We carried out an announced comprehensive inspection on 28th 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.

Background

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

East Quay Health Limited is a minor surgery service which is available to all GP practices in Somerset to enable their patients receive a small range of surgical treatments under local anaesthetic without the need to attend hospital. The service is based within East Quay Medical Centre with a suite of rooms including a theatre, consultation room, recovery room, sluice room and a small waiting area. The service is only accessible to patients following a referral from their own GP. Typical minor surgery procedures include vasectomy (male sterilisation), sigmoidoscopy and pile banding (treatment for haemorrhoids), excision/ biopsy of skin and subcutaneous tissue, and surgical treatment of ingrowing toenail. Procedures are funded either by the NHS or privately. Costs vary dependent on the procedure required.

The service runs approximately 2-3 sessions per week on variable days and 1 - 2 Saturdays per month dependent on patient demand. Two surgeons who have substantive posts at NHS hospitals share their expertise and are supported by two experienced practice nurses, an administrator and a 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. The registered manager was also the registered manager for the host GP practice East Quay Medical Centre.

East Quay Health Limited is a private company with its directorship and governance formed by the partners of the host organisation East Quay Medical Centre.

We obtained positive feedback about the service through comment cards posted to patients who had recently used the service. Eight cards were returned. We did not speak to patients attending the service on the day of inspection. We also used information from East Quay Health Limited’s own patient feedback, which is obtained post-operative, which is part of the organisations follow up process. This was in the main very positive; where there was adverse comment the service has addressed these, such as an update in the provision of post-operative care information.

Our key findings were:

• Staff had the information they needed to deliver safe care and treatment to patients.
• The service had a good safety record.
• The service had a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the surgical procedure and the outcomes for patients.
• The service obtained consent to care and treatment in line with legislation and guidance.
• Staff treated patients with kindness, respect and compassion.
• The service respected and promoted patients’ privacy and dignity.
• The service took complaints, concerns and comments seriously and responded to them appropriately to improve the quality of care.

Structures, processes and systems to support good governance and management were clearly set out, understood and effective.  Directors of the service all had specific accountable lead roles as well as the overarching management of the business and service.

We found patients had sufficient information to give informed consent before they received their treatment. Consent forms were signed by the patient and the surgeon to show they had discussed and agreed to their operation. Patients said “Relevant information was provided in the appointment letter and information leaflet” and “The surgeon put me at ease and explained everything very well”.

Feedback from patients about their treatment and care was very positive. Comments included “I received excellent and efficient treatment”, “The surgeon was very approachable and the nurse put me at ease” and “A very good service, I was seen promptly”.

We saw the provider had appropriate policies and procedures to ensure safe and suitable premises. Quarterly health and safety risk assessments were carried out. This included fire risk assessments and assessments of the fabric of the building. These measures helped protect patients, staff and visitors against the risks of unsafe or unsuitable premises.

The provider had a small established team of experienced staff who were able to meet people’s needs. Patient feedback included “I couldn’t have asked for a nicer team of doctors and nurses”, “The nurses are superb, very friendly and warm” and “A first class service in every respect”.

We found all records relevant to the management of the service were accurate and fit for purpose. Records were kept securely and could be located promptly when needed.

We looked at comments from people who used the service and saw that they were happy with the treatment that had been provided. There were comments such as "I have nothing but praise for my minor op". and "I found the service provided, from the pre-op briefing, the op itself and post-op was of an excellent standard throughout". We saw that staff protected people's privacy and maintained their dignity.

People who were due to have an operation were given written information about the procedure that they could read in their own time. However, most of them were not asked to give written consent for the operation. Therefore it was not possible to know whether they had understood the risks associated with the operation.

Care and attention was paid to people's individual needs so that they received effective and appropriate treatment. Staff were trained to understand the specific needs of people having operations under local anaesthetic. There were facilities in place to deal with emergencies and people who used the service were protected from the risk of abuse. Staff were supported and managed effectively and were encouraged to up-date their skills and knowledge.