We carried out an announced comprehensive inspection on 13 June 2018 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are practices safe?

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

Are practices effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are practices caring?

We found that this practice was providing caring practices in accordance with the relevant regulations.

Are practices responsive?

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

Are practices well-led?

We found that this practice 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 practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CountryHealth Ltd is an independent provider of GP services, which specialises in thyroid health. They offer a range of specialist diagnostic services and treatments, which include complementary therapies, with a focus on functional medicine. They offer health screening for individuals and companies.

This practice is registered with Care Quality Commission (CQC) under the Health and Social Care Act 2008 in respect of some, but not all, of the practices it provides. There are some exemptions from regulation by CQC which relate to particular types of services and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At CountryHealth Ltd, services are provided to clients under arrangements made by a government department. These types of arrangements are exempt by law from CQC regulation. Therefore, at CountryHealth Ltd, we were only able to inspect the services which are not arranged for patients by a government department. The practice refers patients to affiliated practitioners, for example a counsellor, a reflexologist and a QiGong teacher. (QiGong is a holistic system of coordinated body posture and movement, breathing, and meditation). We did not inspect the affiliated practitioners as they are out of the scope of CQC regulation.

The practice is registered with the CQC under the Health and Social Care Act 2008 to provide the following regulated activities:

• Diagnostic and screening procedures
• Treatment of disease, disorder or injury.

The GP is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the practice. 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 practice is run. The GP is also the nominated individual. (A nominated individual is a person who is registered with the Care Quality Commission to supervise the management of the regulated activities and for ensuring the quality of the practices provided).

We spoke with one patient and received comments cards from six about the service they had received. All the feedback we received was extremely positive, particularly in relation to the comprehensive explanations and advice and how friendly and welcoming the staff were.

Our key findings were:

• There was an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and managed.
• There was an infection prevention and control policy and procedures were in place to reduce the risk and spread of infection.
• Each patient registered at the practice received a registration health check. An initial GP consultation established the necessary actions to investigate the health need and included taking detailed medical history and a physical examination, if appropriate. This was followed by an action plan, whilst diagnostic tests were completed, if appropriate. Follow up GP consultations were undertaken to review and refine the treatment plan.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Emergency medicines were safely managed. There was evidence that checks had been undertaken, as there were records to demonstrate that medicines near to their expiry date had been ordered and supplied. However there was no record of each monthly check.
• We found some emergency equipment was out of date. This equipment was removed during the inspection. Following the inspection the GP sent an incident report, with an updated checklist.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The consultation and treatment rooms were based on the first floor. Patients with mobility needs could have a consultation in a room on the ground floor, although this needed to be arranged in advance.
• Patients said they were listened to, treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about the practice and how to complain was available and easy to understand. This included a specific children’s complaint form, written in a way that children could understand and complete. The practice had not received any complaints in the previous 12 months.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• There was a clear leadership structure and staff felt supported by management.
• The practice proactively sought feedback from staff and clients, which it acted on.
• The practice had several policies and procedures which were in place to govern activity.

There were areas where the provider could make improvements and should

• Embed the newly implemented system for recording checks of the emergency medicines and equipment.
• Undertake clinical audits to demonstrate clinical effectiveness.