At our last inspection carried out on 20 July 2018 we found the provider was not providing well led care. Whilst improvements had been made from an earlier inspection, governance processes to improve safe provision of care had not been embedded and tested. Consequently, the provider had breached relevant regulations and we issued a warning notice which the provider was required to comply with by 31 October 2018.

At this focused inspection we found the provider had continued along a path of improvement and had met the requirements of the warning notice. Due to the focused nature of the inspection we gathered evidence and applied a judgement to the question of whether the provider was providing well led care.

Our findings were:

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 as a focused inspection to check whether the service had taken the actions to meet the requirements of the Warning notice issued to them following inspection on 20 July 2018. When we carried out the July inspection we continued to find the service was not meeting all the legal requirements and regulations associated with the Health and Social Care Act 2008.

Specifically, we found the provider had breached the regulation relating to provision of: Good governance.

The provider had continued to send CQC a weekly report of prescribing undertaken and progress made against their improvement action plan. At the inspection on 14 November 2018 we found the provider had continued to make significant improvements and had tested the implementation of some improvements via auditing and review.

Medicare Reading Limited is registered with Care Quality Commission (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 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. Some of the services available at Medicare Reading are exempt by law from CQC regulation. Therefore we were only able to inspect the regulated activities as part of this inspection.

The provider has a 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.

Due to the focused nature of this inspection we did not seek feedback from people using the service. We reviewed policies and procedures in place to support the management of the service, spoke with staff and reviewed patient records to corroborate our findings.

Our key findings were:

• The provider had introduced a system to receive and act upon safety alerts.
• Safeguarding systems in place were appropriate. Staff had a clear understanding of safeguarding processes and their knowledge had been tested during training.
• A programme of clinical audit and review was in place and audit outcomes were recorded and shared.
• There was a system of one to one meetings with clinicians to discuss clinical performance and development.
• Appropriate clinical and prescribing guidelines had been introduced. Adherence to these guidelines was being monitored.
• Systems had been put in place to identify, assess and manage risk. For example, the quality of medical records was being monitored.
• The provider sent information to the patient’s registered UK GP to support continuity of care.
• Staff received training appropriate to their role and appraisal systems had been improved.
• Medicines for use in an emergency were appropriate and security of medicines had been improved.

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

• Improve the process for staff acknowledging receipt and understanding of policies and guidelines. Staff recording their receipt of such documents did not date the document when they had read it.

We carried out an announced comprehensive inspection on 20 July 2018. This inspection was carried out to follow up on a range of concerns arising from earlier inspections undertaken in February and April 2018. As a consequence of these inspections we imposed conditions upon the provider’s registration and issued requirement notices for the provider to improve services. We also asked the provider to send us an action plan detailing the improvements they intended to make. Therefore at this inspection we followed up on the actions the provider told us they would take to improve and asked 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 not providing well-led care in accordance with the relevant regulations.

This inspection was planned as a comprehensive follow up inspection to check whether the service had taken the actions to improve set out in their action plans arising from earlier inspections. The provider gave us regular updates on progress made in delivering service improvement. At this inspection we found the provider had made significant improvements. However, these improvements had been undertaken in a short period of time and they could not be assessed for effectiveness and sustainability in the longer term.

Medicare Reading Limited is an independent health care provider. They offer private GP services for adults and children and a range of other private health care services including dermatology, gynaecology and urology. The services are mainly aimed at the Polish speaking communities in Reading but are offered to the whole community. Medicare Reading Limited also provides dental treatment. The dental service was inspected separately. The dental report can be found by selecting the ‘all reports’ link for Medicare Reading Limited on our website at www.cqc.org.uk

Medicare Reading Limited is registered with Care Quality Commission (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 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. Some of the services available at Medicare Reading are exempt by law from CQC regulation. Therefore we were only able to inspect the regulated activities as part of this inspection.

The provider has a 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 feedback from seven people about the service from a combination of comment cards and face to face discussions. All seven were very positive about the service describing it as responsive to their needs.

Our key findings were:

• The provider had introduced a system to receive and act upon safety alerts.
• Safeguarding systems in place were appropriate but had yet to be tested.
• A responsible officer for the service had been appointed to provide clinical leadership and monitor clinical performance.
• Appropriate clinical and prescribing guidelines had been introduced. Adherence to these guidelines was being monitored. However, it was too early to evaluate whether adherence would be sustained.
• Systems had been put in place to identify, assess and manage risk. For example, the quality of medical records was being monitored. However, these systems were not always operated consistently.
• The provider sent information to the patient’s registered UK NHS GP to support continuity of care.
• Patient feedback on the service was positive.
• Staff received training appropriate to their role and appraisal systems had been improved.
• Medicines for use in an emergency were not risk assessed or held securely. The provider rectified this within one day of the inspection.

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 that are sustainable.

You can see full details of the regulations not being met, that resulted in enforcement, at the end of this report.

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

• Review the advice to staff relating to identifying potential life threatening conditions.
• Continue to review the adherence to appropriate clinical guidelines and prescribing guidelines.
• Review the changes made in response to inspection to evaluate whether they are effective and sustainable.

