We carried out an announced comprehensive inspection on 4 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 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 service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Medical Express Clinic provides an independent doctors consultation service from a single clinic in the Harley Street area of West London. Patients can book appointments or attend on a walk-in basis. The service provides onward referral to diagnostic and specialist services as appropriate. The service treats both children and adults. It typically treats between 200 and 500 patients per month.

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 Medical Express Clinic, some services are provided to patients under arrangements made by their employer. These types of arrangements are exempt by law from CQC regulation and we did not include these within the scope of our inspection.

One of the GPs at the clinic 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.

We received 31 completed comment cards completed by patients in the days leading up to the inspection. These were wholly positive and described the service as accessible, the quality of care as excellent, and the staff as kind, patient and professional.

The service is registered to provide the regulated activities of: diagnostic and screening services; treatment for disease, disorder or injury and, surgical procedures.

Our key findings were:

• There was a vision to provide a competitive, personalised service with a strong focus on preventive care. However quality improvement activity was more limited.

• The clinicians were aware of current evidence-based guidance and had the skills and knowledge to deliver effective care and treatment.

• Patients were able to access the service in a timely way. Staff were caring.

• The provider had some systems in place to protect people from avoidable harm and abuse. It had not appropriately assessed all risks however.

• The provider had systems in place to record, monitor, analyse and share learning from significant events. Systems to act and learn from safety alerts were under-developed.

• The service had arrangements in place to respond to medical emergencies.

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

• Ensure care and treatment is provided in a safe way to patients.

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

There were areas where the provider could make improvements and

should

:

• Review its quality improvement activity, in particular the scope to increase its use of clinical audit to drive improvement.
• Review the systems in place for supporting patients whose first language is not English.
• Review the systems in place to obtain useful feedback from patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

People told us they were happy with the service and staff. They described staff as "very nice" and "friendly". They told us staff asked their permission before undertaking an examination. They told us they had also signed a consent form. People said they were provided with information about treatment and tests they needed to have done.

People said the clinic was clean but also told us they thought it would be more clinical "like a hospital". We found the provider had not updated infection prevention and control policies and procedures in accordance with the latest guidance. Staff did follow general precautions to prevent the spread of infection.

The provider had safe and effective recruitment processes in place to ensure staff were fit and able to undertake their role. We saw records were stored securely and people's medical records were readily available and were fit for purpose.

We were unable to speak with people who use the service about this outcome on this occasion. However, information leaflets and patients' guides are available and given to people to enable them make informed decisions about their care and treatment. Individual records are kept for each patient which show that patients experience safe and appropriate care.