Lymington Urgent Treatment Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed and inspected against six quality statements, Shared direction and culture; Capable, compassionate and inclusive leaders; Freedom to speak-up; Workforce equality, diversity and inclusion; Partnership and communities and Learning, improvement and innovation. During our assessment of this key question, we found the service was outstandingly well-led. The leadership, governance and values of the service were used to drive and improve the delivery of high-quality care and treatment. We identified an inclusive and exceptionally positive culture of continuous learning and improvement. This was based on meeting the needs of people who use services and the local community, and all leaders and staff shared this. Leaders proactively supported staff and collaborated with partners to deliver care that was highly integrated, person-centred and reduced inequalities.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders were exceptionally proud of the service as a place to work and spoke enthusiastically of the supportive and highly person-centred culture. They spoke about patients with tenderness and kindness. For example, explaining how staff used activities such as bubbles for children to comfort them whilst their medical history was obtained from their parents. Staff on all levels told us they were highly motivated and driven by the principles of the service’s Esther model. They gave us multiple examples of how this approach of continuous quality improvement, cross-organisational communication, problem-solving, and staff training improved the quality and sustainability of care and people’s experiences. Staff told us that they were actively encouraged to speak up and the service had a ‘no blame’ approach to incidents and complaints that supported them to raise concerns. Staff felt involved with service improvements and gave many examples of how their feedback had led to improvements. They felt communication was excellent and they were kept updated when processes had changed and improved. We received staff feedback forms as part of our assessment which showed staff felt the provider and staff had a positive caring attitude towards both staff and patients. Staff demonstrated they contributed to learning by completing monitoring tasks including contributing to audits such as medicine management. Leaders told us that the service had sought and achieved improved workforce sickness benefits and reasonable adjustments for staff who required flexible working patterns.

The provider’s strategy and supporting objectives and plans were stretching, challenging and innovative, while remaining achievable. We saw many examples throughout this assessment of how the innovative Ester model had enhanced creative joint working to the benefit of patients. The urgent treatment centre was awarded with the Partnering Health Limited team of the year in 2023 which celebrated their exceptional collaborative approach. A service improvement plan was reviewed every 2 weeks and service leaders shared updates weekly which ensured staff on all levels were actively participating in achieving the short-term and long-term goals required to meet the provider’s strategy. There was an integrated approach to monitoring, reviewing and providing evidence of progress against the strategy and plans. The service was proactive in acting upon service feedback through patient forum groups and meetings with ‘Ester café’ sessions. They were responsive to both positive and negative feedback and used themes and trends to make service improvements. This included, implementing a wheelchair accessible reception area for patient sign-in and larger waiting areas and renovation to the paediatric area. The provider maintained a risk register with service improvement actions and business continuity arrangements. The provider carried out additional face-to-face equality and diversity training for staff in response to care of patients with protected characteristics to ensure everyone was included in their treatment decisions. Staff were given opportunities to develop their clinical skills and were provided with additional training and continuous professional development (CPD). The service provided a staff member with an apprenticeship to gain a nursing qualification as part of their role as a Healthcare Support Worker. The provider had plans to appoint physician associates for specialist clinical development roles within the service.

Leaders told us they were highly focused on modelling and developing the desired culture. They understood the value of corroboration and explained the service’s values, developed through 8 core meetings with local working groups and staff engagement events. Leaders told us they had opportunities to develop their clinical expertise and skills through additional training and continuous professional development (CPD). For example, we identified the clinical manager had undertaken ‘serious incident investigation training’. The provider planned to fund the clinical manager’s Master’s level 7 apprenticeship as part of investing in leadership development and succession planning. This meant that people received a more integrated response to feedback and responses to care and treatment. Leaders understood the challenges to providing a collaborative and integrated approach to urgent care and therefore were able to develop clinical pathways through evaluating end to end review of patient cases to inform service improvements. The registered manager had undertaken CPD in healthcare leadership and previously worked for an ambulance service as a paramedic. Staff told us that having a service manager with a clinical background was an asset and aided with understanding the challenges and pressures staff faced and was able to provide solutions where possible. Leaders told us they had plans to recruit a deputy clinical manager and service co-ordinator to provide cover and resourcing capabilities to assist with service performance further. Staff told us that leaders had a good track record of addressing and identifying problems early. For example, during a case of alleged bullying within the workplace. We received 14 staff feedback responses during our assessment and identified outstanding and complimentary themes regarding improved clinical service provision, working conditions, person-centred care and support for staff provided by leaders.

