British Pregnancy Advisory Service (BPAS) Plymouth provides a termination of pregnancy service within the outpatient department of the Local Care Centre, Mount Gould Hospital, Plymouth. This is a rented space from the current providers. Local Care Centre, Mount Gould Hospital, Plymouth

The service at BPAS Plymouth is commissioned by three local clinical commissioning groups.

BPAS Plymouth provides a range of termination of pregnancy services including :

Pregnancy testing, unplanned pregnancy counselling/consultation, early medical abortion, abortion aftercare, miscarriage management referral, sexually transmitted infection testing and contraceptive advice and contraception supply.

We carried out this comprehensive inspection as part of the first wave of inspection of services providing a termination of pregnancy service. The inspection was conducted using the Care Quality Commission’s new methodology. We have not provided ratings for this service. We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities which it provides

The inspection team comprised of two inspectors. The inspection took place on 3 May 2016.

Our key findings were as follows:

Are services safe at this service

• Staff were encouraged and supported to report incidents. Incidents were investigated and the learning, including learning from incidents at other BPAS locations, was shared with the staff. Staff were aware of their responsibilities under the duty of candour.

• The environment was visibly clean, staff followed BPAS infection control procedures and infection control rates were low.

• Medicines were appropriately managed to ensure they were safe to use. Drugs to induce abortion were appropriately prescribed by a doctor for women undergoing early medical abortion. Systems were in place to ensure the correct ordering and monitoring of stock.

• Patients’ records were completed, legible, up to date and stored securely. Accurate record keeping was monitored through audits.

• There were sufficient numbers of suitably trained staff available to care for patients.

• Safeguarding procedures were in place to protect both vulnerable adults and children from harm.

• Processes had been put in place to promote the safety and wellbeing of patients including eligibility criteria and risk assessments.

Are services effective at this service

• Patients had their needs assessed, and care planned and delivered, in line with evidence based guidance and recommendations, including Department of Health Standard Operating Procedures and professional guidance. Pain management was considered and action taken to ensure patients were comfortable.

• BPAS has a planned programme of monitoring with audit outcomes fed back to staff to promote good practice, develop skills, or address areas of poor practice.

• BPAS has competency training in place to support the development of staff. Staff received regular supervision and appraisals.

• Multidisciplinary working was undertaken with GPs involved when possible and pathways to transfer patients in place.

• Patients had access to information to inform their decisions and were provided with reference material. Contact was available out of hours by a telephone helpline for any further questions.

• Consent was obtained from the patient at each stage of the treatment and recorded in the patient’s record. Staff were clear about their roles and responsibilities to ensure patients with limited capacity or understanding were managed correctly and in line with best practice.

Are services caring at this service

• We saw patients were treated with compassion, kindness, dignity and respect. Patients and those attending with them were treated with respect and consideration.

• Staff respected patient confidentiality and ensured patients’ dignity was maintained.

• Patients’ beliefs and faiths were respected and their choices supported.

Are services responsive at this service

• The service was planned and delivered to meet patients’ needs. Patients could access the service within a short timescale and were given options to attend alternative clinics. This included a fast track appointment system to prioritise patients with a higher gestational age and more complex needs or circumstances. The service monitored its performance against the waiting time guidelines set by the Department of Health.

• The service took into account patients’ specific needs to support them through the treatment including patients with complex needs. Staff recognised patients’ personal, cultural, social and religious needs.

• Patients’ complaints were listened and responded to. Learning was taken from complaints and used by staff to reflect and change their practice.

However :

• BPAS should advise patients’ that staff only provide impartial, non-directive advice and are trained as counsellors but not to a Diploma level. If therapeutic counselling is required, BPAS will refer patients on to external services with appropriately trained pregnancy counsellors.
• The provider should audit those patients who exceed the 10 working days to treatment to evidence patient choice.

Are services well led at this service

• Staff followed the vision for the service by treating all patients with dignity and respect in a non-judgemental way. The development strategy for this service was on-going.

• There was an established governance structure at both national, regional and local level to manage risk and quality including an established process for sharing learning.

• Staff spoke positively about how they enjoyed their work and felt a strong sense of family and teamwork.

• Public and staff engagement was encouraged to develop the service provided.

However, there were also areas of where the provider needs to make improvements.

The provider should:

• BPAS should advise patients’ that staff only provide impartial, non-directive advice and are trained as counsellors but not to a Diploma level. If therapeutic counselling is required, BPAS will refer patients on to external services with appropriately trained pregnancy counsellors.
• The provider should audit those patients who exceed the 10 working days to treatment to evidence patient choice.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Patients were positive about the way they had been treated. They said that staff had treated them with respect and provided information, support and reassurance throughout the process.

We saw that assessment of patients health were undertaken and care was planned and delivered to meet patient’s needs.

Information and support was provided to patients at each stage of treatment. Consent and agreement by patients confirmed their understanding of explanations provided by staff.

Staff received training and support to deliver care and treatment safely to patients.

The provider regularly monitored the service to make sure that risks to patient safety were minimised and an appropriate standard of care and treatment provided.