We carried out an announced comprehensive inspection on 6 September 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 not 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

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.

IPSA Medical Clinic is a private GP service that provides services to adults and children. It is located in Hampstead, in the London borough of Camden, within a pharmacy owned by the same business. IPSA Medical Clinic is situated on the lower ground floor of the building.

The GP is the registered manager of the service. 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 this inspection we asked for CQC comment cards to be completed. We received 64 completed CQC comment cards. All the completed cards indicated that patients were treated with kindness and respect. Staff were described as friendly, caring and professional. Some patients commented on how using the service had helped them with their individual care needs and to resolve their concerns.

Our key findings were:

• Staff personnel files did not contain all of the information we would expect to find for all staff, including, interview summaries, evidence of training in the Mental Capacity Act and information governance.
• Systems were in place to deal with medical emergencies and staff were trained in basic life support. However, there was no record that all medicines and equipment for use in an emergency were being regularly checked, and oxygen masks and tubing were past their expiry dates.
• The GP had not received training in safeguarding of vulnerable children.
• There were no curtains or screens in the consulting room to maintain patients’ privacy and dignity during examinations, investigations and treatments.
• The service had some policies to keep staff and patients safe, but it did not have a health and safety policy or a fire safety policy.
• Staff sought patients consent to care and treatment in line with legislation and guidance.
• There was a clear procedure for handling alerts from organisations such as MHRA (Medicines and Healthcare products Regulatory Agency).
• Information about services and how to complain was available and easy to understand.
• The consultation room was well organised and equipped, with good light and ventilation.
• The GP regularly assessed patients according to appropriate guidance and standards such as those issued by the National Institute for Health and Care Excellence.
• Staff were kind, caring and put patients at their ease.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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 consider installing curtains or a screen in the consultation room for the benefit of patient privacy and dignity.
• Review and consider making baby changing and changing waste disposal facilities available for the benefit of patients.
• Review and introduce a system to ensure that learning from meetings is shared .
• Review and consider providing a hearing loop in reception for the benefit of patients who have a hearing impairment.

We did not speak with people who used the service on this occasion; however we did review comments made by people that completed the satisfaction questionnaire. We found that the majority of people stated that they were happy with the service and felt that they had received a professional and personal service and that they were not rushed during the consultation.

At the inspection on the 26 September 2014 we found that the provider had made the required improvements. We found that the provider had implemented the appropriate checks to ensure that emergency medication was easily located in the surgery and was checked regularly. Policies and procedures had been updated and the provider had carried out a satisfaction survey. There was a complaints log in place although we were told that the practice had not received any complaints. There were regular checks undertaken in line with the infection prevention and control policy to ensure that the premises were clean at all times.

People who used the service were involved in decisions about their treatment and care and were cared for in an environment that allowed privacy, dignity and independence. One person told us, "I have been involved in a wide discussion, nothing has felt rushed."

Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. The arrangements in place to deal with foreseeable emergencies did not ensure that equipment and emergency medicines were readily accessible or that there were ongoing equipment checks and systems to replace used items.

There were suitable arrangements in place for protecting people against the risks associated with unsafe use and management of medicines.

People carrying out the regulated activities provided by the service were suitably experienced and skilled for their roles. The doctor was also the registered manager. The doctor undertook ongoing training and professional development and was registered with the General Medical Council. This ensured people received safe care and treatment.

There were policies in place to guide practice but there was no regular review of policies or monitoring of the quality of the services provided. This meant that the provider may not be enabled to come to an informed view about the standard of care and treatment provided to people who used the service and there was a risk that care may be inappropriate or unsafe.