We carried out an announced comprehensive inspection on 17 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.

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.

Well Travelled Clinics is a limited company which is a subsidiary of the Liverpool School of Tropical Medicine (LSTM).  All profits go back into the research and development work of LSTM. The service provides a private pre-travel advice, vaccination and malaria prophylaxis service to the travelling public of the northwest of the UK and a number of UK based corporate clients. In addition GPs sometimes referred patients who had complex medical issues and the service worked alongside consultants from local hospitals for additional support.

The service is also involved in education for example providing annual vaccination and immunisation updates for a local commissioning body. The service is located in Liverpool city centre, close to all major transport links.

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. Those occupational health related services provided to clients under a contractual arrangement through their employer or government department are exempt by law from CQC regulation. Therefore, they did not fall into the scope of our inspection.

As part of our inspection we asked for Care Quality Commission comment cards to be completed by patients prior to our inspection visit. We received 44 comment cards, all of which were positive about the standard of care received.

Our key findings with respect to the regulations were:

• Systems were in place to protect people from avoidable harm and abuse. When mistakes occurred lessons were learned.
• There were effective arrangements in place for the management of vaccines and medicines.
• 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.
• The service took part in audit and research.
• Care Quality Commission (CQC) comment cards reviewed indicated that patients were very satisfied with the service they received. Patients commented that they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available.
• There was a clear leadership structure and staff felt supported by management and worked very well together as a team.

• The service had introduced a system whereby the patient’s computerised medical record had a box to tick for verbal consent given. If the consent was not recorded the computer system would not allow the clinician to move from the record on the computer until this was actioned.
• There were additional systems in place to keep vaccinations stored at optimal temperatures by having an alarm that was sent to another office overnight if the fridge temperatures deviated from the optimal temperature range.
• Non clinical staff had been trained to identify early signs of allergic reactions post vaccination.

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

• Review the monitoring system for incoming medicine safety alerts.
• Have a cleaning schedule in place for any medical equipment.

We spoke with one person who was using the service, who was very complimentary. The person we spoke to told us the nurse travel adviser (NTA) they saw on their first visit had asked them which country and region they were going to and what they would be doing when they were there. They told us that the NTA then advised them on the relevant health risks and gave detailed advice on preventative measures they could take and the vaccines and medication available. The person we spoke with said "The nurse was excellent. I felt that I was consulted and not patronised in any way". They also said "They've given me really good advice, they're very professional here and I have no complaints."

We were told by the person using the service, that the service also gave written information about the vaccines, medication and that this advice was very useful.

We visited Well Travelled Clinics on the 21st November and received information from the Managing Director on the 26 November to support this compliance review. We found the service was fully compliant in all essential standards of quality and safety we looked at.

We spoke briefly with one person using the service. They said, “I’ve just been in the care of a lovely woman and I’ve been looked after very well. I come regularly and everyone is very nice”.

We found that there were good policies and procedures in place to ensure people were given good advice before they consented to receiving immunisation they needed. Staff were familiar with and aware of people's rights to make their own decisions, and of their duty of care to protect vulnerable people and children.

People were treated by staff that were of good character and trained well. There were systems in place to monitor the service provided. Quality Assurance monitoring results showed a high satisfaction with 'What the service did well'. Some of the written comments included:

‘Explained everything and gave good advice’.

‘Helped to understand what’s needed and the side effects. Answered all of our concerns’.

‘Lots of information & offer of follow up info. Very non-judgemental’.

‘Friendly, informative & knowledgeable. For someone who is terrified of needles, everything was done to ensure my comfort’.