This service is rated as Good overall.

The previous inspection was in February 2018.

The inspection report for the previous inspection can be found by selecting the ‘all services’ link for Healthy Balance on our website at www.cqc.org.uk.

Since the February 2018 inspection, our methodology has now changed and therefore this is a rated inspection and the key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Healthy Balance in Buckinghamshire on 20 May 2019. 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.

Healthy Balance is registered with Care Quality Commission (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 regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some of the services available at Healthy Balance, for example chiropody, osteopathy and nutrition services, are exempt by law from CQC regulation. Therefore we were only able to inspect the GP service including the joint injection clinic as part of this inspection.

The Practice Manager 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.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection, we received 30 completed comment cards which were all positive about the standard of care they received. The service was described as first-rate and professional, whilst staff were described as attentive, helpful and caring. Many cards referred to the GP service, however there was no method to establish exactly how many of the 30 cards referred to the GP services provided.

Our key findings were:

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

• There were systems in place for the overall management of significant events and incidents. Risks to patients were assessed and managed.

• Staff treated patients with compassion, kindness, dignity and respect.

• There was a process to ensure that care and treatment delivered were in accordance with evidence-based guidelines.

• Staff demonstrated that they understood their responsibilities, and all had received training on safeguarding children and vulnerable adults relevant to their role.

• Patient feedback highlighted that patients appreciated the care provided and described the service as first class, caring and patient focused.

• There were systems to support improvement and innovation work. For example, in partnership with Bucks County Council, the service was awarded a 'Safe Place' status. This scheme provides reassurance to vulnerable people, and to their families and carers, so that they have a means to alert someone of any potential risk or emergency if they are out alone.

We saw an area of outstanding practice:

• Given the low numbers of significant events, the service had contacted a local GP practice and the clinical commissioning group and requested three anonymised significant events. We saw the service used these external significant events as a learning opportunity and reviewed the incident alongside their own significant event processes and procedures to ensure they were effective.

Whilst we found no breaches of regulations, the provider should:

• Review and implement a programme with the view to increase the level of quality improvement; this may include further clinical audit activity.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

​Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection of Healthy Balance in Buckinghamshire on 14 February 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.

Healthy Balance provides private GP services including the provision of a joint injection clinic. Services and treatment are available for adults and children. Additionally, the GPs can request investigations (electrocardiograms, blood tests, x-rays and scans) to assist diagnosis.

Healthy Balance also has arrangements in place with external healthcare professionals who provide services from their premises.

Healthy Balance has core opening hours of Monday to Friday from 9am to 5pm. In addition to the core hours, Healthy Balance is open until 8pm on Tuesday and Thursday evenings and between 9am and 12 noon each Saturday. This service 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 is detailed in patient literature supplied by the service.

Healthy Balance is registered with Care Quality Commission (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. Some of the services available at Healthy Balance for example chiropody, osteopathy and nutrition services are exempt by law from CQC regulation. Therefore we were only able to inspect GP services including the joint injection clinic as part of this inspection.

The practice manager 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.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection, we received 41 completed comment cards which were all positive about the standard of care they received. The service was described as excellent, professional, helpful and caring. However, there was no method to establish how many of the cards referred to the GP services provided.

Our key findings were:

• Activity within the GP service including the joint injection clinic was increasing each year since the launch of the service in 2012.

• The service had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved their processes.
• The service ensured that care and treatment was delivered according to evidence-based research or guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The service was proactive in seeking patient feedback and identifying and solving concerns.
• The culture of the service encouraged candour, openness and honesty.

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

• Review and implement a programme with the view to increase the level of quality improvement; this may include further clinical audit activity.

The practice was clean and bright with a variety of comfortable seating in the reception area. There was disabled access in a private car park, and easy-push doors and non-slip flooring inside the practice. The treatment rooms for those of limited mobility were on the ground floor. The yoga gym was on the first floor, with no lift access. All treatment rooms were in private areas to ensure confidentiality and dignity.

People were told about risks associated with their treatment and were asked to give consent before any procedures took place. There were separate consent policies for children and teenagers, and also for the use of photographs.

We heard the receptionists speak to people in a courteous and pleasant manner, and noted that people were given a choice of appointments to suit their needs.

We saw a safeguarding policy and procedures that ensured people being treated at the practice would be kept safe from harm. The staff had been appropriately trained, and were aware of their safeguarding responsibilities.

The staff recruitment policy was robust, and ensured that people were looked after by qualified and trained practitioners.

There was a system in place to monitor the quality of service provided, and we saw that changes had been made as a result of quality audits. The service took account of comments that they received and changes were made when necessary.