We carried out an announced comprehensive inspection on 4 December 2018 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.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 on 4 December 2018 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.

The service provides private GP services including health screening, particularly sexual health screening and travel vaccinations.

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 general exemptions from regulation by CQC which 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. At Lomack Health Clinic services are provided to patients under arrangements made by an insurance company with whom the service user holds a policy (other than a standard health insurance policy). These types of arrangements are exempt by law from CQC regulation. Therefore, at Lomack Health Centre, we were only able to inspect the services which are not arranged for patients by an insurance company with whom the patient holds a policy (other than a standard health insurance policy).

The principal 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.

As part of our inspection, we asked for Care Quality Commission comment cards to be completed by patients prior to our inspection. We received 20 comment cards which were positive about the level of care provided. Patients told us staff were caring and took time to understand their needs.

Our key findings were:

• The service provided a bespoke travel vaccination and sexual health screening service.
• The service had developed a dedicated sexual health telephone line where patients spoke directly to a clinician and received tailored advice. This service was completely confidential.
• There was clear oversight of risk and processes with clear policies and procedures.
• The service had adequate controls of infection prevention and control.
• The service completed regular audits and mock inspections to ensure it was working in line with current legislation.
• The service worked to current evidence-based guidelines and gave up-to-date travel advice.
• The service completed patient feedback exercises and acted on any suggestions or concerns.
• Patients were able to book appointments at a time that was convenient, this included weekends.
• Clinical records were accurately maintained and stored securely.

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

• Review the process for completing fire drills and ensure they are completed regularly.
• Review the process for minuting meetings and support from the wider provider organisation.
• Review infection control procedures to include implementation of a cleaning schedule for all soft furnishings and carpeted areas.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

During our scheduled inspection of Lomack Health Clinic on 6 September 2013, we identified non-compliance regarding the assessing and monitoring of the quality of service provision. We found that the provider could not fully evidence that the service had an effective quality monitoring process in place which protected people who used the service from poor quality care.

We could not find evidence to support that audits were undertaken in respect of infection control, fire alarms or extinguishers or some equipment that was used on occasions. We also found that there was not current evidence that feedback from staff, people who used the service or their relatives were listened to. This meant that we could not evidence that the service was well led, or had learnt lessons from any concerns raised to drive improvement. We imposed compliance actions with regards to this and told the provider they needed to make improvements in this area.

The provider submitted an action plan in October 2013, which stated that the provider had implemented regular monitoring checks on the equipment within the building, including treatment couches and the fire safety systems. We were also told that a robust infection control auditing system had been put in place. We were told that compliance would be achieved by November 2013. On 5 December 2013, we carried out an inspection to check that these actions had been implemented.

We spoke with three people as part of our inspection on 5 September 2013. People said they were provided with appropriate information and received full explanations on their care and treatment at the Lomack Health Clinic prior to being asked to give consent. They said they felt fully involved in the discussions and decisions made around their care. One person told us, “I found the service to be what I expected, people are all helpful and the treatment I wanted was discussed with me fully.”

During our visit we found people's contribution to discussions and decision making about their treatment to be documented. We noted each individual had their medical history recorded and where necessary any risk factors specific to them reviewed and detailed.

We found the premises to be clean and well maintained and the layout appropriate for the types of treatment given. Infection control processes were adhered to and staff had a good working knowledge of how to reduce infection control risks.

We saw 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 robust systems in place in relation to the monitoring of first aid kits or clinical equipment.

There was a clear complaints system in place and we found that complaints were dealt with according to the provider’s policy. 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 on 13 February 2013, we saw that a system of stock control forms was used to monitor the expiry dates of all the medications and vaccine injections used at the service. The balance of stock recorded on each sheet we checked matched with the available stock in the drugs cabinet and vaccine injection refrigerator. All the medications and vaccine injections we checked were within their expiry dates.

The people we spoke with said they were provided with useful information and received full explanations and advice on their care and treatment at the Lomack Health Clinic. 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 approachable and appeared competent and professional. 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 discussions and decision making about their care to be documented. We found that each individual had their medical history and where necessary any risk factors specific to them reviewed and recorded. We saw that arrangements were in place to deal with foreseeable emergencies including appropriate staff training. We found that the doctor was appropriately registered and knowledgeable in such things as protecting people from the risk of abuse.

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 in relation to the recording and appropriate disposal of medicines. We saw that some medicines and vaccine injections were out of date.

One person said of her visit to the Lomack Health Clinic: "My experience here has been very professional and one that I have been completely comfortable with".