We carried out an announced comprehensive inspection on 5 March 2019 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 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 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.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of most, but not all, of the services it provides. At Christchurch Clinics, the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation. Therefore, we were only able to inspect services related to our regulation. The GP 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.

We received feedback about the regulated service through comment cards from 44 people. People told us that staff were caring and that they were treated with dignity and respect. They told us staff were friendly and helpful.

Our key findings were:

• There was a process in place for significant events, that was in line with the Duty of Candour.
• There were some systems in place to identify, assess and manage risk.
• There were no formal processes in place to check patient’s identities or whether the adult with a child had parental responsibility. Following our inspection, the provider implemented a protocol to check identities and parental responsibility.
• There was no formal process for documenting consent to speak with patients’ GPs. Following our inspection, the provider updated their registration process so show information was shared with the NHS GP unless the patient opted out of this.
• There were emergency medicines kept on site in case of anaphylactic shock. There were no other emergency medicines kept, no oxygen and no defibrillator and no risk assessments to support these decisions. Following our inspection, the emergency medicines and equipment kept were reviewed and risk assessed and appropriate actions were taken.
• There was a system in place for the safe recruitment of staff.
• The immunisation status of staff was not routinely sought on recruitment. Following our inspection, the provider implemented a protocol for checking staff immunisation status.
• Staff had access to appropriate training for their role.
• Information relating to patients was accurate and enabled staff to make appropriate treatment choices.
• The service kept up to date with latest guidance. They used this as appropriate to their service.
• Patients could make an appointment to suit their needs and wishes.
• There were systems in place to respond to incidents and complaints.
• There were limited processes in place for quality improvement. Only one audit had been completed.
• Most policies and procedures relevant to the management of the service were in place and kept under review. However, some policies did not contain a drafting date or review date. There were a couple of procedures/ policies which also needed minor amendments to be fully relevant to the service.
• Staff were aware of their roles and responsibilities.
• There was a clear leadership structure in place.

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

• Review policies and procedures to ensure it is clear they are the current version and are fully personalised to the service.
• Introduce a programme of quality improvement activity.
• Ensure that the new systems implemented since inspection, for the checking of patient’s identity and parental authority, information sharing with GPs, the recording of the immunisation of staff and the storage of appropriate medicines and equipment for use in a medical emergency, is maintained over time.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care