We carried out an announced comprehensive inspection of the AMS Clinic Manchester on 30 September 2017 to ask the service provider 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

We carried out this announced 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.

AMS Clinic Limited is an independent circumcision provider which is registered in Bradford, West Yorkshire to operate from locations in Bradford and Manchester. The Manchester based service was established in April 2017 and operates from accommodation within Cheetham Hill Medical Centre, 244 Cheetham Hill Road, Manchester, Lancashire, M8 8UP. The service provides circumcision to infants aged from two weeks up to one year for cultural and religious reasons under local anaesthetic, and carries out post procedural reviews of patients who have undergone circumcision at the clinic.

The service operates from Cheetham Hill Medical Centre, which is a modern, purpose built GP practice which is easily accessible for those bringing children to the clinic for example it has level floor surfaces, automatic doors and parking available. The AMS Clinic Manchester operates from a treatment room located on the ground floor for delivery of services. They also have access to a consultation room which is used to discuss the procedure with parents and provide further information; using verbal and visual aids. Patients and their parents can also access other areas of the medical centre such as waiting areas and toilets.

The service is led by three directors (male) who have each been identified a specific area to lead on. The registered provider is one of the directors who is the managing director and is also responsible for registration with the Care Quality Commission. The second director leads on staffing and rotas and the third on clinical areas including carrying out the procedure in the event of staff shortages.

The service is delivered by one nurse and one health care assistant who are both present during every procedure. These clinicians are all trained and experienced in minor surgery and carry out the procedure from both the Bradford and Manchester locations on a regular basis. As part of a service level agreement with Cheetham Hill Medical Practice a practice receptionist supports parents and patients on arrival at the clinic, they also manage bookings for the clinic and record on a clinic system.

The clinic operates from the Manchester site from 10.30am until 12.00pm on alternate Saturday mornings.

Our key findings were:

• The service was offered on a private, fee paying basis only and was accessible to people who chose to use it.
• Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
• The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
• There were systems, processes and practices in place to safeguard patients from abuse.
• Information for service users was comprehensive and accessible.
• Patient outcomes were evaluated, analysed and reviewed as part of quality improvement processes.
• Staff had the relevant skills, knowledge and experience to deliver the care and treatment offered by the service.
• The clinic shared relevant information with others such as the patient’s GP and when required safeguarding bodies.
• There was a clear leadership structure, with governance frameworks which supported the delivery of quality care.
• The service encouraged and valued feedback from service users via the website.
• Communication between staff was effective with regular documented meetings across both sites.

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

• Review the process for checking the identity of parents and obtaining proof of parental authority.
• Review medication held at the medical centre for the treatment of medical emergencies including the treatment of anaphylaxis.