Lymington Urgent Treatment Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed and inspected against six quality statements, Person-centred care; Care provision, integration and continuity; Providing information; Listening to and involving people; Equity in access and Planning for the future. During our assessment of this key question, we found an outstandingly responsive service. Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care. People and communities were always at the centre of how care was planned and delivered. The health and care needs of people and communities were understood and they were actively involved in planning care that met these needs. People could access care in ways that met their personal circumstances and protected equality characteristics. People, those who supported them, and staff could easily access information, advice and advocacy. This supported them in managing and understanding their care and treatment. There was excellent partnership working to make sure that care and treatment met the diverse needs of communities. People were encouraged to give feedback, which was acted on and used to deliver improvements.

This service scored 96 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were outstandingly satisfied with the service they received from the urgent treatment centre overall. The service had collated and reviewed patient feedback by month. 86% of the feedback responses submitted for May 2024 had a 5-star outstanding feedback rating. 46 of these outstanding feedback submissions related to people saying they had a positive person-centred care and treatment experience. Where patient's raised concerns, the service contacted them where possible to provide a more personable response and to obtain further clarity on feedback for consideration of future service improvements. People who attended the service with suspected pelvic and hip fractures were able to be diagnosed by x-ray at Lymington Hospital, within the shared premises. A result of joined up working with system partners, the patient person-centred care journey was improved as the time and travel required for people to attend the nearest emergency department was reduced. People were able to receive care in a quicker timeframe as referrals were able to be initiated to the local frailty support team by the service. The service initiated two-week wait referrals for investigations for suspected cancer, including mechanisms to ensure primary care providers received and reviewed the referrals. This highlighted a potential reduction in the time people were identified for a two-week wait review by the primary care provider. We received feedback from a local charity which worked closely with the service. They had raised funds to improve and redesign the paediatric waiting room as a result of the increased patient demand. The charity was able to fund a new slit lamp and tonometer (an instrument for measuring the pressure in the eye) which upon an audit review, had reduced emergency department (ED) admissions by 600 patients a year.

Staff and leaders told us how the service had worked innovatively with partners to ensure staff understood how best to support people. They described how adjustments had been made as a result of effective joint working to ensure staff developed a highly individualised approach, particularly when supporting people with multiple and complex needs. Staff provided examples of how patient care had improved as a result of working closely with local healthcare organisations to provide joined up care. Such as working in partnership with the crisis team at TreeTops Sexual Assault Referral Centre (SARC). A process had been developed which involved labelling specimen urine samples for suspected vulnerable people with discrete guidance and instructions to identify whether further support was required or additional safeguarding processes needed to be followed to protect the people from any domestic violence. Staff also described how the service met the needs of neurodiverse people and people with learning disabilities. Leaders told us staff held first aid training days with a local special needs school to improve education and community engagement. The service considered feedback from an audit carried out by a disability nurse specialist. As a result of the audit, adjustments had been made to the environment with new colour coded signage in hospital grounds to make it easier for people to find their way in the hospital. Autism spectrum disorder (ASD) storyboards were designed so that children could understand what the urgent treatment centre (UTC) did and how their treatment would be carried out. This enabled children to be active partners in their treatment and informed treatment decisions. Staff told us clinicians followed-up with primary care providers to ensure a comprehensive handover was provided for those patients who had been instructed to be seen again in-hours.

Staff worked pro-actively to support their patient community to received co-ordinated and flexible care through ongoing evaluation of the support the service could offer. Leaders explained how they had carried out a large-scale audit of 2568 cases presented at the urgent treatment centre. As part of this audit they had reviewed cases referred by the local hospitals including from emergency departments to the urgent treatment centre to determine whether referrals had been appropriate and could be supported by UTC. Learning was taken from those cases that were deemed to be out of the urgent treatment centre's remit and new clinical pathways had been developed based on the review of cases seen by diagnosis. This helped the service utilise newly implemented local protocols and clinical pathways more effectively. For example, leaders described a system was being developed to identify children or vulnerable adults signposted to Emergency Department (ED) who were then “not brought" to ensure they were followed up and not left without care. Following clinical assessment, referrals for patients to a specialty with a working diagnosis rather than sending patients to the ED was better for the patient journey and were more likely to attend and get the care they needed. The provider told us that they had developed a strong working relationship with the local emergency departments (ED) as a result of an increased number of ED referrals from the Urgent Treatment Centre (UTC). Consequently, the UTC on some instances were able to accept people from busy emergency departments helping to reduce the pressure placed on the local urgent and emergency care system. Staff told us clinicians were positioned ‘on the door’ during sign-in as a safety mechanism to review highly unwell people and to ensure ambulatory care or ED referral was provided where required and out of scope of UTC care.

