We carried out an announced focused inspection on 28 February 2019 to ask the service the following key questions; Are services safe and well-led?

We previously carried out an announced comprehensive inspection at Bin Seena Health Limited on 19 December 2018 and 16 January 2019. As a result of our findings during that visit the provider was served warning notices for breaches of regulation 12 (Safe care and treatment) and regulation 17 (Good governance).

The full comprehensive inspection report from that visit was published on 12 March 2019 and can be read by selecting the ‘all reports’ link for Bin Seena Health Limited on our website at www.cqc.org.uk.

At our inspection on 28 February 2019 we found that the provider had taken action and was now compliant with the regulations.

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Bin Seena is a community pharmacy on Edgware Road in London which offers private consultations with a doctor. The service is currently available to adults only.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner including the prescribing of medicines. Our inspection focused solely on the doctors consultation service. The pharmacy’s dispensing and related services are exempt from CQC regulation and are regulated separately by the General Pharmaceutical Council.

One of the pharmacists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• The provider had improved the quality of record keeping. The doctors were recording consultations in line with professional standards.

• The service had improved the arrangements in place for the management of medicines, particularly the safe prescribing of medicines.
• There was evidence of improved oversight and more opportunities for clinical review and monitoring although quality improvement activity was not yet embedded.

There were areas where the provider could make improvements and should:

• Review the information it records for relevant patient consultations in relation to ‘safety netting’.
• Review and implement appropriate quality improvement and monitoring activity.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 22 November 2017 to ask the service the following key questions: Are services safe, effective, caring, responsive and well-led?

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Bin Seena is a community pharmacy on the Edgware Road in London which in addition to offering a range of pharmacy related services (such as NHS dispensing, the sale of over the counter medicines and an emergency contraceptive service) offers private consultations with a doctor on an ad hoc basis. The doctors consultation service is available to local residents, commuters and the sizeable number of tourists and temporary residents staying in this area, primarily from the Middle East and Gulf States.

The service is open from 9am until 1am seven days a week. The doctors consultation service is open to adults only and runs by arrangement, with the majority of consultations taking place during the evening. We were told the practice sees around 50 patients per month on average with all consultations conducted in person and on the premises. Two doctors are currently contracted to provide the service. One is a qualified GP (on the GMC GP register) and the other is a psychiatrist (on the GMC specialist register). Both of these doctors are male. Several members of the staff and both the doctors are able to speak Arabic.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner including the prescribing of medicines. Our inspection focused solely on the doctors consultation service. The pharmacy’s dispensing and related services are exempt from CQC regulation and are regulated separately by the General Pharmaceutical Council.

The service does not currently have a registered manager in post. At the time of the inspection, one of the pharmacists was in the process of applying to CQC to carry out this role. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Ten patients provided feedback about the service. All the comments we received were positive about the service, for example describing the doctors and staff as knowledgable, friendly, clear and helpful.

Our key findings were:

• The provider had some systems in place to protect people from avoidable harm and abuse. However, the provider had not assessed and put systems in place to manage some key risks, for example, the service was not equipped to respond to a medical emergency on site.

• There were effective arrangements in place for the management of medicines.
• The doctors were aware of current evidence based guidance and had the skills and knowledge to deliver effective care and treatment.
• The patient feedback we received in the course of the inspection indicated that patients were satisfied with the service they received.
• Information about how to complain was available. The provider had not received any complaints about the service in the last year.
• There was a clear leadership and organisational structure. The provider had a range of policies but these were not effectively underpinning the doctors consultation service.
• The provider did not have effective systems in place to monitor and learn from practice, for example through incident reporting.

We identified regulations that were not being met and the provider must:

• Introduce systems to assesss, monitor and improve the quality and safety of the service, for example, by implementing an effective incident reporting system.
• Ensure that the consultation records include an accurate and complete record of the consultation in line with GMC guidelines.
• Ensure that the service is suitably equipped to respond to a medical emergency.

You can see full details of the regulations which were not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the written policies governing service activity to ensure these are fit for purpose and updated periodically.
• Review its procedure for monitoring safety alerts and ensuring that any relevant to the doctors consultation service are implemented.
• Review the availability and accessibility of written information about the service, for example the provision of information in Arabic.
• Review its recruitment procedures to ensure that a record is kept of verbal references where these have been obtained.
• Review whether staff training around safeguarding and abuse should be updated to include issues such as modern slavery and trafficking.
• Review the induction procedures for the doctors contracted to work in the service.

We carried out an announced comprehensive inspection on 19 December 2018 and 16 January 2019 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

We previously carried out an announced comprehensive inspection at Bin Seena Health Limited on 22 November 2017. As a result of our findings during that visit the provider was served requirement notices for breaches of regulation 12 (Safe care and treatment) and regulation 17 (Good governance). The service submitted an action plan to tell us what they would do to make improvements and meet the legal requirements.

The full comprehensive inspection report from that visit was published on 5 February 2018 and can be read by selecting the ‘all reports’ link for Bin Seena Health Limited on our website at www.cqc.org.uk.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. In particular, we needed to check that the service had improved following our previous inspection which was carried out on 22 November 2017. 

Bin Seena is a community pharmacy on Edgware Road in London which offers private consultations with a doctor. The service is currently available to adults only. This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner including the prescribing of medicines. Our inspection focused solely on the doctors consultation service. The pharmacy’s dispensing and related services are exempt from CQC regulation and are regulated separately by the General Pharmaceutical Council.

One of the pharmacists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Twenty-five people provided feedback by completing comment cards about the service. All but two of the cards were wholly positive. People told us they were pleased to have access to this type of medical service and several commented that their health problem had been fully resolved. A common theme in the comments was the helpfulness of the doctors and pharmacy staff. One of the negative comments related to having to wait too long for the doctor to arrive at the pharmacy and the other described their experience as poor without further detail.These comments were not typical.

Our key findings were:

• The service had some systems in place to protect people from avoidable harm and abuse.

• There were areas where the service had improved since our previous inspection in November 2017. For example, the service was now equipped to respond to a medical emergency.

• The service did not have effective arrangements in place for the management of medicines, particularly the safe prescribing of medicines.

• The patient feedback we received in the course of the inspection indicated that patients were generally very pleased with the service they received.

• Information about how to complain was available. The service had not received any complaints about the service in the last year.

• There was a clear leadership and organisational structure but effective oversight was lacking.

• The service had reviewed its policies but these were not always effectively implemented.

• The service had systems in place to monitor and learn from incidents although there had been no incidents since our previous inspection.

• Clinical record keeping was sparse and not in line with professional standards.

We identified regulations that were not being met and the service must:

• Ensure that care

  and treatment is provided in a safe way.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations which were not being met at the end of this report.

There were areas where the service could make improvements and should:

• Review mechanisms for obtaining and learning from patient feedback.

• Review the scope for implementing quality improvement activity such as clinical audit.

• Review the provision of information about the service in languages other than English.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice