We carried out an announced comprehensive inspection on 13 August 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

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.

The provider, which is 3VHealthcare Limited, is registered with the Care Quality Commission (CQC) to provide services at Thornbrook Road, Chapel-en-le-Frith, High Peak, Derbyshire, SK23 0RG. The clinic has been used to provide services to patients since 2009. It is registered with the CQC to provide three regulated activities which are diagnostic and screening services; treatment of disease, disorder and injury; and surgical procedures.

3VHealthcare Limited - Thornbrook Surgery provides consultant-led NHS clinics in the Chapel-en-le-Frith area of the High Peak. The service works closely with the provider's other location, 3VHealthcare Limited - Goyt Valley Medical Practice, situated half-a-mile away, which also provides consultant-led NHS clinics and an ultrasound scanning facility. The office opening hours are Monday to Friday 8am to 5pm, and patients can contact the service by telephone between 8.30am and 16.30pm. Clinical sessions are available throughout the week at different times according to the specialty. Monthly ophthalmology clinics are held on a Saturday at the Goyt Valley site in Chapel-en-le-Frith.

Patients are referred into the service by authorised clinicians, including GPs, nurse practitioners and optometrists. All clinical sessions are provided on the ground floor within a GP practice. Adequate parking is available for patients at each location.

Three GPs are the directors of 3VHealthcare Limited and there is also one non-executive director of the company. There is a management team comprising of an office manager, and three named service managers with responsibilities for each specialty. Four administrative staff support the team including IT support, these staff are based in a health centre situated next door to Thornbrook Surgery. This is solely an administrative base and no regulated activities are provided from this site. 3VHealthcare Limited staff also use a room at Thornbrook Surgery which is rented from the practice. The service also employs a pharmacist on a sessional basis. In addition, there are 15 consultants, two GPs with a Specialist Interest (GPSI), an associate specialist, and a diagnostic radiographer who work for the service on a sessional basis, but are not directly employed. Two specialist nurses (a rheumatology and an ophthalmology nurse) are employed on a zero hours contract to support the consultant clinics.

A GP from one of the three practices which established the service is the registered manager, and this GP is also one of the three directors of 3VHealthcare Limited. 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.

Our key findings were:

• The service provided prompt and easy access to the clinics it provided for patients residing locally. This was highly valued by patients who otherwise would need to travel to hospitals some distance away, and the area was subject to poor transport links and frequent adverse weather in the winter months.
• We received 50 CQC comment cards from patients about this service. We also spoke with several patients attending the service on the day of our inspection. The patients’ responses were almost entirely positive about their experiences at the service. Comments included that patients felt staff were very friendly and courteous, they felt listened to and their questions were answered in a way which was easy to understand, as well as being treated with dignity and respect. Patients also told us they valued having access to this service locally and that they received an appointment promptly after being referred.
• Directors and managers spoke with passion about the service and their commitment to deliver a service to meet the needs of their patients. There was a clear vision to provide high quality, locally-based, and sensitive care.
• The management team liaised effectively with visiting clinicians to ensure the continuity and coordination of care and service delivery. Service managers provided a named person for both patients and staff as a point of contact. There were clear responsibilities, roles and systems of accountability to support good governance and management.
• The service maintained comprehensive records of activity and outcomes to assess quality of service provision. This included monitoring satisfaction through the Family and Friends Test, and quality was discussed regularly with their commissioning Clinical Commissioning Group (CCG). An annual quality account was produced by the service.
• There was effective management of significant events. The service had a low threshold to record incidents to ensure everything was captured and learning opportunities maximised.
• The clinical staff used evidence based guidance to ensure appropriate and effective treatment and advice was given to patients.
• Staff told us there was an open and inclusive culture of management and felt their views were listened to.

There were some areas where the provider should make improvement:

• Consider the development of a regular clinical audit programme.
• Develop an induction protocol for visiting consultants
• To continue the ongoing work in developing a designated website for 3VHealthcare Limited to enhance patient information.
• To review the availability of information on the complaints procedure for patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We did not speak with any patients who used the service during our visit.

We found that effective systems were in place to ensure that medicines and clinical and surgical supplies were available and in date, and were used appropriately to ensure the welfare and safety of patients who used the service.

An effective system was also in place to ensure that patients were aware of the complaints procedure, and that complaints were handled and responded to appropriately.

On the day of our inspection we spoke with the registered manager and four members of staff. We spoke with four patients over the telephone after our inspection. This was because there were no clinics held at Thornbrook 3VHealthcare on the day of our inspection. One patient told us, “The service is absolutely fantastic, I’m very pleased. The location is very handy and the appointments have suited me”. Another patient told us, “Dr X is nice and friendly and really informative. They are interested in me and ask my opinion”. A third patient told us, “It was brilliant. Dr X is very understanding and listens to me”.

Patients told us that before they received any care or treatment they were asked for their consent and their wishes were respected. We saw that patients experienced care, treatment and support that met their needs because they were cared for by suitably qualified, skilled and experienced staff.

We saw that patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had an effective system to regularly assess and monitor the quality of the service that patients received. We saw that there were systems in place to gather and analyse the views of patients who used the service.

Thornbrook surgery provides outpatient consultant led dermatology clinics for patients living in the Chapel en le Frith area. The aim of the clinics is that they are held locally so that patients do not have to travel as far to access treatment.

We spoke with four patients who were receiving treatment from the provider, either at Thornbrook surgery or their sister practice – Goyt Valley medical practice. Everyone we spoke with was happy with their treatment and told us that staff were always friendly and welcoming, that they had received their appointments in a timely manner and that they felt their consultant had put a lot of effort into their care. None of the patients we spoke with had needed to make a complaint about their care but said that they did not know how to do this. We found that the provider did not have an effective complaints system in place to ensure the patients could complain and that their comments and complaints would be responded to appropriately.

During our inspection we found that a number of medicines and medical devices were out of date. It is important that expiry dates of medicines and medical devices are monitored to ensure they are safe to use.

We found that there were ineffective procedures in place for the recruitment of self-employed clinicians and for the monitoring of their professional registration status.