We carried out an announced comprehensive inspection on 15 May 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 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.

Citydoc Moorgate provides travel vaccinations, sexual health services and doctor consultations to the whole population.

The medical director is the registered manager. 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.

Eleven people provided feedback about the service.

Our key findings were:

• The service had systems and processes to minimise most risks to patient safety.
• The service had adequate arrangements to respond to medical emergencies.
• There was a process for reporting and investigating significant events and incidents, however the provider did not hold clinical meetings where these could be discussed.
• Staff received essential training, and adequate staff recruitment and monitoring information was retained.
• There was evidence of quality improvement activity.

• Patient feedback indicated that staff were caring and courteous and treated them with dignity and respect.

• The service responded to patient complaints in line with their policy.
• The service had good facilities and was equipped to treat patients and meet their needs.
• There were systems in place to collect and analyse feedback from patients.
• The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.

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

• Review the contents of the service website to ensure the correct opening hours are displayed and consider including information about how to access GP services when the service is shut.
• Ensure that recently introduced processes to check the identity of patients registering with the services and to ensure that adults attending with a child have parental responsibility to consent to care and treatment, are cascaded to all staff.

• Ensure that arrangements in place to monitor the quality of pathology sample-taking by individual clinicians are shared with staff across each of the service’s locations.
• Consider holding regular clinical meetings where clinicians can discuss learning from significant events and updates in current evidence based guidance and standards such as the National Institute for Health and Care Excellence (NICE) best practice guidelines.
• Ensure that the service’s policy around data security and information management, including those in place to govern email usage, is cascaded to all staff.
• Review arrangements in place to contact patients who may require booster vaccinations or additional courses of treatment.
• Consider carrying out an assessment of the risks associated with providing a nurse only service every Wednesday.

On the day of our inspection, the clinic was quiet. We spoke with one patient and looked through the recent patients' feedback questionnaire forms from ten other patients.

Positive feedback was given by the patient we spoke with and was documented on all the feedback forms. The patient told us they found the clinic "really good" and one feedback comment was that the staff were "helpful in arranging appointments."

We looked at patients records and the treatment protocols. We spoke with two members of staff. The records we viewed were accurate and up to date.

We found that the premises were appropriate for their intended purpose. All areas of the practice were seen to be hygienic and well organised.

The process used by the provider for recruitment of staff was appropriate. We saw that all the essential checks had been carried out on all staff. We saw the registration details of the clinical staff with their respective professional bodies. This meant that the provider had systems in place to protect patients from harm and to have their health and welfare needs met by appropriately qualified staff.

The complaints process was clearly displayed and we saw evidence that complaints had been acted upon.

On the day of our inspection the clinic was busy. We observed that some patients had to wait to see the doctor even where they had made an appointment and the two staff working in the clinic, a doctor and a receptionist were finding it hard to attend to all the patients in a timely manner. The patients told us they were satisfied with the care they received at the clinic but were not all satisfied with how long they had to wait and we observed that they did not receive an apology or clear information about waiting times. Medical notes were kept as computer records in a secure environment. Consultation rooms were private and gave a high level of confidentiality. We did not see any information, price lists or records of satisfaction surveys displayed but staff told us that the clinic had just been decorated and these were about to be replaced and patients told us they had received the information they needed. There were safeguarding procedures in place and staff were aware of the reporting and escalation of any concerns. All reasonable measures had been taken to allow for disabled persons access. Audit and monitoring information was collected but was held at head office and the results were not available to inform the work in the clinic.