We found the provider had made sufficient improvement to enable us to lift the conditions relating to not registering new patients and checking identity of patients we had placed on their registration. However, further progress is still required and enforcement action is detailed in the enforcement section of this report.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced follow up inspection of Medicare Reading Limited in Berkshire on 17 April 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 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. The previous judgements have not been amended following this inspection.

Medicare Reading Limited is an independent health care provider. They offer private GP services for adults and children and a range of other private health care services. The services are mainly aimed at the Polish speaking communities in Reading but are offered to the whole community. Appointments are offered with Polish and English speaking doctors and health care professionals specialising in a variety of areas. Additionally, the doctors can request investigations (electrocardiograms, blood tests, scans and x-rays) to assist diagnosis. If appropriate, the doctors can oversee treatment and management as a main point of contact. Medicare Reading Limited also provides dental treatment. The dental service was inspected separately. The dental report and previous comprehensive report can be found by selecting the ‘all reports’ link for Medicare Reading Limited on our website at www.cqc.org.uk

Medicare Reading Limited is registered with Care Quality Commission (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 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. Some of the services available at Medicare Reading are exempt by law from CQC regulation. Therefore we were only able to inspect the regulated activities as part of this inspection.

The provider has a 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.

Our key findings were:

• The service had improved the systems to keep patients safe and safeguarded from abuse.
• The system for dealing with patient correspondence regarding care and treatment delivered externally had been improved.
• Information needed to deliver safe care and treatment was not always available to the relevant staff in a timely manner.
• The service was unable to provide evidence that the consultations of all clinicians were undertaken in line with national UK guidelines.
• We saw that systems for managing medicines did not always mitigate risks to patients. When information was shared with a patient’s NHS GP it was often confusing and did not make clear what treatment had been given.
• There were insufficient arrangements for identifying, recording and managing risks, issues and implementing mitigating actions.
• The practice had a governance framework but this did not support the delivery of safe, effective and responsive care.
• The levels of risk found at this inspection was a direct result of the provider not ensuring appropriate systems had been implemented to effectively identify, manage and mitigate risk.
• Medicare Reading Limited is not currently registered to provide the regulated activity of maternity and midwifery services. We saw evidence that the regulated activity had been undertaken. The provider has subsequently submitted an application to register for this regulated activity.
• The provider demonstrated a willingness to work with CQC to improve the quality and effectiveness of the service.

Following our inspection we sent the provider a letter detailing our concerns. The provider sent CQC an action plan which reduced some of the risks found during the inspection. We undertook enforcement action as detailed at the end of the report.

The areas where the provider must make improvements as they are in breach of regulations are:

• 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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

Medicare Reading Limited (also known as Medicare Polscy Lekarze) provides private GP services to adults and children and a range of other private health care services including dermatology and gynaecology. The registered provider is Medicare Reading Limited.

Services are provided from:

• Medicare Reading Limited, 603 Oxford Road, Reading, Berkshire RG30 1HL.

Medicare Reading Limited was founded in 2013 and is located in converted privately owned premises within Reading, Berkshire. All Medicare Reading Limited services, including GP services, are provided from the same premises, which contain two treatment rooms, two dental suites and an office. There is an open plan reception area and waiting area with seating.

The team at Medicare Reading Limited consists of two doctors on the specialist register for internal medicine, undertaking general practice services, ultrasound and electrocardiograms, (one female and one male), three gynaecologists (two female and one male), a practice manager and three receptionists. Medicare Reading also provides GP services to patients from foreign countries that require medical assistance whilst visiting the UK from abroad. These are mostly one-off consultations.

Medicare Reading has core opening hours of Monday to Sunday from 7am to 11pm. This service is not required to offer an out of hours service but does offer an emergency out of hours contact number on its website and patient literature. Patients who need urgent medical assistance out of corporate operating hours are also requested to seek assistance from alternative services such as the NHS 111 telephone service or accident and emergency.

The inspection on 17 April 2018 was led by a CQC inspector who was accompanied by a GP specialist advisor, a second CQC inspector and a translator.

During our visit we:

• Spoke with a range of staff, including an internal medicine doctors who provides GP services, the practice manager who manages the full range of services, including the GP services, and the registered manager.
• Looked at information the service used to deliver care and treatment plans.
• Reviewed documents relating to the service.

We carried out an announced comprehensive inspection of Medicare Reading Limited in Berkshire on 21 February 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 not 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.

Medicare Reading Limited is an independent health care provider. They offer private GP services for adults and children and a range of other private health care services including dermatology and gynaecology. The services are mainly aimed at the Polish speaking communities in Reading but are offered to the whole community. Appointments are offered with Polish and English speaking doctors and health care professionals specialising in a variety of areas. Additionally, the doctors can request investigations (electrocardiograms, blood tests, scans and x-rays) to assist diagnosis. If appropriate, the doctors can oversee treatment and management as a main point of contact. Medicare Reading Limited also provides dental treatment. The dental service was inspected seperately. The dental report can be found by selecting the ‘all reports’ link for Medicare Reading Limited on our website at www.cqc.org.uk

Medicare Reading Limited is registered with Care Quality Commission (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 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. Some of the services available at Medicare Reading are exempt by law from CQC regulation. Therefore we were only able to inspect the regulated activities as part of this inspection.

