We carried out an announced comprehensive inspection at Loughton Private Medical Clinic on 30 October 2018. At that inspection, we found that the service was not carrying out safe, effective or well-led care. Breaches of regulation were identified.

We served warning notices in respect of the governance and safety at the practice. This was because medicines were not being stored or managed in accordance with legislation and guidance, patients accessing the slimming clinic were not being appropriately monitored and there was poor clinical record keeping. Further risks were identified which included a lack of effective systems to ensure patients were protected from the risk of abuse and poor infection control. Patients’ identification was not being checked.

We carried out an announced focused inspection at Loughton Private Medical Clinic on 11 March 2019. We found that necessary improvements had been made and the provider had met the requirements of the warning notices.

Our findings were:

Are services safe?

Necessary improvements had been made. The provider had met the requirements of the warning notice.

Are services effective?

Necessary improvements had been made. The provider had met the requirements of the warning notice.

Are services well-led?

Necessary improvements had been made. The provider had met the requirements of the warning notice.

The provider should:

• Finalise the safeguarding vulnerable adults’ policy.
• Continue to improve and embed systems to check patients’ identification and record consent to share information with their GP.
• Continue to improve systems to share information with the patient’s GP.
• Evidence adherence to current regulated activities in clinical notes.

We carried out an announced comprehensive inspection on 30 October 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 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.

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.

Loughton Private Medical Clinic is an independent consulting doctors service which provides a private general medical consultation service, cardiac diagnostic centre, slimming clinic and male impotence clinic. They also carry out medical research.

One person provided feedback about the service by way of comment card. This praised the care and treatment provided by the clinical and non-clinical staff at the service.

Our key findings were:

• Individual care records did not contain all the necessary information needed to deliver safe care and treatment.
• It was not always clear whether patients had consented to share information with their NHS GP.
• Controlled drugs were not stored or managed in accordance with legislation. The standard procedures and policies reflecting the dispensing and management of medicines did not reflect current guidelines.
• Patients accessing the slimming clinic were not being assessed and monitored appropriately.
• The provider was committed to cardiology research which they had been undertaking over the past 45 years.
• Identification was not checked to ensure that patients accessing the slimming clinic and associated medicines were aged 18 or over.
• The service did not advise patients of the risks of unlicensed medicines.
• The service did not review its antibiotic prescribing nor did it take action to support good antimicrobial stewardship in line with local and national guidance.
• Clinical staff were not always clear as to how to identify and manage patients with severe infections, for example sepsis.
• There was no suitable signage indicating where oxygen was stored.
• There was no safeguarding vulnerable adults or infection control policy. The child safeguarding policy was out of date. It was unclear whether clinical staff had received child safeguarding training to a required level.
• There was no policy on recording or investigating significant events with a view to ensuring lessons were learnt.
• The provider asked patients to complete feedback questionnaires, which were all positive.
• There were not effective systems to ensure that premises and equipment were safe, including in relation to infection control.
• Staff recruitment checks were not consistent and there were no systems to record the immunisation status of staff.
• There were positive relationships with GPs and the pharmacy in the locality.
• There were not effective systems to ensure clinical staff were appropriately indemnified.
• Statutory notifications required by legislation were not submitted to the Care Quality Commission.
• There was no system to receive and act upon patient safety and medicine alerts and updated guidance.
• Effective and sustainable improvements were not made when these were identified by the Care Quality Commission and other stakeholders.
• A trained chaperone was not available should one be requested.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The provider should:

• Make available a trained chaperone and thereafter display information in the premises as to the availability of a chaperone.

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

At our inspection of Loughton Private Medical Clinic on 29 April 2013 we found that the provider did not have effective systems in place in relation to complaints or to ensure that people were always protected from the risk of infection.

At our inspection on 19 November 2013, the provider was able to demonstrate that they had taken steps to address the identified shortfalls. We did not speak with people who used the service at this inspection.

We spoke with three people during our visit to the service. They told us that they felt well treated and cared for by the provider. One person said, ”The care and treatment is amazing."

People felt there were enough skilled and experienced staff to meet their needs. One person said,” The doctor is brilliant, professional, but makes you feel comfortable. He diagnosed my problem on the first appointment but still did the tests and referred me to a consultant who confirmed the diagnosis.”

We looked at the medical records of five people using the service. We saw that people’s needs were assessed and care and treatment planned for in a way that met their needs.

The premises was being redesigned and decorated. This would include improvements such as a ground floor accessible toilet and a records storage room.

We found that systems to manage cross infection were not effective. There was no proper hand washing facilities available to staff in the testing or consultation rooms.

We found that while action had been taken in response to people’s comments, the provider’s complaints procedure was not accessible and complaints were not well managed.

We spoke with three of the five people who had visited the clinic on the day of inspection, either in person or by phone. Everyone told us that they were confident in the service they received and the expertise of the provider. One person said, “He is a really wonderful doctor,” and another person said, “He is a lovely man.” They said that their whole family used the service, and they felt that the proprietor was like a friend to them.

One person told us that the provider had given them plenty of time, and listened to what they had to say. He gave a detailed explanation of his diagnosis and the results of the diagnostic tests, and discussed the options for treatment. They said, “He discussed everything fully with me so that I could make decisions.” Another person told us, “He explains the diagnosis and any diagnostic tests or treatment needed very clearly. He has never not been able to answer questions.”

Six people with whom we spoke were complimentary about the written and verbal information given by the doctor and his staff at Loughton clinic. They all felt well informed about their treatment and medication and said that “The doctor always listens” and that “You never feel rushed”.

We were told that privacy and dignity are upheld at all times and that people could express their views about their care and treatment, and were involved in the decision making process. Waiting times were rarely a problem. The doctor spent a lot of time explaining care and treatment plans.

People said the screening and assessment practices within the clinic were very good. They received results of tests quickly and were confident that the consultations with the doctor met their individual needs. They said they “felt safe” and “listened to” and felt that their welfare was protected by the doctor’s approach. They told us that they were treated as an individual, “not a number”.

There were no safeguarding concerns in the clinic and we were told by people who attend the clinic that the staff would not tolerate any abusive practice should it occur.

Everyone we spoke with told us that the facilities were satisfactory. The overall impression given was of a comfortable welcoming environment. Whilst parking was limited people rarely experienced problems because appointments were well managed which avoided a build up of people trying to access the clinic at the same time. They were pleased that the dentist had recently moved out of the premises as this reduced the pressure on waiting areas and facilities.

The view of all the people with whom we spoke was that the staff were caring and well informed regarding the screening procedures that are carried out at the clinic. They feel safe, confident that the staff know what they are doing and care about their individual needs.

All the people to whom we spoke were positive about the doctor. In some cases, because of his assessment and fast tracking practices, they felt he had diagnosed them quickly and saved them from more serious health problems.

We spoke with two people who had recently used the service and been supplied with medicines. They told us they were satisfied with the service provided. Both people said that they had discussed the possible side effects and had been informed that the medicines supplied were not licensed. One person with whom we spoke noted the doctor had refused to dispense some medication and fully explained why it would not be appropriate to do so.

People were confident that the staff had the right skills and competencies. They knew them by name and had no concerns regarding their ability to do the job. Everyone with whom we spoke recommended the clinic and rated the service provision as good. They told us they rarely had to wait for an appointment and that the screening practices were good. The doctor and clinical physiologist explained procedures well and follow up care was in place. Out of hours contact with the doctor was good.