within the 15 minute target. This meant there was an ongoing risk of patients needing urgent medical attention not being identified in a timely manner. An action plan was in place to continue to make improvements in meeting this target.
  • Patients were not consistently able to access care and treatment at the service in a timely way. The service had a target to provide treatment and discharge the patient within 4 hours. The service was meant to achieve this for 95% of patients but the average was 89-95% so slightly below the target.
  • Staffing at the service was not in line with the rotas that workforce planning exercises had deemed necessary. The rotas showed that there was a gap of at least 10% for the urgent care practitioners each month, meaning there were times when there were not enough staff working.
  • The service was not consistently monitoring the effectiveness of the work of individual clinicians. Not all the clinicians were receiving consistent regular and high-quality clinical supervision. In addition the audits of clinicians notes were not taking place as robustly as needed to ensure all clinicians were delivering appropriate clinical care.
  • The service did not yet have formal mechanisms to engage with patient groups.
  • Whilst governance processes had improved, there was still scope for these to be further strengthened, particularly in terms of ensuring staff performance was adequately monitored.

However, the following areas had been addressed:

  • The service had improved the management of incidents and complaints, and mechanisms were in place to share learning.
  • Leaders now had the capacity and skills to deliver high-quality, sustainable care.
  • The service had developed a clear vision and credible strategy to deliver high quality care.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

The areas where the provider should make improvements are:

  • Review the detail required in the review of clinical competencies.

I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

20 and 21 October, and 7 and 8 November 2022

During a routine inspection

This service is rated as Inadequate overall. The service had previously been inspected between 10 November and 8 December 2021. The inspection rated the service as requires improvement overall and in the safe, effective and well led key questions. Caring and responsive were rated as good. The service was found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008, and requirement notices were served.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Harold Wood Urgent Treatment Centre on our website at www.cqc.org.uk

We carried out an announced comprehensive inspection of Harold Wood Urgent Treatment Centre on 20 and 21 October, and 7 and 8 November 2022. We found that some of the breaches of regulation from the previous inspection had been addressed, but others had not been. We also found breaches in other areas.

This inspection was part of a follow up on our previous system wide review of urgent and emergency care services across the North East London (NEL) integrated care system that was carried out in November 2021. At that time, we identified issues with flow in and through the urgent and emergency (UEC) pathway and had significant concerns regarding the impact of this on safety and quality of care. Due to ongoing concerns regarding the UEC pathway and patient safety, during November 2022 we inspected all four urgent treatment centres (UTC) provided by the Partnership of East London Cooperatives (PELC), and both emergency departments (ED) and medical care provided by Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT). Subsequent to significant concerns that were identified at these locations, the Commission found that the challenges these services faced were also complicated by wider challenges within the health and social care system. A Quality Summit with NHS England and system wide partners was convened to devise an action plan to address the concerns identified.

Following this inspection, the key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Inadequate

Are services well-led? – Inadequate

At this inspection we found:

  • The service could not be assured that it was providing safe care to patients attending the service, particularly those with potentially serious conditions.
  • There were insufficient procedures and processes in place to ensure learning from incidents and complaints. There were not clear systems in place to demonstrate improvements when things went wrong.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, the service was not meeting the targets specified by its commissioners.
  • The organisation did not have sufficient procedures in place to ensure that effective staffing was being provided.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Patients were not able to access care and treatment at the service in a timely way.
  • Leaders did not have the capacity and skills to deliver high-quality, sustainable care.
  • There were some clear responsibilities, roles and systems of accountability to support good governance and management. However, lines of accountability and designated decision-making authority were unclear.
  • The service did not have a clear vision and credible strategy to deliver high quality care and promote good outcomes for patients.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of safe care and treatment.
  • Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good governance.
  • Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good staffing.

The areas where the provider should make improvements are:

  • Review compliance with infection protection and control guidance at the site.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

10, 11, 17, 18 and 25 November 2021

During a routine inspection

This service is rated as Requires Improvement overall.

We carried out an announced comprehensive inspection of Harold Wood Urgent Treatment Centre on 10, 11, 17, 18 and 25 November 2021. We are mindful of the impact of COVID-19 pandemic on our regulatory function. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We found breaches relating to the safe, effective and well led key questions. Following this inspection, the key questions are rated as:

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

At this inspection we found:

  • The service had good systems to manage risk in most areas so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes. However, incidents were not being processed within their own specified timelines.
  • The organisations own audits showed that best infection control practice was not being consistently followed.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines. However, the service was not meeting the targets specified by its commissioners.
  • The organisation did not have sufficient procedures in place to ensure that effective staffing was being provided.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Patients were able to access care and treatment from the service, although it was not routinely meeting the four-hour target for patient throughput.
  • The leadership and governance functions at the organisation had been improved and were mostly in line with its constitution. However, some governance functions did not meet the needs of the organisation.
  • Staff that we interviewed stated that the culture of the organisation had improved since the previous inspection, although some staff said that they were not listened to.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure that care and treatment is provided in a safe way to patients. Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
  • Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good governance. Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
  • Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good staffing. Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care