Enter and view: GP Assessment Unit and Acute Medical Unit, Leicester Royal Infirmary

Healthwatch Leicester carried out an Enter and View visit to the GP Assessment Unit (GPAU) and Acute Medical Unit (AMU) at Leicester Royal Infirmary to understand patient experiences of these key parts of the hospital's emergency care pathway. The visit was prompted by previous patient feedback about acute medical services and by the increasing importance of the GPAU and AMU within the hospital's wider emergency care redesign programme. 

Overall, the report found that patient experiences within both units were generally positive, particularly regarding the care provided by clinical staff. Patients frequently praised doctors, nurses and other healthcare professionals for their professionalism, communication and commitment to patient care. Most patients reported feeling informed about their treatment and said they were able to ask questions about their care.

The Acute Frailty Unit (AFU) received particularly positive feedback. Healthwatch highlighted the work of the Meaningful Activities Coordinator, whose activities helped support older patients, including those living with dementia. The report noted that the unit's dementia-friendly approach and multidisciplinary model of care had received national recognition and appeared to be delivering positive outcomes for patients.

Patients on the AMU generally described their treatment positively and felt staff kept them informed about their diagnosis and care plans. The "No Decision About Me Without Me" communication initiative was viewed favourably and appeared to help promote patient involvement in care decisions. Patients and relatives appreciated the efforts staff made to communicate effectively despite the busy environment. 

However, some communication issues were identified. A small number of patients reported periods when they were unclear about what tests were planned, how long they might be waiting or what would happen next. Some relatives would have welcomed more regular updates about patients' progress, even when there was no significant change in their condition. 

A significant finding was that many patients had a limited understanding of the role of the GP Assessment Unit. Three of the four GPAU patients interviewed said they were unsure what the service was, what would happen during their visit or why they had been referred there. One patient was incorrectly directed to another part of the hospital when seeking the GPAU, while another expressed confusion about their follow-up arrangements after attending the Emergency Department. The report concluded that better public information and education about the service were required. 

The physical environment of the GPAU and Emergency Department attracted some criticism. Healthwatch found that signage was poor, with limited information directing patients to the GPAU and insufficient signs for facilities such as toilets. Patients also highlighted difficulties accessing refreshments during long waits, and there were concerns that patients could miss appointments if they left the waiting area to obtain food or drinks.

The report also identified several accessibility issues. These included concerns about the gradient of the entrance ramp, uncertainty about the operation of hearing loop systems, lack of adult changing facilities, and insufficient visibility of accessibility features. Healthwatch recommended a full review of disabled access arrangements within the Emergency Department. 

Additional operational issues included a leaking water dispenser, limited hand sanitiser provision, an electronic patient display system occasionally showing incorrect information, unclear ownership of estate management issues, and concerns about the visibility of sensitive patient information displayed on screens in staff areas.

Staff spoke positively about the service and described feeling supported by management. Although the units were operating with a nursing vacancy rate of approximately 15 posts, managers felt staffing remained safe through flexible deployment, recruitment and support from agency and bank staff. Staff also highlighted successful discharge-planning processes and strong collaboration with community services to support patients leaving hospital safely. 

The report concluded that the GPAU and AMU were providing good-quality care and effective clinical services, particularly in patient communication, frailty care and discharge planning. However, improvements were needed in public awareness of the GPAU, signage, accessibility, refreshments, infection control measures and operational management of the Emergency Department environment. Healthwatch recommended that these issues be addressed as part of the ongoing redevelopment of Leicester Royal Infirmary's emergency care services.