We carried out an announced comprehensive inspection on 28 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 safe care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing safe care in accordance with the relevant regulations.

Background

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.

Medecins du Monde UK is a registered charity and is part of the Medecins du Monde (Doctors of the World) wider network which is an international humanitarian organisation that has clinics in developed and developing countries. Since 2006, services are provided to patients from the ground floor of the Praxis Community Projects Centre in a church building which houses a range of other services committed to empowering vulnerable migrants. The Doctors of the World UK programme model is designed to support and offer primary care, health and social advice to excluded people including sex workers, asylum seekers, undocumented migrants and homeless people. The service can be accessed by local buses and is within easy access of Bethnal Green Underground Station. The service is registered with the Care Quality Commission to provide the regulated activity of Diagnostic and screening activities from: Praxis, Pott Street, London, E2 OEF.

The main service provided from the clinic is health advocacy to ensure people can access mainstream health-care, with referrals and signposting to other health and social care providers, including antenatal care and mental health counselling. Volunteer GPs and nurses carried out health checks, including screening for STIs, contraception counselling and provision, and prescription from a limited formulary.  They also facilitate monthly Tuberculosis (TB) and sexual health screenings in partnership with two London hospitals. Employed staff at local level comprises of a full time Programme Manager, programme staff and volunteer manager, clinic and helpline officer, health advisor, policy and advocacy managers, GP champions and campaign lead. Since the UK programme started in 2006, Medecins du Monde UK have provided help to 13,362 vulnerable migrants across their UK clinics. Patients who require further investigations or any additional support are signposted on to other services such as NHS GPs and A&E.

The service’s opening hours are Monday, Wednesday and Friday 11am to 3pm. Appointments are available between 11am and 2pm with limited availability for walk in’s on the day. The appointment and advice lines are open Monday to Friday between 10am and 12midday; outside of these hours patients were advised to email the service.

The programme 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.

Our key findings were:

• There were effective systems in place for recording, investigating and learning from incidents.
• Care and treatment was provided in line with evidence based guidance.
• Staff worked with other health professionals and other organisations where appropriate and supported patients to access other healthcare services.
• The provider participated in improvement activity such as clinical audit and other benchmarking to support service improvements.
• Care and treatment was planned and delivered to suit the needs of the patients they saw.
• Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005. This was underpinned by a standing operating procedure.
• The service had a complaints policy in place and information about how to make a complaint was available for patients.
• There was a clear organisational structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• Feedback from patients about the care and treatment they received was very positive.

There were areas where the provider should make improvements:

• Review and update the business continuity plan.
• Continue to review the service’s fire arrangement to ensure risk assessments are undertaken as per recommendations.
• Review and consider having onsite emergency equipment such as a defibrillator and oxygen.
• Review the emergency medicine risk assessment and consider detailing which emergency medicines are unsuitable to stock.

At our previous inspection we found the service non compliant with keeping emergency procedures up to date, updating policy and procedures for staff about safeguarding children and adults, emergency medications were out of date for safe use, staff and volunteers did not have access to relevant training and that systems for mentoring the quality of the service were not used. As a result of our previous inspection the provider had closed the service temporarily to carry out a review, which we found had led to positive changes to the way the service was now operating. We make reference to the steps that the provider had taken to comply with the regulations later in this report.

One person we spoke with was using the service for the first time, the other had used the service a few times before. The person who was making their first visit told us they had felt satisfied with the advice that had been given to them and said “I would come here again if I needed to, but they have helped me find a doctor near where I live.” The other person said “I have always been happy with the help I have been given and tell my friends that they should come here for help.”

The manager told us a quarterly clinical governance and quality board had been established by the provider. As the service had only recently started operating after a period of closure this board had not held their first meeting as yet. We will look at the effectiveness of these arrangements at our next inspection.

People we spoke with were using the service for the first time. They had referred themselves for consultation and told us that they felt safe using the service, that they had been treated with respect, and that their questions were answered in full.

Some people had concerns about the lack of privacy in the reception area.

Staff were able to describe their specific responsibilities in managing foreseeable emergencies. However there was no paediatric emergency equipment or medicines available, and we found emergency medicines that had passed their expiry date which could put people at risk.

Some staff and volunteers were able to describe their safeguarding responsibilities. However, there were no policies in place for safeguarding of vulnerable adults and not all staff were able to correctly describe the safeguarding referral process. There was no safeguarding information available for people using the services. Most of the staff had not attended safeguarding training.There were no clear policies in place regarding arrangements for treating children or staffing for children.

There was a variation in the provision and uptake of training and development for staff and volunteers. Not all staff and volunteers we spoke with were aware of the existence of clinical policies they should be following.

There were some opportunities for staff and people using the service to give feedback to the provider, which was reported to a Board of Trustees and acted upon.

The people who spoke with us, although having little working knowledge of the service, all said they were satisfied with the advice and support that they have received.