We were not able to speak to people using the service because there were no appointments booked at the time of this inspection. We gathered evidence of people’s experiences of the service by reviewing the satisfaction questionnaires returned to the service. We found that people who had used the service stated that they were given information about their care and treatment before they underwent procedures. They said that staff were "very professional" and "welcoming”.

Appropriate medical checks were undertaken before people received treatment. We also looked at feedback questionnaires that had been completed in the last twelve months. Letters of thanks that had been sent to Dr. Nelda Frater stated that patients were happy with the service.

People who use the service reported that Dr. Frater had understood their problem and that they understood their proposed treatment. A medical history was taken for each person and there were procedures in place to deal with emergencies.

There was a safeguarding policy in place for protecting vulnerable adults and children. Staff were able to describe what action they would take if they had concerns for a person’s welfare.

Staff received adequate training and supervision. They attended annual appraisals.

The service conducted audits to monitor the quality of the service it was providing.

People, who use services were very positive about the service they received, they are fully involved in the treatment and all areas of risk and choices available to them were discussed at the consultation.

We spent time in the waiting area and staff were seen to liaise with all patients in a respectful and dignified manner. Evidence from our inspection and quality assurance audit records from January 2011 to September 2011 showed that the patients that had used the service were happy with the treatment received.

We carried out an announced comprehensive inspection on 2 July 2018 and 11 July 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 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.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the private medical 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. The Frater Clinic provide corporate health screening and pre-employment screening programmes to some employers. These types of arrangements are exempt by law from CQC regulation. Therefore, we did not inspect these.

The service is registered with the CQC for the regulated activity of treatment of disorder, disease and injury.

The Frater Clinic provides private general practitioner (GP) services and consultations with specialist consultants across a range of secondary care specialties. Forty-seven clinicians have been granted practising privileges at The Frater Clinic, including specialist doctors in cardiology, endocrinology, general surgery, gastroenterology, breast surgery, obstetrics and dermatology. The work of some of these, such as counselling and physiotherapy is out of scope of CQC registration and regulation.

GP care at the clinic includes travel medicine, treatment of short and long term conditions, immunisations and antenatal care. Minor surgery is performed at the clinic by a doctor who is a specialist in dermatology.

Sixteen people provided feedback about the service, which was wholly positive.

Our key findings were:

• A number of risks, including infection, hazardous substances and fire, were not adequately assessed or mitigated.

• Recruitment records and records of staff checks were incomplete and the clinic had no systems to check the recruitment of shared reception staff or staff used as chaperones.

• There was not an effective system for monitoring the quality of care, in line with the clinical model. There was no formal quality improvement programme, and no recent evidence from audit or other quality improvement activity of improvement in patient care. There was very limited evidence of learning and improvement from patient safety alerts, incidents and complaints.

• A review of 20 patient records found instances where the care provided was not in line with local or national guidance.

• There were limited mechanisms for patients to provide written feedback and little evidence that this had been used to make improvements to the quality of services.

• Details of the clinic complaints policy were not available on the website. Records of the one complaint received were incomplete.

• Patient feedback for the services offered was consistently positive.

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

• 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.

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

• Review information available to patients about costs of treatment and staff working at the clinic.