Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Adsum Healthcare Limited based in Old Amersham, Buckinghamshire on 17 October 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.

Background to Adsum Healthcare Limited

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 Adsum Healthcare Limited was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Adsum Healthcare Limited is based in Old Amersham, Buckinghamshire and provides a range of pre-operative assessment and post-operative care for surgical procedures in vascular surgery. The service also provides consultations, examinations and treatments for other vascular diseases and disorders. This includes micro-sclerotherapy (for small varicose veins) and ultrasound guided foam sclerotherapy (for large varicose veins). Sclerotherapy is a medical procedure used to eliminate varicose veins and spider veins.

Sclerotherapy involves an injection of a solution (generally a salt solution) directly into the vein. In addition to the vascular procedures, Adsum Healthcare Limited also provide a variety of aesthetic cosmetic services, for example, radio frequency skin tightening for reduction in the appearance of wrinkles.

All services are provided from:

• Adsum Aesthetics, The Broadway, Old Amersham, Buckinghamshire HP7 0HP.

This service is registered with Care Quality Commission (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. The aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation. Therefore we were only able to inspect the vascular service and not the aesthetic cosmetic services.

Adsum Healthcare Limited was formed in 2010 and moved to the premises, a converted residential dwelling in Old Amersham in 2011. The premises have been converted into three treatment rooms, an open plan reception area, a waiting area and a back office. All vascular services were located on the ground floor.

The vascular surgeon (with practising privileges) is also the owner of Adsum Healthcare Limited and is supported by two vascular nurses in the provision of all vascular procedures. A practice manager and medical secretary undertake the day to day management and running of the service.

The practice manager is the registered manager. (A registered manager is someone who has been selected by a provider to be legally responsible for managing regulated activity from a provider location).

The service was open between 8am and 5pm Monday to Friday. When necessary, the service could stay open longer to accommodate patients’ needs. Out of regular clinic hours, an emergency telephone line and emergency enquiry email address was available to all patients. The telephone line was covered by the vascular surgeon. The emergency number was published on the website and included on all of the clinic’s post-procedure information leaflets. If patients called the day to day contact number out of hours there was a voice message diversion for emergencies.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection. All of the 29 patient comment cards we received were positive about the service experienced. Patients said they felt the Adsum Healthcare Limited offered an excellent service and staff were efficient, helpful and caring. They said staff treated them with dignity and respect and the care they received exceeded their expectations. Patients stated they felt all the staff took an interest in them as a person and overall impression was one of wanting to help patients.

Following the inspection we spoke with four patients who had all recently used the vascular service. All four patients commented their experience had been excellent and aligned to the findings on the comment cards. All the patients we spoke with said they would recommend the service.

Our key findings were:

• There was an effective system in place for reporting and recording significant events.

• Procedures were in place for monitoring and managing risks to patient and staff safety. For example, there were arrangements to prevent the spread of infection and compliance with these was monitored.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about their care.

• Staff were supported to receive training appropriate to their role and to keep up to date with developments and best practice in sclerotherapy.

• All written and verbal feedback from patients told us they had very positive experiences of the vascular clinic and felt they were treated with respect, compassion and dignity.

• Every patient attending the service had their own particular pattern of venous disease which meant no two procedures were the same. Treatment plans were tailored to individual needs and according to the best options for treatment at that time.

• Patients we spoke with told us (and comments cards confirmed) they had flexibility and choice to arrange appointments in line with other commitments. Patients also commented that they were offered cancellation appointments if these were available.

• Information about services and how to complain was available and easy to understand.

• There was a clear staffing structure and staff were aware of their own roles and responsibilities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

The practice was clean and bright with comfortable seating in the reception area. All treatment rooms were in private areas to ensure confidentiality, privacy and dignity. A chaperone was available on request.

Before people received any care or treatment they were asked for their written consent. People were informed of any associated risks and benefits with their treatment prior to their consent being sought. There were separate consent policies for each different procedure. Written consent was scanned into personal records.

We heard the receptionist speak to people in a courteous manner, and noted that people were given a choice of appointments to suit their preferences. Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

People who use the service were protected from the risk of abuse, because the staff had been appropriately trained, and were aware of their safeguarding responsibilities.

There were effective recruitment and selection processes. The staff recruitment policy ensured that people were looked after by qualified and trained practitioners.

There was a system to monitor the quality of service provided, and we saw that changes had been made as a result of quality audits. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.