We carried out an announced comprehensive inspection on 16 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 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.

Dr Stephen Alex Bobak is the registered manager at The London Travel Clinic at Wandsworth. 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.

The London Travel Clinic at Wandsworth is an independent travel clinic in London and provides travel health services including vaccinations, medicines and advice on travel related issues to both adults and children. The service operates under a contract to provide travel health to the patients of a GP practice located within the same building. Prior to our inspection patients completed CQC cards telling us about their experiences of using the service. Six people provided feedback about the service. All were positive about the care provided by clinical staff but two comments related to difficulties making appointments.

Our key findings were:

• There were limited systems in place to keep patients safeguarded from abuse. Information about who to contact with a concern was not accessible to staff. Staff had received safeguarding training.
• The system for managing medicines did not ensure they were safe to use.
• Not all risks were assessed or well-managed.
• The premises were clean; however, no infection control audits had been completed.
• Procedures for managing medical emergencies were lacking.
• Although the service had a standard operating procedure for this location it did not contain all necessary information. Other policies and procedures available were generic and did not reflect day to day practice at the service.
• The complaint system was not advertised but the service would provide patients with an email address which they could contact after their appointment, to provide feedback.
• The service had systems in place to respond to incidents. When incidents did happen, the service learned from them and improved.
• The service reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, there was no evidence of activity which aimed to improve the quality of clinical care provided.
• The appointment system reflected patients’ needs. Two comment cards indicated that patients found it difficult to make appointments at the service. NHS patients would be sent to the provider by their local GP.
• Staff involved patients in their care and treated them with compassion, kindness, dignity and respect.
• There was a lack of effective managerial oversight and some areas of governance were not sufficient to ensure safe care and that quality of services improved.

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

You can see full details of the regulations not being met at the end of this report.

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

• Advertise the service’s complaints procedure and keep appropriate records of complaints received.

Establish processes for sharing information when necessary with a patient’s GP in the absence of patient consent. 

We spoke to two people who use the service and observed the nurse's interactions with three additional people during our visit. We had no concerns with what we observed at the clinic. One of the people we spoke to told us they had a "very good" experience. However, one person told us they did not feel they were treated with respect and did not find the nurse knowledgeable in relation to their travel needs. They said the nurse "was not concerned about [them] as a patient", and were further "frustrated" when the required vaccine was not in stock although the clinic knew they were coming for it. We reviewed feedback received during the past six months from people who use the service and found that it was generally positive, with no similar comments to the ones made by the person we spoke to.

The London Travel Clinic in Wandsworth was housed in a clean office located above the Wandsworth Medical Centre, with access for people with disabilities. The clinic was staffed by one nurse who also carried out reception duties. The reception area offered leaflets on travel-related diseases, travel kits such as first aid, sterilisation and safe water, travel books which included health information and other travel health paraphernalia. A list of fees was displayed in several places in the reception area.

There were suitable infection control practices, patient record management, management of medicines and staff were suitably qualified.