The service worked with the local commissioners to review key performance indicators and patient safety events to provide learning outcomes. Feedback from the local clinical group, with Portsmouth hospitals and commissioners were highly complementary. This included the thorough review of end to end cases where patient case studies were discussed to further embed learning and implemented changes to service provision where required. There was a focus on a development of learning and clinical skills for practitioners within the urgent treatment centre. For example, further external training courses were available to staff such as safeguarding level 4 and palliative care workshops. The local hospital charity, Friends of Lymington supported the urgent treatment centre by funding specialist equipment and project management. They were also highly complementary about the service’s leadership. They described them as being proactive and understanding the needs and preferences of the local community. They described different types of clinical cases that had presented at the urgent treatment centre and the manner in which care was delivered went above and beyond to ensure high quality care and excellent outcomes for people. The Friends of Lymington told us there were ongoing plans to redesign the current UTC facility to meet the increasing patient demand above what was commissioned. This included plans to expand the clinical treatment areas to include four additional clinical rooms for the purpose of isolation, if required, thereby building in resilience and enabling continued care in any future pandemic. Commissioners told us that the provider held effective oversight of vulnerable people, monitored their safeguarding registers and co-ordinated and monitored care by working with the local authority.

The provider worked creatively and proactively to ensure there was continuity in people’s care. They developed new ways of working and continued to upskill staff to enable them to respond to people’s needs. We identified examples where the service worked well with other healthcare services because they had developed robust, comprehensive clinical pathways based on various injuries and illnesses. The UTC worked for example, with a local fracture clinic to join up care for elderly and frail patients who presented with musculoskeletal issues. This meant people had a more accessible healthcare journey through referral pathway options. Referrals generated by 111 and the clinical assessment service (CAS) were continuously reviewed to ensure they remained appropriate. Case reviews were used to develop staff skills thereby increasing the service’s community responsiveness through ongoing learning. For example, additional ‘spotting the sick child’ training and the introduction of enhanced paediatric monitoring equipment (such as pulse oximeters, a device that measures oxygen saturation in the blood). ‘Lunch and learn’ sessions were available for staff with opportunities for refresher training on different clinical treatment topics, including the review of national guidance. We were provided with examples of changes made to treatment as a result of a ‘lunch and learn’ session such as a new epistaxis protocol (refers to nasal bleeding of any cause. Most epistaxis is minor and insignificant, but it may be severe and life threatening, and it can be indicative of more serious disease), providing more convenient and less painful than traditional nasal surgery. The provider identified an average of 10-11 children who had been referred onto the ED from the service. The audit resulted in an improved measure to alert ED of the clinical information surrounding the child.

People were outstandingly satisfied with the service they received from the urgent treatment centre overall, including how the service had provided information to people about their care and treatment. The service had collated and reviewed patient feedback by month. We identified 86% feedback responses submitted for May 2024 had 5-star outstanding rating. 48 of these outstanding feedback submissions related to people saying they had a positive experience that resulted from the service going above and beyond in providing information about the care and treatment for patients. This is also related to receiving responses to queries, incidents and complaints. If people raised concerns, the service contacted them where possible to provide a more personable response and to obtain further clarity on feedback for consideration of future service improvements. We identified positive feedback trends in relation to the information provided by the service to people that helped them understand their care and treatment and advice should their conditions deteriorate.

The service worked pro-actively to ensure their local community received accurate information about the service to inform their treatment decisions. Leaders told us that the service held an open evening in conjunction with the ‘Friends of Lymington’ charity. This gave the local community information on the remit of the urgent treatment centre as well as opportunities for people to participate and understand the service. We were provided with positive feedback about the engagement event and plans were in place to hold future sessions. Staff told us the service had enrolled a volunteer who supported people to complete online forms and health information questionnaires where required as well as assisting patients who had disabilities and wheelchair users across the Lymington hospital premises. Staff gave examples how they shared information tailored to people’s needs such as guidance given to blind people to assist accessibility within the hospital as well as information about care and treatment options available in braille provided by the service.

