We carried out an announced focussed inspection at Edgbaston Private Medical Practice on 2 October 2018. This was to follow up on progress made by the practice since our previous inspection on 22 November 2017 and ensure legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were being met.

Our findings were:

Are services safe?

We found that this service was providing safe 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 practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC inspected the practice on 22 November 2017 and asked the provider to make improvements regarding the systems and processes to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk. We checked these areas as part of this focussed inspection and found the provider had made the necessary improvements.

The practice provides a private general medical service to adults and children. Services include private GP consultations, child immunisations, travel vaccinations, contraceptive and sexual health services, health screening and lifestyle management.

This service is registered with 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. Non-invasive cosmetic procedures provided to patients are exempt by law from CQC regulation. Therefore, at Edgbaston Private Medical Practice, we were only able to inspect the services which are not part of their aesthetics service.

The principal GP 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.

Our key findings were:

• The provider was able to demonstrate clearly the action they had taken to improve the provision of safe care.
• Systems to help keep patients safe and safeguarded from abuse had been strengthened.
• The provider had improved the management of risks. Comprehensive risk assessments had been undertaken in relation to fire safety and legionella.
• Effective monitoring arrangements for infection prevention and control, the management of vaccines and staff training had been put in place.
• The provider had strengthened recruitment arrangements. Timely checks were made of a person’s suitability to work for the service.
• Emergency medicines had been reviewed and were in line with recommended guidance.
• The practice had reviewed accessible information for patients and had produced easy read information for patients who may benefit from it.
• Record keeping in relation to staff meetings had been improved to ensure key issues were discussed as standing agenda items and for the follow up of matters arising.

We carried out an announced comprehensive inspection on 22 November 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led? We previously inspected the service as part of a pilot inspection of independent health care in March 2016.

Our findings were:

Are services safe?

We found some areas where the service was not providing safe care in accordance with the relevant regulations. For example, risk assessments and systems for monitoring risks were not always well documented to demonstrate a comprehensive approach to identifying and managing them.

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

Edgbaston Private Medical Practice registered with CQC under the provider organisation Lister Medical Group Ltd in June 2016. Prior to this Edgbaston Private Medical Practice was registered under the provider organisation Listers Medical Associates Ltd and was inspected as a pilot service on the 18 March 2016 for the inspection of independent healthcare organisations. At the inspection on the 18 March 2016 the service was found to be compliant against the regulations associated with the Health and Social Care Act 2008.

Edgbaston Private Medical Practice provides a private medical service to adults and children. Services include a private general medical service, immunisations such as child immunisations and travel vaccinations, contraceptive and sexual health services, health screening and lifestyle management. The practice team consists of a principal GP, two associate GPs, a practice manager and a team of four support / administrative staff.

• The service is located in a converted house that has been adapted to provide medical services in a business area of Edgbaston, Birmingham. The provider has recently opened a branch surgery in Birmingham City Centre located at Imperial & Whitehall Chambers, First Floor, 23 Colmore Row, Birmingham B3 2BS.

The practice is open for appointments six days a week between 9am and 6pm on Mondays, Tuesdays, Wednesdays and Fridays. On Thursdays between 9am and 7pm and on a Saturday between 9am and 1pm. Appointments can be booked in person, by telephone or by email. The practice offers patients the option as a pay as you go service or through an annual subscription. In the last 12 months the service carried out 6136 consultations.

The practice is not required to offer an out of hours service. Patients who need medical assistance out of corporate operating hours are requested to seek assistance from alternative services such as the NHS 111 telephone service or accident and emergency.

This service is registered with 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 practice is part of a limited company called Lister Medical Group LTD and non-invasive cosmetic procedures are offered as part of the Edgbaston aesthetics service which is also part of Lister Medical Group Ltd. The non-invasive cosmetic procedures provided to patients under arrangements made by the Edgbaston aesthetics service are exempt by law from CQC regulation. Therefore, at Edgbaston Private Medical Practice, we were only able to inspect the services which are not arranged for patients under the Edgbaston aesthetics service.

The principal GP 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

As part of our inspection we also asked for CQC comment cards to be completed by patients prior to our inspection. We received 48 completed comment cards where patients and members of the public shared their views and experiences of the service. Patients spoke highly of the service, they described staff as professional, helpful and friendly. They told us that they felt they felt listened to and would be happy to recommend the service to others.

Our key findings were:

The service was providing safe, effective, caring, responsive and well led care in accordance with the relevant regulations.

• There were systems in place to keep patients safe and safeguarded from abuse, although the provider did not have systems for actively seeking assurance of parental responsibility for children attending the service.
• The practice assessed risks to patient safety and we found the premises appeared well maintained. However, risk assessments and systems for monitoring risks were not always well documented to demonstrate a comprehensive approach to identifying and managing them. Following the inspection the provider sought to review and revise some of the systems in place.
• There were effective systems in place for recording, investigating and learning from significant events.
• Care and treatment was provided in line with evidence based guidance.
• Staff worked with other health professionals where appropriate and supported patients to lead healthier lifestyles.
• The provider participated in improvement activity such as clinical audit to support service improvements.
• Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
• Patient feedback through CQC comment cards and the provider’s own surveys showed patients were happy with the service received and that they felt involved in decisions about their care.
• Services were provided that were responsive to the needs of the population served. This included timely and flexible services.
• There was clear leadership and governance arrangements to support the running of the service and delivery of high quality care. Staff felt supported.
• The provider was proactive in identifying challenges and responsive to feedback received to support service improvements.

We identified regulations that were not being met and the provider must:

• Ensure effective systems for managing risks to ensure a comprehensive assessments are undertaken and rationale for decisions made are clear.

You can see full details of the regulations not being met at the end of this report.

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

• Review and implement systems for providing assurance that persons accompanying a child has parental responsibility.
• Review systems for obtaining DBS checks to ensure they are current at the time of recruitment.
• Review and identify how accessible information may be obtained if needed for patients.
• Review record keeping in relation to staff meetings to ensure key issues are discussed and for monitoring staff training.