Leaders had a deep understanding of issues, challenges and priorities in the service and were able to provide short notice clinical support and shift cover as part of contingency planning. Rotas were planned 12 weeks ahead of time where possible to give staff awareness of working patterns and to accommodate reasonable adjustments and flexible working. Leaders had created and implemented team development and competency documents for each role within the service. This encompassed clinical supervision, audits of skills, prescribing and consultation records and notes. Leaders provided staff with monthly newsletters which included patient case reflections, clinical summaries and potential clinical trials. Staff were given ‘thank you letters’ during periods of good performance. The service had implemented an inclusive recruitment protocol, with recruitment selection tests; clinical scenarios and involved existing staff during interviews to ensure prospective recruits shared the service culture and direction. Leaders celebrated and encouraged safe innovation. For example, staff had further training opportunities such as nasal cauterisation and packing in conjunction with the local Ear, Nose and Throat (ENT) hospital department to improve the care and treatment in response to increased prevalence of clinical presentation.

Staff we spoke to were able to identify the Freedom to Speak-up Guardian and felt confident they would support staff to speak up if needed. We received staff feedback forms as part of the assessment which highlighted the open and honest culture which encouraged staff to raise concerns and those who do are supported without fear of retribution. When concerns were raised, leaders explained how they investigated sensitive and confidential information and lessons were shared and acted on. Staff told us internal staff surveys were acted on and used to make improvements to the service. This included introducing additional medical equipment required to treat patients as well as the implementing of new clinical pathways where appropriate.

The provider had a whistleblowing policy in place which detailed the Freedom to Speak-up Guardian and how they could be contacted. This individual was part of the wider Partnering Health Limited organisation but worked outside of the urgent treatment centre. The service reviewed incidents via an electronic reporting platform and feedback was given to staff where appropriate. We saw examples of incidents which included the appropriate investigations were carried out. When something went wrong, people received a sincere and timely apology and were told about any actions being taken to prevent reoccurrence. There was a zero-tolerance policy in relation to the abuse of staff with mechanisms in place to protect people and minimise the likelihood of reoccurrence.

The provider valued diversity in the workforce. Policies and work practices were proactively reviewed and adjusted to ensure equality, diversity and inclusion across the workforce. We saw reasonable adjustments were made for staff where required, such as completing pregnancy risk assessments that ensured triage shifts were bespoke and planned ahead of time. Leaders took action to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act. We saw examples of how workforce equality had been considered and processes had changed as a result of understanding the needs of all staff members. We identified a ‘lunch and learn’ session that raised awareness of menopause and how that affected both service users and staff members. The provider updated the human resource (HR) policy as a result which included funded HRT medicine (hormonal medicines used to treat menopausal symptoms) for its staff members. We identified fair and equitable treatment of staff, particularly in relation to rota management and staff resourcing arrangements. For example, rotas were planned 12 weeks ahead to ensure adequate cover arrangements were in place such as leave period. Temporary staff such as locum and bank shifts were advertised ahead of time to prevent workforce burnout. Staff told us that they felt listened to and formal feedback was obtained annually and was used to drive service improvements. We identified examples such as expanding patient information forms, ‘Healthier Together’ cards, including online access to information about the treatment and conditions. Staff told us they had opportunities to develop their clinical skills through Continuing Professional Development (CPD) in areas of individual interest such as work experience arrangements with the eye casualty hospital and outreach team. This helped to improve the experience of staff in a wide area of clinical care.

We did not look at Governance, management and sustainability during this assessment. The score for this quality statement is based on the previous rating for Well-led.

People were outstandingly satisfied with the service they received from the urgent treatment centre overall, including the transfer care between local healthcare organisations. The service had collated and reviewed patient feedback by month. We identified 86% feedback responses submitted for May 2024 had 5-star outstanding rating. 21 feedback submissions related to the service proactively working with local healthcare providers to ensure their care and treatment was joined up and effective. Referral pathways were available and people who moved between services were seen in a timely way with the information they required to inform future planning. 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.

