We carried out an announced comprehensive inspection at Dr A I McKenzie on 7 December 2017. During the inspection it was found that the service was not providing safe, effective or well led care in accordance with the regulations (Health and Social Care Act, 2008). The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for Dr A I McKenzie on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 June 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 December 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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.

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.

We carried out an announced comprehensive inspection 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 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 Dr McKenzie was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC previously inspected on Dr McKenzie on the 13 January 2013 and found the service compliant with the regulations reviewed.

Dr McKenzie provides a single-handed private medical consultation service. The establishment is registered for diagnostic and screening, treatment of disease, disorder or injury and services in slimming clinics. The practice is based in the Broomhill area of Sheffield, close to transport links. It is based on the ground floor of the building and consists of a waiting and reception room, and Dr McKenzie's surgery. Dr McKenzie is supported by a receptionist.

The practice is open on:-

Mondays  to Friday  8.30am to 5pm.

The practice was not required to offer an out-of-hours service.

The registered provider told us 75% of their work related to occupational health assessments, with the rest spread across:

• Private GP work – Dr McKenzie stated that the service had approximately 50 regular local patients. In addition, they saw people who travelled around the world and wanted a single consultation.

• Administering vaccinations for meningitis and chickenpox virus.
• Providing a slimming clinic - Dr McKenzie saw approximately 30 patients a month.
• The provider did not treat babies under 12 months or pregnant women.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC that relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Services that are provided to patients under arrangements made by their employer, a government department and an insurance company with whom the servicer user holds a contract (other than a standard health insurance policy) are exempt by law from CQC regulation. Therefore we are only able to inspect the services which are not arranged for patients by their employers, a government department or an insurance company with whom the patient holds a policy (other than a standard health insurance policy).

As part of our inspection, we reviewed 22 Care Quality Commission comment cards where patients made extremely positive comments about the service. They described the service as very professional, they said the doctor listened to what they said and informed them about their care and treatment. They described the service as good, excellent and exemplary.

Our key findings were:

• The provider and the receptionist explained that the practice had 50 regular patients who had been with the practice for many years and whom the doctor knew very well. This enabled the doctor to provide a consistent approach when responding to the patient’s needs
• The provider assessed patients treatment needs.

• The provider offered longer appointments where needed.
• Treatment costs are available in the patient information booklet, on a notice in the waiting room, on the clinics website and in various leaflets.
• There was a complaints procedure, which was available in the patient information booklet.
• The provider responded to the issues pointed out during the inspection and submitted updated evidence to us. However these issues should have been dealt with more proactively and been under regular review.

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

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular, the provider must:-

• Ensure a legionella risk assessment is carried out on the premises and any recommendations made acted on. (A Legionella risk assessment is a report by a competent person giving details as to how to reduce the risk of the legionella bacterium spreading through water and other systems in the work place.)
• Ensure that the premises meet the requirements of the electrical at Work Regulations 1989.
• Ensure that systems and processes are carried out to ensure effective qualitative improvements of effect care and treatment.

• Ensure an appropriate risk assessment is carried out for the management of medical emergencies.

• Ensure arrangements are put into place to receive and comply with patient safety alerts, recalls and rapid response reports issued through the Medicines and Healthcare products Regulatory Authority (MHRA) and through the Central Alerting System (CAS).

Ensure care and treatment are provided in a safe way to patients. In particular, the provider must:-

• Ensure patients are given appropriate information about the medicines that are provided for weight loss.
• Ensure that vaccines are stored following Public Health England Protocol for ordering and storing and handling medication.

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

There were areas where the provider could make improvements and should. For example:-

• Review the possible risk of the spread of infection and associated diseases in the practice.

• Review the policy on management of controlled drugs to ensure it reflects activities within the clinic.

• Review the security and the process for obtaining Controlled Drugs in line with legislation.

• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.

• Review patients receiving medicines for weight loss and advise them to have regular breaks from treatment in line with the manufacturers advice.
• Review the process for checking the patient's identity when they present at the service.
• Review training attendance to ensure current guidance is followed.

There were no people who used the regulated services attending for treatment at this location on the day of our visit. Therefore it was not possible to obtain people’s views directly.

However, we saw written feedback from patients that had been collated as part of the practices quality monitoring. We found that all of the comments made were positive and all respondents had stated that they were “confident about the Doctor’s ability to provide care,” and confirmed they would be “happy’ visiting the practice again.” People’s comments included; “I am filled with hope,” and “Dr. Mckenzie provides consistent and thorough care and has been a much valued GP to me for over twenty years.”

We observed that people were treated with dignity and respect, and all consultations took place in private.

We saw that appropriate records were kept of people’s consultations and treatment so that their identified needs could be met.

We found that Dr McKenzie had undertaken appropriate training to maintain his skills and relevant checks had been undertaken so that people were provided with a safe service that met their needs.

There was an appropriate system in place to ensure people could voice any comments or complaints about the service and these would be responded to by the service. People who used the service were asked for their views about their care and treatment.

There were no people who use the regulated services attending for treatment at this location, on the day of our visit, so it was therefore not possible to get their direct views. We did however; see feedback from them that was received as part of the services quality monitoring. Comments in these indicated people were “Very Happy” with the service. Others commented on the “Very relaxed atmosphere” and that the service was “Very efficient and friendly” and had “Lovely people”.