We carried out an announced comprehensive inspection on 24/08/18 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 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 CQC inspected the service on 29/08/17 and asked the provider to make improvements regarding safeguarding service users from abuse and improper treatment, staffing and good governance. We checked these areas as part of this comprehensive inspection and found the issues identified at the last inspection had been addressed.

The owner of the service 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.

Our key findings were:

• The shortfalls identified at our previous inspection of the service had been mitigated by the provider.
• There was a system for reporting, investigating and learning from incidents, complaints and safeguarding issues.
• There were effective arrangements to respond to emergencies and major incidents.
• Staff were aware of current evidence based guidance and they were appropriately trained to carry out their roles.
• People’s privacy and dignity was respected.
• The provider was focused on meeting the needs of the local population.
• Systems were in place to gather feedback from patients and staff.
• There were appropriate arrangements for managing risk.

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

• Review procedures for sharing information with patients’ NHS GPs.
• Continue to develop quality assurance systems and clinical leadership.
• Review the vision and strategy for the service.

We carried out an announced inspection on 29 August 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check on concerns we had received and whether the registered provider was meeting the legal requirements within the Health and Social Care Act 2008 and associated regulations.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notice section at the end of this report).

Are services effective?

We found that this service was providing not effective care in accordance with the relevant regulations (see full details of this action in the requirement notice section at the end of this report).

.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 have told the provider to take action (see full details of this action in the requirement notice section at the end of this report).

Background

Poland Medical is an independent provider of medical services and treats both adults and children in the London Borough of Ealing. Services are provided primarily to Polish people. Services are available to people on a pre-bookable appointment basis. The clinic employs doctors on a sessional basis most of whom are specialists providing a range of services from gynaecology to psychiatry. Medical consultations and diagnostic tests are provided by the clinic however no surgical procedures are carried out.

The clinic also provides dental services. A copy of the full report of the dental service is available on our website:

http://www.cqc.org.uk/search/services/doctors-dentists

The property is leased by the provider and consists of a patient waiting room & reception area, one dental surgery and three medical consultation rooms which are all located on the ground floor of the property.

Poland Medical is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, surgical procedures and treatment of disease, disorder or injury.

The clinic is owned by an organisation and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Poland Medical is the owner of the service.

The clinic employs 13 doctors all of whom are registered with the General Medical Council (GMC) with a licence to practice. The doctors work across both the West London and Coventry locations. Other staff include the registered manager and a team of reception staff. Poland medical is a designated body (an organisation that provides regular appraisals and support for revalidation of doctors) with one of the specialist doctors as a responsible officer (individuals within designated bodies who have overall responsibility for helping with revalidation). The doctor is also medical advisor to the clinic.

The clinic is open Monday to Friday from 8am to 8pm, Saturday from 8am to 5pm and Sunday from 11am to 6pm. The provider does not offer an out of hours service or emergency care. Patients who require emergency medical assistance or out of hours services are requested to contact NHS direct or attend the local accident and emergency department.

Our key findings were:

• Systems and processes were in place to keep patients safe. However, we identified some shortfalls in relation to safeguarding children, staff recruitment, infection control and the management of prescription pads.
• There was some evidence that staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Some quality improvement was evident however it was limited particularly in relation to clinical audit. There were no medicine audits carried out to monitor the effectiveness of prescribing.
• Information about the services and how to complain was available. Complaints were dealt with in a timely way.
• Governance arrangements were in place however there was no program of continuous clinical and internal audit and no structured meetings that allowed for the sharing of learning from complaints and significant events with all staff.
• There were no multi-disciplinary meetings.
• We did not see any evidence of clinical supervision.
• There was no system for the reconciliation of pathology test results.

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

• Ensure patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Introduce formal supervision and support for clinical staff.

In addition the provider should:

• Review how prescription pads are managed.
• Develop the vision for the clinic and implement a strategy to deliver it.
• Update policies and procedures to include review dates.
• Review the system of managing communication with a patient’s NHS doctor.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

During our visit we were not able to speak to people who use the service. However, we looked at information gained by the provider through a recent feedback survey they had carried out. The feedback told us that people felt informed about their treatment and that they were treated with respect. People indicated that they chose to use the service due to the Polish speaking doctors and their confidence in the skills of the doctors they met with.

However, during the inspection we found that the service was providing dental services to people. The service is not currently registered with the CQC to provide this service, as it is not registered for the regulated activity of Surgical Procedures. We have asked the provider to submit a complete application to the CQC. We have informed the provider that it is an offence to provide a dental service untl the serviced is registered for the regulated activity of Surgical Procedures.

We received information from the Accountable Officer of the Local Primary Care Trust which raised concerns about how medicines were prescribed and managed in the clinic. We visited the clinic twice to speak to staff and review records.

Patients were not asked about this outcome on this occasion due to the nature of the information provided.