Staff told us the service went above and beyond when working with partners and the local community to meet people’s needs. For example, the service hosted first aid courses including for the New Forest South Cubs to encourage children to be aware of and carrying out basic first aid. They told us about the innovative projects and proactive joint working described throughout this assessment. Leaders told us that they were involved with the Hampshire Urgent Care seminars which enabled them to improve care through effective planning of resources within the integrated care system (ICS) and also provided opportunities to network with external stakeholders. Staff told us partnerships also provided opportunities to develop their skills and progress within the service. This included Healthcare Support Worker Nurse apprenticeship in partnership with the local university hospital.

The service worked with the Lymington Hospital Friends charity to improve the wellbeing of patients which included a recent project on people who experienced strokes and their rehabilitation. They told us a therapy garden was built at the Lymington hospital in conjunction with the Urgent Treatment Centre, providing motor-skills workshop activities to improve community care. The service worked collaboratively with a local clinical group in conjunction with Portsmouth hospitals commissioners to develop learning and clinical skills for practitioners within the urgent treatment centre. We saw evidence of outstanding feedback to external training collaboration in relation to the management of musculoskeletal and hand trauma, improving the skillset of clinical staff and treatment outcomes. As a result, people had access to clinical pathways to the local university hospital through joined up care. Staff had access to a mobile triage referral system, with suspected hand injuries stratified by risk and severity in line with national guidelines. We identified feedback that showed the service used the local healthcare network to identify new and innovative ideas that led to better treatment outcomes for people.

The service excelled at building relationships with healthcare partners. This was evident in the clinical pathways and array of treatment options that had been developed to the benefit of people using the Urgent Treatment Centre. This included joint working with the crisis team at TreeTops Sexual Assault Referral Centre (SARC); expansive fracture clinic referral options to extend accessibility for people who lived in Dorset; Solent podiatry as well as referral pathways for frailty and admissions to Medical Assessment Unit (MAU) and Forest Assessment Centre (FAC) for elderly and vulnerable people. The Urgent Treatment centre worked with services within the Lymington hospital so that people had easy and timely access to diagnostic imaging where required. The UTC worked with diagnostic hospital team to review patient cases to ensure musculoskeletal referrals were appropriate, to inform care and treatment as well as learning for clinical staff. The service highly valued feedback from people and viewed them as equal partners in service improvement. This included proactively seeking feedback about how the service was run. We saw improvements that had been made on recommendations from the Esther café (patient forum). The provider also worked with patients to carry out a Patient Led Assessment Audit of the care and environment in May 2024 which recognised positive performance and a review of subtopics. This included infection prevention and control; hand hygiene and equipment; dementia friendly environment; privacy, dignity and well-being. The audit resulted in patients stating they felt very confident that a good level of patient care and experience was being delivered from the service.

The service celebrated innovation. There was a clear, systematic and proactive approach to learn, seek out and embed new and sustainable ways of working. We saw examples of improved clinical treatment pathways as a result of end-to-end patient case reviews identified through service audits. This included developing a local thrombophlebitis pathway with Forest Assessment Centre within Lymington hospital for suspected deep vein thrombosis (DVT) which can be mistaken for cellulitis. The service implemented patient information advice for suspected DVTs and dedicated clinical documentation to support referrals. Specific training was given to clinical staff to ensure prospective care and treatment was safe and effective. Leaders had further training opportunities for Health Services Investigations Body (HSSIB) complaints training, offering face to face and virtual responses to patients who were identified as frail or vulnerable as part of complaints or incidents processes. The clinical manager contributed research to the British Paramedic Journal in relation to a systematic review and discharge from care for patients with low-voltage electrical injuries and electrocardiograms (ECG) as part of the ongoing focus on continuous learning, innovation and improvement of the urgent healthcare system. The GP lead was part of a local committee for carbon reduction which included local stakeholder organisations and healthcare providers. Meetings in relation to driving improvements to meet the NHS Southern Health Strategy had taken place. The provider’s environmental management systems had met the standards for ISO14001 certification. Action had been taken to improve environmental sustainability such as acquiring a fleet of electric cars and electronic prescribing reducing paper wastage, including online advice sheets with QR codes. Leaders told us plans were in place to collaboratively work in relation to a cellulitis (a common deep skin condition) and antibiotic research trial.