People’s preferred method of communication was considered when using the service, this included in service feedback requests as well as when sharing information with primary care providers such as people’s GP practices. Process were in place for staff to submit care and treatment notes to people’s GP’s within 2 hours of patients being seen at the urgent treatment centre to ensure information was shared and provided in a timely way. Information provided was legible and accessible. The service had provided training in relation to General Data Protection Regulation (GDPR) with compliance oversight held by the Service Co-ordinator. We saw examples where information was sent confidentially and securely via communication systems. The service had no information governance breaches within the past 12 months. The provider had developed an easy-read booklet on services provided by the urgent treatment centre and guidance on accessing the service from within the local area. Digital screens were in place within the waiting area which provided information relating to healthcare promotion and local initiatives as well as approximate waiting times based on current service levels. We saw examples where the provider went above and beyond meeting the needs of people by providing patients triage to emergency department forms which included suspected diagnosis and potential treatment with safety netting of signs and symptoms of what to look out for if symptoms deteriorated before arriving at the emergency department. This included ‘healthier together’ information cards as well as digital access to information with QR codes available.

People were outstandingly satisfied with the service they received from the urgent treatment centre overall. The service had collated and reviewed patient feedback by month. We analysed patient feedback from May 2024 and found a total of 198 feedback responses from 2311 feedback requests. We identified 86% feedback responses submitted for May 2024 had 5-star outstanding rating. 12 feedback submissions related to a positive response received in relation to queries, incidents and complaints. If patient's raised concerns, the service contacted them where possible to provide a more personable response and to obtain further clarity on feedback for consideration of future service improvements. We identified positive feedback in relation to the information provided by the service to people and involving them in service improvements, including regular engagement with patient forums; complaints management and implementing feedback about the service as well as outcomes from incidents. We were presented with examples of how the service listened to and involved people in relation to their feedback or complaints. People were offered face to face or telephone feedback for resolutions where possible and considered those with mobility difficulties within the local community.

Leaders told us service feedback themes were shared with the local commissioners and clinical sub-groups. This included case study reviews to improve the outcome of future care and treatment for patients and shared learning with staff. Leaders also told us that dedicated time was given to the lead GP and Governance Manager for clinical reviews of incidents and complaints. Staff were able to provide us with examples of learning outcomes as a result of this such as a change to the scope of practice and treatment for charcot foot (a problem which can affect the foot in people with neuropathy, nerve damage with numbness). The service had reviewed the clinical pathway and had improved this to include referral to local podiatry services within 48 hours upon clinical presentation to prevent weight bearing and further complications with this type of conditions. Further staff training was given to clinical staff at the service to ensure this implemented process was embedded. Staff told us that clinical staff reflections contributed towards their annual appraisal process and there were opportunities to develop their clinical skills through continuing professional development (CPD).

We identified the provider had a ‘booking in’ process for people, this included the offer to all people to be involved in their patient forum. This was innovative and helped gain an insight into feedback to drive service improvements. As urgent care providers typically do not have a returning patient population, the service created a patient forum to give local patients an opportunity to engage with the provider on a routine basis. The service held routine engagement with their patient forum, called the ‘Esther café’, which encouraged opportunities for people to raise feedback for service improvements. We saw examples of positive outcomes as a result of feedback raised via this method such as the innovative ‘See and Treat’ model with a dedicated room for this type of triage. This system enabled people to be streamlined and treated more efficiently, as people were able to be seen interchangeably between staff depending on their conditions. The service was able to review and audit patient feedback following the introduction of the ‘See and Treat’ model and engaged with the patient forum for reflections. In addition, patient wallboards had been introduced with advice on a range of clinical conditions and treatments were available throughout the premises. Patient feedback was also obtained via a text messaging service following visits which included both quantitative and qualitative data. This provided insight into any improvements required to the service provision as well as highlighted outstanding areas of service, particularly noting the care and treatment provided by the UTC. Service leaders held oversight of patient feedback for quality assurance purposes and information was used to present proposed improvements within governance staff meetings. Patient identifiable information was redacted to protect confidentiality. Feedback response letters were submitted and patients were also offered face to face meetings with service leaders should a complaint be identified.

People were outstandingly satisfied with the service they received from the urgent treatment centre overall, including accessibility and being seen and treated within efficient timeframes. The service had collated and reviewed patient feedback by month. We analysed patient feedback from May 2024 and found a total of 198 feedback responses from 2311 feedback requests. We identified 86% feedback responses submitted for May 2024 had 5-star outstanding rating. 86 feedback submissions related to efficient, timely access to care and treatment. If patient's raised concerns, the service contacted them where possible to provide a more personable response and to obtain further clarity on feedback for consideration of future service improvements. We found positive feedback in relation to waiting times, accessibility and the consideration of people who required additional support to access services. We identified that lunch boxes were made available for frail and diabetic patients for those with up to 4-hour waits during the lunchtime period which highlighted above and beyond approach to the care for people.

