We carried out an announced comprehensive inspection on 12 December 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 not 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.

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 general 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. Some of the services available at Global Health Medical Services are exempt by law from CQC regulation. Therefore, we were only able to inspect the regulated activities as part of this inspection.

The lead doctor 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.

Eighteen patients provided feedback about the service; all were positive about the treatment and care received from the service.

Our key findings were:

• The service had systems to manage risk so that safety incidents were less likely to happen.
• The service had some systems in place to safeguard children and vulnerable adults from abuse; however, not all staff we spoke with knew how to identify and report safeguarding concerns. Staff had not received safeguarding training relevant to their role.
• Clinical staff we spoke to were aware of current evidence-based guidelines and they had the skills, knowledge and experience to carry out their roles.
• There was some evidence of quality improvement through clinical audits; however, the service had not undertaken any completed cycle clinical audits.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Consent procedures were in line with legal requirements.
• Systems were in place to protect personal information about patients.
• Patients could access care and treatment from the service within an appropriate timescale for their needs.
• The service proactively gathered feedback from patients and staff.
• There was a focus on learning and improvement at all levels of the service.

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

• Ensure effective systems and processes are in place to ensure good governance in accordance with fundamental standards of care. The provider did not have a system in place to implement and monitor medicines and safety alerts; there was no business continuity plan in place for major incidents; some of the policies in place were not service specific.

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 service procedures to ensure staff received training relevant to their role.
• Review service procedures to consider completed cycle clinical audits including antimicrobial prescribing audits are undertaken.
• Review service procedures to consider how to maintain patients’ privacy and dignity in consulting rooms.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice