We carried out an announced comprehensive inspection on 30 November 2017 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.

CQC inspected the service on 6 July 2017 and asked the provider to make improvements regarding systems and policies to govern activities within the clinic to include: recruitment processes, electrical testing or regular calibration of equipment, infection control, fire safety, risks or response to medical emergencies and risks of lone working. We also required the provider to put in place a system to ensure the clinician had access to up to date safety alerts.

We checked these areas as part of this comprehensive inspection and found these had been resolved.

Harmony Medical Diet Clinic provides a private weight reduction service for adults and supplies medicines and dietary advice to the patients who use the service. The service operates from a first floor consulting room above a parade of shops in Bedford town centre. It is open from 10am to 4pm on Thursdays.

The clinic was run by one doctor; there were no support staff. The registered manager was a doctor but did not work regularly within the business. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider runs two further clinics in Coventry and London. The regulated manager provides supervision and support to the doctor who provides the service.

We collected feedback about the service by speaking to five patients during the inspection. Patients said the doctor was knowledgeable, and they received lifestyle and dietary advice in addition to medicines. Patients told us they felt supported to lose weight.

Our key findings were:

• Patients were provided with a range of information on diet, exercise and any medicines that were prescribed.
• Feedback from patients was positive about the care they received.
• The service was flexible to fit in with patient choice: patients could visit the doctor for weight management advice and be weighed as often as they wished. There was no charge for this type of consultation.
• The doctor was knowledgeable about strategies to improve weight loss and had produced information for patients to support healthy diets.
• The doctor had systems in place to monitor the clinical efficacy of the service provided
• The service used recognised screening processes to identify patients who could be at risk of eating disorders or co-morbidities.
• Medicines were prescribed in line with the service prescribing policy which reflected national guidance.

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

• Consider the need to include information on the website for patients on how to raise a concern or complaint.
• Review the need to provide in-house appraisal for the doctor working in the service and formally record occasions of clinical supervision.
• Review and risk assess the appropriateness of having a family member or friend as a translator.

We carried out an announced comprehensive inspection on 6 July 2017 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 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 the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Harmony Medical Diet Clinic provides a private weight reduction service for adults and supplies medicines and dietary advice to the patients who use the service. The service operates from a first floor consulting room above a parade of shops in Bedford town centre. It is open from 10am to 4pm on Thursdays. The waiting area for the service was shared with other agencies for example a physiotherapist and as such the waiting area did not contain information specific to the slimming service.

The clinic was run by one doctor, there were no support staff. The registered manager was a doctor but did not work regularly within the business. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider runs two further clinics in Coventry and London. The regulated manager provides supervision and support to the doctor who provides the service.

We collected feedback about the service from seven patients through CQC comment cards and speaking to patients during the inspection. Patients said they received good advice, the doctor was knowledgeable and they felt supported to lose weight.

Our key findings were:

• Patients were provided with a range of information on diet, exercise and any medicines that were prescribed
• Feedback from patients was positive about the care they received.
• The service was flexible to fit in with patient choice: patients could come and consult with the doctor for weight management advice and be weighed as often as they wished. There was no charge for this type of consultation.
• The doctor was knowledgeable about strategies to improve weight loss and had produced information for patients to support healthy diets.
• The doctor had systems in place to monitor the clinical efficacy of the service provided and used recognised screening processes to recognise patients who could be at risk.

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 relating to recruitment, access to safety alerts, electrical testing and calibration of equipment, risk assessments for handling medical emergencies, fire safety and infection control.

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:

• Review and risk assess the appropriateness of having a family member of the patient as a translator.
• Review risk assessments with regard to having a chaperone service.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available

The people we spoke with said they were provided with useful information and received full explanations and advice on their care and treatment at Harmony Medical Diet Clinic in Bedford. They said they felt involved in the discussions and decisions made around their care. They told us they had no concerns about the doctor who was pleasant and attentive and appeared competent. The people we spoke with said they had no concerns about the service but knew how to complain if they needed to.

During our visit we found people's contribution to decision making about their care to be documented. We found that each individual had their medical history and any risk factors specific to them reviewed and recorded. A full appointment history/chronology of treatment was recorded for each individual. We found that the doctor was appropriately registered and maintaining some form of continuing professional development relevant to his role.

We found that people had a variety of methods available for them to share their views and opinions about the service. However, we found there were no appropriate arrangements in place to ensure the doctor received training, supervision and appraisal.

One person said of her visit to Harmony Medical Diet Clinic in Bedford: “It’s absolutely worthwhile using this service. I’ve been using it for years.” Another person said: “The doctor went through every aspect of the treatment and I totally understood everything that was explained.”

As part of this review we looked at 59 responses to satisfaction surveys for this service. These were very positive and indicated that people felt that they were given all the necessary information and support to achieve their personal weight loss goals.

Comments included. “I am very satisfied and will be recommending people to visit”, and “I’m really happy to keep my diet going with the help of the clinic”.

People confirmed that Dr Hirsch gave a full explanation of the medication given out by this clinic, how it should be taken and how the diet worked. They said he was very approachable and encouraged people to ask lots of questions, which he responds to with appropriate explanations and advice about the steps people had to take to achieve an appropriate and healthy weight loss,”