We carried out an announced comprehensive inspection of the Northern Circumcision Clinic – Leeds on 14 October 2017 to ask the service provider 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 comprehensive 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.

Northern Circumcision Limited is an independent circumcision service provider which is registered in Billingham, County Durham and operates from locations in Leeds and Sheffield. The Leeds based service operates from accommodation within Rutland Lodge Medical Centre, Scott Hall Road, Leeds, West Yorkshire, LS7 3RA. The service provides circumcision to those under 18 years old for cultural and religious reasons under local anaesthetic, and carries out post procedural reviews of patients who have undergone circumcision at the clinic. The majority of circumcisions carried out by the clinic were on children under one year of age.

Rutland Lodge Medical Centre where the service is hosted is a modern GP practice which is easily accessible for those bringing children or young people to the clinic, for example it has level floor surfaces, automatic doors and parking is available. The Northern Circumcision Clinic - Leeds utilises the minor surgery room within the practice for the delivery of services, as well as ancillary areas such as waiting areas and toilets.

The service is led by two directors (one male/one female) and is delivered by four clinicians (all male – one of whom is also a director). These clinicians are all trained and experienced in this area of minor surgery, being either qualified paediatric surgeons or GPs. Other staff working to support the clinic includes a booking clerk, and an assistant who supports the operation of the service in a non-clinical delivery role. As part of a service level agreement with Rutland Lodge Medical Centre a practice receptionist supports parents and patients on arrival on behalf of the clinic.

The Leeds based service provides one to two sessions per clinic, and clinics are held at approximately three weekly intervals depending on patient demand.

We spoke with the parent of one infant patient during the inspection. They told us that they could not fault the service. They said staff were ‘really friendly’, the procedure was fully explained and support was given throughout. We received 24 CQC comment cards which had been completed by parents of patients accessing the service before our visit. These comments were all extremely positive about the service they and their child had received. Comments noted that staff were professional and helpful and that they would recommend the service to others.

Our key findings were:

• The service was offered on a private, fee paying basis only and was accessible to people who chose to use it.
• Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
• The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
• There were systems, processes and practices in place to safeguard patients from abuse.
• The service had risk management processes in place to manage and prevent harm.
• Information for service users was comprehensive and accessible.
• Patient outcomes were evaluated, analysed and reviewed as part of quality improvement processes.
• Staff had the relevant skills, knowledge and experience to deliver the care and treatment offered by the service.
• The clinic shared relevant information with others, such as the patient’s GP and when required safeguarding bodies.
• We saw evidence that when a complaint was received it was investigated thoroughly and mechanisms were in place to make subsequent improvements to the service based on complaints.
• There was a clear leadership structure, with governance frameworks which supported the delivery of quality care.
• The service encouraged and valued feedback from service users. Comments and feedback for the clinic showed high satisfaction rates.
• Communication between staff was effective with meetings and post sessional debriefings being held.