We carried out an announced comprehensive inspection on 4 October 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well led?

Our findings were:

Are services safe?

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

Are services effective?

We found that this service was 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 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.

Buckinghamshire Musculoskeletal Integrated Care Service is part of Care UK Clinical Services Limited. There are two central clinics one at High Wycombe and Aylesbury and six other locations, which were in existing health centres and hospitals across Buckinghamshire. We inspected High Wycombe and Aylesbury as medical clinicians were based at these centres.

Buckinghamshire Musculoskeletal Integrated Care Service was established in 2011. The service provides clinical assessments and a treatment service for patients presenting with a musculoskeletal conditions. A musculoskeletal condition is any condition affecting the joints, muscles, ligaments and nerves that may cause pain or reduced function. The service is provided to patients 16 years of age or older.

These treatments include specialised clinics, including hand clinics and a sports injury clinic, as well as group classes focussing on:

• Shoulders
• Pilates
• Osteoarthritis
• General rehabilitation
• Hydrotherapy
• Acupuncture

Aylesbury Vale and Chiltern clinical commissioning groups commission Buckinghamshire Musculoskeletal Integrated Care Service.

The service has been registered since 1st July 2011.

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.

Michelle Saunders 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:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks were appropriately managed and identified.
• Staff were aware of safeguarding and what constituted abuse. Staff at all levels of the organisation understood their responsibilities to protect patients from avoidable harm. They were able to explain the types of concerns which would result in a safeguarding alert being raised and had received safeguarding training to an appropriate level.
• The service had suitable facilities and the environment was well equipped to treat patients and meet their needs.
• The care delivered to patients was evidence-based and in line with key documents such as National Institute of Clinical Effectiveness (NICE) guidance. Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff received training appropriate to their roles and any further training needs had been identified and planned.
• Staff appraisals were completed and staff had sufficient clinical supervision
• There was routine monitoring of patient outcomes of care and treatment, and patient feedback was actively sought on a regular basis.
• There was evidence of multidisciplinary working with other health professionals and organisations outside of the service. Staff worked effectively with the local NHS trust, GPs and specialists; to seek advice when needed.
• When we talked with patients, they said staff were passionate and committed to providing good care.
• Staff were observed providing care to patients with kindness, compassion and dignity.
• The provider had a clear vision, values and strategy, which was shared by all staff. There was an effective clinical governance framework in place. Service leads demonstrated they understood organisational risks and were seen to be positively managing these through action plans and regular reviews.
• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• Staff spoke positively about the support they were given by senior management.

However,

• Patients and staff told us they found it difficult to make regular follow up appointments.