We previously carried out an announced comprehensive inspection at Newcastle Circumcision Services on 17 November 2017, during which we found the provider was not providing safe or well led services.

We identified two breaches of regulations relating to safe care and treatment and good governance, and issued requirement notices. We also told the provider there were areas where they should make improvements. However, we found they were providing effective, caring and responsive services, in accordance with the relevant regulations.

The full comprehensive report relating to the November 2017 inspection can be found by selecting the ‘all reports’ link for Newcastle Circumcision Services, on our website www.cqc.org.uk.

We carried out this announced focused inspection at Newcastle Circumcision Services on 25 September 2018. We inspected the following key questions: Safe; Effective; Well led. This was to check the service met the requirements of Regulations 12 (Safe care and treatment) and 17 (Good governance), of the Health and Social Care Act (Regulated Activities) Regulations 2014, and had made the necessary improvements.

Our findings were:

Are services safe?

We found the service was providing safe care in accordance with the relevant regulations. Specifically, the provider had addressed the requirement notice we set and had made improvements to how they provided safe care and treatment.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations. Specifically, the provider had:

• Established effective systems and processes to ensure good governance, in accordance with the Fundamental Standards of Care.
• Improved their arrangements for assessing, monitoring and improving the quality and safety of the services they provided.

Following our inspection in November 2017, we also asked the provider to review their:

• Arrangements for, and the risks associated with, carrying out circumcision procedures on children aged over 12 months, in a community setting. At this inspection, we found the provider had reviewed their arrangements for providing circumcisions for children aged over 12 months, within a community setting. The provider told us they had revised and strengthened their case selection process, to make sure that only children who could safely undergo a circumcision procedure were circumcised.
• Complaints procedure to make sure it provides people who use the service with clear and accurate advice, about what to do if they are dissatisfied with how their complaint has been handled by the provider. At this inspection, we found the provider had reviewed and updated their complaints procedure. The procedure now states that the complainant should contact the Care Quality Commission (CQC), if they are dissatisfied with the action taken by the provider to address their complaint. We told the provider CQC does not investigate complaints and that they should review their policy further, and that they should consider signposting patients who may be dissatisfied with the response to a complaint for further adjudication. Within 48 hours of our visit, the provider had made arrangements with a GP located in the Newcastle area, to act as an independent complaints adjudicator, should this be required. The provider’s complaints procedure had been updated to reflect this.
• Approach to seeking feedback from people who use the service, so they have access to feedback about all aspects of the care and treatment they provide, to help improve the quality of the service. At this inspection, we found the provider had devised a new text feedback form, which they now send to the parents or, where appropriate, legal guardians of children following completion of a circumcision procedure. The provider told us they had received some feedback, but not as much as they would have liked.

The areas where the provider should make improvements are:

• Strengthen their arrangements for ensuring they maintain patient identifiable information in line with data security standards and retain medical records for the required period of time.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 16 November 2017 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 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.