The provider has a 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.

Our key findings were:

• The service did not have clear systems to keep patients safe and safeguarded from abuse.
• Systems for sharing information with a patient’s GP did not enable them to deliver safe care and treatment placed patients at risk of harm
• The system for urgent referrals exposed patients to the risk of harm.
• The service was unable to provide evidence that the work of all its clinicians was undertaken in line with national UK guidelines.
• The service did not always share relevant information with a patient’s GP when necessary.
• Prescribing was not audited or reviewed to identify areas for quality improvement.
• Patients reported they generally felt involved in decision making about the care and treatment they received.
• The facilities and premises were appropriate for the services delivered.
• Patients with a long-term condition did not receive an annual review to check their health and medicines needs were being appropriately met.
• There were insufficient arrangements for identifying, recording and managing risks, issues and implementing mitigating actions.
• The practice had a governance framework but this did not support the delivery of safe, effective and responsive care.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• Ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or investigation.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

Summary of any enforcement action

We are now taking further action in relation to this provider and will report on this when it is completed.

We carried out this unannounced inspection on 31 May 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Medicare Reading is also known as Medicare Polscy Lekarze. This is an independent medical practice, providing a range of GP run services. This includes consultations, diagnosis and treatments related to orthopaedics, cardiology, dermatology, gynaecology, dentistry, aesthetics, and paediatrics. Ultrasound scanning is available, along with blood tests.

The services are delivered from a designated location, with suitable facilities, which were clean and well equipped. The service is open from 8am to 9pm seven days per week. Patients who require urgent medical advice are also able to contact an emergency number between the hours of 7am and 11pm.

The clinical services are delivered by Polish GPs who speak English as a second language. They are registered with the GMC and have admitting rights to undertake their clinics.

Blazej Celmer 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 found that this practice was providing safe, effective, caring, responsive and well-led care in accordance with the relevant regulations.

Our key findings were:

• The service was not providing any treatment or care to people outside of the regulated activities currently registered for.
• The premises and equipment was well maintained and appeared clean and tidy.
• Medical equipment was stored securely.
• Patient electronic records were stored securely and were comprehensive in the recording of care and treatment.
• Significant events were identified appropriately and mitigating actions and learning

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

• Ensure that the security arrangements for keys used to access medicine cupboards are improved.

When we visited Medicare on 28 May 2014 we found that all the relevant checks required to ensure staff were of good character and fit to perform their duties had not been carried out. Medicare told us, by sending us an action plan, they had completed the necessary checks. We carried out this visit to check that action had been taken.

We looked at staff personnel records and spoke with the practice manager. We found significant progress had been made. We did not speak with patients during this visit.

The practice manager supplied us with evidence of appropriate recruitment procedures being put in place. The records we reviewed showed appropriate checks had been carried out for all staff working at the practice. The risk of patients being cared for by staff who were not suitably qualified, skilled or experienced had been reduced.

This was a follow up inspection to check compliance with warning notices. We found improvements to procedures for recording consent for treatment and awareness of the Mental Capacity Act 2005. Systems had been introduced to record information about patient consultations and there were arrangements to deal with foreseeable emergencies. We also found that procedures had been introduced to reduce the risk of infection to patients and staff. Quality monitoring systems had been introduced and records were stored securely. However we found that some information required for staff recruitment had not been collected. The clinic had not checked information relating to the previous employment of staff.

Health care professionals work from the clinic on a self-employed basis with practice privileges. The clinic offers appointments with a range of health care professionals on their website. At the time of our inspection there were two doctors, a dentist and a phlebotomist holding regular clinics. We spoke with the registered manager and a director of the company. We did not speak with any patients on this inspection.

There were processes in place to obtain consent for care and treatment but these were not always followed.

Care and treatment was not always planned and delivered in a way that was intended to ensure people’s safety and welfare. Appropriate records were not kept to evidence that treatment was provided in line with people’s needs. Arrangements to deal with foreseeable emergencies were inadequate.

The appropriate guidance had not been followed to ensure that people were protected from the risk of infection. There were no processes in place reduce the risk of cross contamination and infection.

There was no evidence that appropriate checks had been completed before staff began work.

The provider did not have a system to assess and monitor the quality of the service. There was no system to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Records were not kept securely and could not be located promptly when requested.

During our unannounced comprehensive inspection of this practice on 31 May 2017 we found breaches of legal requirements of to the Health and Social Care Act 2008 in relation to:

• Regulation 17 Good Governance.

We undertook this focused inspection to check that the provider now met legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our previous comprehensive inspection by selecting the 'all reports' link for Medicare at www.cqc.org.uk

Are services Well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Key findings

• Overall, we found that effective action had been taken to address the shortfalls identified at our previous inspection and the provider was now compliant with the regulation.

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

• Continue to translate dental care records into English for patients who were seen by the dentist who recorded their notes in Polish. This can be completed as and when these patients attend for their appointment.