We carried out an announced comprehensive inspection on 2 November 2017 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

Background

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 practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC inspected the service on 17/18 December 2013 and asked the provider to make improvements regarding;

• Care and welfare of people who use the service
• Management of medicines
• Requirements relating to workers
• Assessing and monitoring the quality of service provision

We visited again on 12 August 2014 to conduct a follow-up focused inspection and found that three out of the four areas identified had met the required standards.We carried out a further focused inspection on 31 March 2015 and found that all required standards had been met.

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 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 Regent Street Clinic Derby, services are provided to patients under arrangements made by their employer with whom the service user holds a policy (other than a standard health insurance policy). These types of arrangements are exempt by law from CQC regulation. Therefore, at Regent Street Clinic Derby, we were only able to inspect the services which are not arranged for patients by their employers with whom the patient holds a policy (other than a standard health insurance policy).

Regent Street Clinic Derby is an independent provider of GP services owned by FBA Medical Ltd. The provider also offers a range of specialist services and treatments such as facial aesthetics, travel vaccinations, sexual health screening, occupational health and offshore medical services to people on both a walk-in and pre-bookable appointment basis. The service does not offer NHS treatment. The clinic is based in the city centre of Derby. It is an accredited yellow fever centre which is registered with NATHNaC (National Travel Health Network and Centre). The practice is also registered with the British College of Aesthetics Medicine (BCAM).

The provider which is FBA Medical Limited is registered with the Care Quality Commission to provide services at Regent Street Clinic Derby, 1 Bridge Street, Derby, DE1 3HZ. The period property has been used to provide services to patients since 2009.

FBA Medical Limited was first opened by the provider in Nottingham in 1998 with the provider as the lead GP and one employed receptionist. Since then the provider has grown the business to provide services at other locations in Watford, Leicester, Leeds, Sheffield and Derby. Staff numbers have increased from one GP and one receptionist to six GPs, one practice nurse, two practice counsellors,one group practice manager, three clinic practice managers, twelve reception & administrative staff, plus book-keeping, accountancy and IT staff.

The Derby clinic property consists of a patient waiting room, reception area and consulting rooms which are located on the first floor of the property. There is not a lift in the property, however, patients can be seen on the ground floor for their appointment if stairs are a problem. There is also an accessible disabled toilet and baby changing facilities available on the round floor. A call centre is located in the Nottingham location which deals with incoming telephone calls for all six locations. There is secure car parking available at the practice via electric gates.

This practice is a member of the Independent Doctors Federation (IDF). The IDF is a designated body with its own Responsible Officer.

The practice does not hold a list of registered patients and offers services to patients who reside in Derby and the surrounding areas and patients who live in other areas of England who require their services. The city of Derby has a university student population who are also able to access private medical services if required.

The clinic offers a same day walk-in service during the opening hours;

• Monday 1pm until3pm
• Tuesday 9am until12noon
• Thursday 3pm until7pm

Investigations such as blood tests, X-rays, Ultrasound scans, MRI and CT scans and referrals to specialist consultants can be arranged on the same day either on-site or via the Nuffield Hospital, Derby.

The local pharmacy partner for the Derby clinic is Markeaton Pharmacy, 126 Keddleston Road, Derby DE22 1FX. The pharmacy provides a delivery service for patients attending the clinic.

The clinic provides one regular GP, a group practice manager, and one clinic administrator.

The group practice manager is the registered manager and works across all six locations. 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.

As part of our inspection we reviewed 15 CQC comment cards wherepeople provided feedback about the service. All of the 15 comment cards we received were extremely positive about the care and treatment received. Patients described the GP as very respectful, knowledgeable and caring. People described the service they received as being ‘first class’ and that they always felt welcomed and listened to by staff. However, two people also said that they had waited longer than expected for their scheduled appointment.

Our key findings were:

• There was a group-wide system in place for reporting and recording significant events.
• The practice used a number of policies and procedures to govern activity which were accessed centrally and aligned to the business.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The provider followed NICE and SIGN guidelines to ensure clinical practice was up to date and to drive improvement.
• There was a process in place to act on safety and MHRA alerts and these were discussed at group meetings with the other clinicans, however, the provider did not keep a log of actions taken.

• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice proactively sought feedback from staff and patients
• The provider actively encouraged patient feedback through a number of forums.

We found an area of notable practice;

• The provider worked with a private laboratory testing service and had formulated a very thorough blood screening assessment for Regent Street Clinic which they called the ‘superscreen’. The more detailed tests identified health issues that could not be picked up with basic NHS testing and had led to early intervention and some very positive outcomes for patients

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

• Consider keeping a centralised record of actions taken for all safety and MRHA alerts so that these can be reviewed by other clinicians within the group in the absence of the lead GP.
• Consider installing a hand wash basin in the consulting room and upgrading the floor covering around the examination area.

On this occasion, we did not speak with any people using the service due to the nature of the standards we inspected. However, patient feedback forms we looked at showed high levels of satisfaction with the service.

We found that most of the required improvements had been made since our previous inspection in December 2013.

Arrangements were in place to deal with medical emergencies to ensure the welfare and safety of people who used the service. Staff had received further training on basic life support, except for two new staff members who had yet to receive this.

Robust recruitment procedures were not followed, as all the required information was not available for new staff to ensure they were suitable to carry out the work.

A system was in place to obtain feedback from patients about the quality of the service they received, and to show that their views were listened to and acted on.

The provider’s policies had been reviewed since our previous inspection. However, these were still being developed, and had yet to be finalised to ensure these detailed the practices followed at the clinic.

We spoke with five people who use the service and three members of staff. People told us they were happy with the care and treatment they received at Regent Street Clinic Derby. One person told us “I am absolutely happy. He (the provider) has a very good doctor - patient manner.”

People told us they did not have any concerns regarding medicines. However we found the provider did not have appropriate arrangements in place to manage medicines.

We found the provider had systems to check the background of people employed at the service. However we did not see evidence that the system was used for all staff.

People told us they would feel able to talk to the provider if they had a concern. One person told us “I've never had to complain, I would have confidence in them to deal with it.” However we found the provider did not have appropriate systems to monitor the quality and safety of the service and did not have effective mechanisms for people who use the service to give feedback regarding their experiences.