Gloucestershire Care Services NHS Trust has been told to address safety concerns in urgent care, after unregistered workers without the right training were left to assess patients.
Overall the trust, which runs a range of community services including seven community hospitals, was rated “requires improvement” by the Care Quality Commission following a series of inspection visits this summer.
In particular, the trust was told to take action to ensure appropriate staffing and skills mix in its minor injuries and illness units.
“We were concerned that some patients waited too long to be assessed by a registered nurse on arrival and that unregistered practitioners were undertaking this task without adequate training or supervision,” said inspectors who concluded safety in urgent care was “inadequate”.
“We were concerned some patients waited too long to be assessed by a registered nurse and unregistered practitioners were undertaking this task without adequate training”
While the inspection team rated the trust “good” overall for being caring, it flagged up staffing challenges in all its services.
The CQC found the trust was struggling to recruit enough nurses, especially senior band 6 district nurses and senior community nurses, and vacancies had increased in the six months leading up to the inspection.
“There was also an issue with nurse retention,” stated the regulator’s inspection report on the trust.
However, it noted that the trust was taking steps to address the staffing issues, including reviewing job descriptions, centralising recruitment and running preceptorship and return to practice schemes.
Meanwhile, it was using bank and agency staff to ensure maintain safe staffing levels.
Inspectors also identified several areas of outstanding practice, such as the trust’s approach to preventing falls both in terms of leadership and practical solutions.
For example, nurses on Jubilee ward at Stroud Hospital have a “tag” system in place in one bay reserved for patients who need extra support and monitoring.
“This system ensured that a member of staff was always present in the bay and could not leave until ‘tagged’ by another member of staff,” said the CQC report.
“This was to help reduce the incident of falls and to observe patients who were confused,” it said.
“All our healthcare assistants were told to cease any activity that resonated with triage”
Susan Field, who was appointed director of nursing this month having been interim director since July, told Nursing Times immediate steps had been taken to address the issue around triage and unqualified staff.
“We did something immediately when it came up during the inspection,” she said. “All our healthcare assistants were told to cease any activity that resonated with triage.
“It was picked up in one unit in particular, but we are working on a detailed action plan with the clinical leads in all units,” she said.
“This includes a review of HCA competencies, a review of their job descriptions and a supporting educational practice programme for HCAs, which is under way at the moment,” she added.