We carried out an announced comprehensive inspection on 15 February 2019 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 care 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.

Mayflower Healthcare Alliance is an independent provider of a community dermatology service, and were undertaking pilots for urology, gynaecology and neurology assessment service. The service carried out minor surgery which included cryotherapy, excisions, biopsies and cauterisation and cutting. The service holds contracts with the local Clinical Commissioning Group (CCG) to deliver community services, closer to patient’s homes and avoid attendances at secondary care. They have been providing these services for approximately 14 years. They treat approximately 8000 patients each year.

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. At Mayflower Healthcare Alliance, the cosmetic treatments provided which were not funded by the NHS are exempt by law from CQC regulation. Therefore, we were only able to inspect services related to our regulation.

A senior 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.

We received 40 Care Quality Commission comment cards, and all of these were wholly positive about the care and service and positive outcomes the patient had received. We reviewed surveys the service had carried out in individual clinics where patients shared their views and experiences of the service. We found patients had reported that they had received excellent care in a timely and efficient manner and by staff who were caring and dedicated.

Our key findings were:

• We saw there was strong leadership within the service and the team worked together in a cohesive, supported, and open manner.
• There was an effective system in place for reporting and recording significant events.
• Information about services and how to complain was available and easy to understand. We found the provider had acted accordingly, responded to complaints with an apology and full explanation.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• All staff had received a Disclosure and Barring Service (DBS) check.
• Risks to patients were assessed and well managed. We found that the provider had clear oversight of all locations from which they provided their services.
• The service held a comprehensive central register of policies and procedures which were in place and staff were able to access these policies easily.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge, and experience to deliver effective care and treatment.
• All patients said they were treated with compassion, dignity, and respect and they were involved in their care and decisions about their treatment.
• The service did not have access to interpretation services for patients whose first language was not English.
• Risk assessments for Legionella were carried out at all four patient sites however the service did not have oversight of the risk assessments. Since the inspection the provider had requested and obtained evidence of legionella assessments for each site.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• We found the provider had not considered all relevant emergency medicines and appropriate risk assessments were not in place. Since the inspection the provider provided us with evidence that they had considered their range of emergency medicines, purchased and risk assessed the full range of required emergency medicines.
• The service proactively sought feedback from staff and patients, which it acted on. Regular surveys were undertaken and reports collated from the findings and action taken where required.
• The service worked closely with an external organisation to promote men’s health checks at local events.

The area where the provider should make improvements is

• Strengthen systems to review emergency medicines available.
• Improve access to information for patient whose first language was not English.
• Develop systems to gain oversight of risk assessments for Legionella at patient clinic locations.
• Strengthen methods of sharing information to all staff.

Professor Steve Field

CBE FRCP FFPH FRCGP Chief Inspector of General Practice