The Gynae Centre is operated by the The Gynae Centre Limited. The service opened in 1999. It is a small independent service in central London, offering gynaecological consultations and minor day surgery for women, as well early medical and surgical termination of pregnancy services up to nine weeks gestation. Minor surgery treatments included, labioplasty, vagionplasty,hymen repair, hysteroscopy, incision/marsupialzation of Bartholin’s cyst, mini curette of uterus and loop excision of the cervix.

The service has no inpatient beds. Facilities include one consultation room and one treatment room with ultrasound diagnostic equipment.

We inspected this service using our comprehensive inspection methodology, under our routine programme of activity. We carried out the announced part of the inspection on 6 October 2016.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We do not currently have a legal duty to rate termination of pregnancy and cosmetic surgery service, or the regulated activities they provide. We do however; highlight good practice and issues that service providers need to improve, and take regulatory action as necessary.

We found the following areas of good practice:

• There were systems for staff to report incidents and for investigatory processes to be allowed.

• The environment was visibly clean and well maintained, and there were measures to prevent the spread of infection.

• There were systems to ensure the safe storage, use, and administration of medicines.

• There were adequate numbers of suitably trained staff to meet patient’s needs. In addition to safety related training, staff were trained with regard to safeguarding vulnerable people. As a result, staff knew how to report safeguarding concerns.

• Patient records were stored safely and medical details were recorded well. We saw evidence to indicate patients’ needs had been discussed, and consent was sought before treatment. Subsequent care and treatment was delivered in accordance with national and professional guidelines.

• We found arrangements had been set up and were used to ensure doctors and anaesthetists met the requirements for practising privileges.

• Patients could access care when they needed it, and they were treated with dignity and kindness, and their privacy was respected.

• Patients were able to raise concerns easily and there were good systems to handle patients concerns in a fair and compassionate nature.

However, we also found the following issues, which the service provider needs to improve:

The service should:

• We gave immediate feedback to the service regarding the decontamination of hysterscopes, as improvements were required to ensure the service was following national guidelines. Within two days of our inspection feedback, the centre had reacted and provided an action plan and evidence of a new service level agreement between themselves and a hospital trust for the provision of sterile services, which took place with immediate effect.

• Provide dates on the policies, which were used to inform staff practices. Although policies provided information to support the delivery of the services, they were not dated and needed to be more in-depth. As a result, it was difficult to determine when they came into use, when they required a review or if they had been updated.

• Update the safeguarding policy to reflect the intercollegiate document 2014 and latest guidelines.

• Provide a policy for the duty of candour. Although staff were able to tell us this meant being open, transparent, and apologising to patients when things went wrong, nursing staff had not received training on this matter, and there was no policy at the centre.

• Make sure the health care assistant (HCA) was not referred to as a nurse, which was misleading to patients, and may have led to assumptions about their skills and competencies.

• Staff told us patients who attended the service for a termination of pregnancy were not routinely made aware of the statutory requirements of the HSA4 forms. They were not informed the data published by the Department of Health for statistical purposes was anonymised.

We were not able to speak with people who use the services on the day of our visit.

We looked at personal records that showed people’s needs were assessed and care and treatment was planned and delivered in line with their individual treatment plan.

Processes were in place to obtain people's verbal and written consent to care and treatment.

Procedures were followed to ensure that people were protected against the risks associated with the unsafe use and management of medicines.

People were not always protected from the risk of infection because appropriate guidance had not always been followed. There was a lack of available information for staff and people using the service to protect them against risks of acquiring infections.

People’s personal records including medical records were accurate and fit for purpose. Records relating to termination of pregnancy met legal and regulatory requirements. Staff records and other records relevant to the management of the services were also accurate and fit for purpose.

There were enough qualified, skilled and experienced staff to meet people’s needs, with arrangements in place for people to contact the doctor out of hours if necessary.

The quality of the service was assessed and monitored, and feedback was taken into account and acted upon.

We were not able to speak with people using this service. As this is a single-handed private doctor service the doctor had made no appointments with patients so that he was able to be free for our visit. We saw evidence from the last patient survey results from 2011 which showed that people using the service were very satisfied with the service offered at this location.