Leaders were able to demonstrate that access performance was exceptional with monthly reports consistently identifying 95% of people being initially screened within 15 minutes of arrival; 99% of people being seen and treated within 2 hours and 99% of people being discharged from the service within 4 hours for the past 12 months. These key performance indicators (KPI’s) were set out nationally by NHS England for urgent care providers and the provider consistently exceeded targets in these areas. Staff told us that the service provided follow-up appointments where required, for example, for people with burns and wound dressing. This relieved the demand placed on GP providers by offering this type of care and treatment provision. Staff told us that there had been a local television advertising campaign to help educate people on what the service could offer and what was in scope of the care and treatment available at the urgent treatment centre to reduce inaccessibility. Ongoing information was made available including guidance and accessibility on social media.

People could access services and care was managed to take account of people’s needs, including those with urgent needs. Waiting times, delays and cancellations were minimal and managed appropriately. People were kept informed of any disruption to their care. The service had implemented a new model of care, in response to increased patient demand and staffing pressures. This included an ‘initial assessment’ and ‘See and Treat’ process with clear protocols, to improve the capacity and safety of the service. Patients were triaged and assessed within target timeframes which were audited and reviewed which illustrated consistent and efficient high performing service provision. The service had adopted a framework for staff of various experience and clinical skills to fulfil the ‘initial assessment clinician’ and ‘see and treat clinician’ roles. This system enabled patients to be streamlined and treated more efficiently, as patients were able to be seen interchangeably between staff depending on their conditions. Health care assistants (HCA’s) had a development pathway which included clinical upskilling, assigned mentorship and funded qualifications to help retain staff and improve service provision for patients. The provider had a service improvement plan, with patient access a standing agenda item. The provider acted on feedback to improve services by expanding the waiting area into the atrium to increase patient capacity, enabling a further ‘see and treat’ room to become available. The reception desk had wheelchair access to accommodate patient needs on sign-in. Bariatric wheelchairs were also available within the premises. The service was open 8am to 9pm daily. Clinicians were on-site until 10pm for any influx of late patients, this included chaperoning and admin cover. The provider had received a Silver Award for Veterans Awareness accreditation as a result of their work and support. The service provided clinics for military veterans to discuss care planning.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not identify any feedback specific to informed decision making about the future of patients care, including at the end of their life.

Staff told us they had access to end-of-life training, immediate life support training (including paediatric) and Deprivation of Liberty Safeguards (DoLS) training to meet the requirements set out in the Mental Capacity Act (2005). The clinical lead and GPs were trained in advanced life support training. This enabled them to identify the causes of cardiac arrest, recognise patients in danger of deterioration, and manage both the cardiac arrest and the 'peri-arrest' problems encountered after initial resuscitation from a cardiac arrest. Staff felt confident there was support and guidance from experienced practitioners with end of life and frailty knowledge.

The provider carried out record audits to ensure palliative or end of life patients were identified and received appropriate care and treatment. The service had mental capacity assessment guidance and flowcharts available to ensure staff were able to follow the requirements set out in the Mental Capacity Act (2005). Discharge against medical advice (DAMA) processes were in place for patients who did not wish to carry out the care and treatment of the service. DAMA processes are applied when a patient, or the parents or caregivers in the case of paediatric patients, decides to leave a healthcare provider without approval of the treating clinician. Independent advocates were available for people who wished to have further support during their time at the service. Staff had access to procedures which enabled them to inform primary care providers such as GP services of any care and treatment carried out, with consent from the person, should DAMA occur, in addition to escalation to local authorities should there be a safeguarding concern. Staff were trained and had guidance to review and ensure specific care plans were identified for people to ensure their resuscitation and emergency treatment wishes were known. The provider had access to annual training for staff in relation to mental capacity act and learning disabilities and consent. Further training course opportunities were made available for staff specifically in relation to ‘Managing difficult conversations about End of Life’. This aided the development of soft skills and communicating with patients about their specific healthcare needs. The provider had implemented specific clinical pathways such as musculoskeletal specialisms as well as referral pathways for frailty and admissions for elderly and vulnerable people to aid the patient journey by reducing the time it took for people to access care from other services.