We carried out an announced comprehensive inspection on 5 January 2016 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.

Background

Bristol Fitness and Wellbeing Centre is part of Nuffield Health a not-for-profit healthcare provider. The health assessment clinic is based within the centre. Over 90% of patients seen in the clinic are employees of organisations who are provided with health and wellbeing services as part of their employee benefit package. The services are provided to adults and older people privately and are not currently commissioned by NHS. The clinic is closely linked to the Bristol Nuffield Hospital. The organisation promotes involvement in the local community and the centre supports local community events such as the Park on Park Street and Bristol Sports Day by offering free health advice sessions and information.

The core opening hours for the clinic are Monday to Friday 8.30am-5.00pm.

The staff team at the clinic consisted of a full time health screening doctor and four physiologists. (a physiologist is a graduate in exercise, nutrition and health sciences, and are full professional members of the Royal Society for Public Health (RSPH). They are trained to carry out health assessments, give advice and motivate lifestyle changes affecting areas such as exercise, nutrition, sleep and stress management. The team undertook the planned health assessments.

The Integrated Clinical Services 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 obtained feedback about the clinic from three completed Care Quality Commission comment cards and speaking with a patient during the inspection. The observations made by patients on the comment cards were all positive and reflected satisfaction with the clinic.

We found the service had met the regulations and had in place robust systems and protocols for staff to follow which kept patients safe.

Our key findings were:

• There was a transparent approach to safety with demonstrably effective systems in place for reporting and recording incidents.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• All health assessment rooms were well organised and equipped, with good light and ventilation.
• There were systems in place to check all equipment had been serviced regularly, including the blood screening equipment.
• Clinicians regularly assessed patients according to appropriate guidance and standards such as those issued by the National Institute for Health and Care Excellence.
• Staff maintained the necessary skills and competence to support the needs of patients.
• Staff were up to date with current guidelines and were led by a proactive management team.
• Risks to patients were well managed for example, there were effective systems in place to reduce the risk and spread of infection.
• Staff were kind, caring, competent and put patients at their ease.
• The provider was aware of, and complied with, the requirements of the Duty of Candour.

During our inspection we spoke with two people who were attending the clinic for a health assessment. One person said the staff were “good, efficient and effective. They were probably too nice but the tests are expensive, so they must treat you with respect and care”. Another person said “staff are very friendly, very good. They make you feel relaxed. Dead on”.

We spoke with one person who told us their privacy and dignity had been maintained at all times. People were involved in discussions about their health and were able to make informed choices about what to do next. People told us that assessments and tests were explained and their consent was sought before they were carried out. One person told us how staff had “explained everything fully and what the results showed”.

People were satisfied with the service that they received. We saw comments such as "I have attended several medicals at this clinic and each one has been excellent”.

The provider had quality assurance processes in place to ensure that equipment was maintained. However, there was no evidence that the defibrillator was checked or was maintained. It was observed that the last daily check of the resuscitation equipment bag was carried out during the week before the inspection. The contents were incomplete and it was not tamperproof in accordance with the provider’s procedures. Resuscitation equipment was not stored in one place to allow easy quick access in an emergency.

There was a complaints procedure in place. No one raised any concerns about the service at the time of our visit.

People were happy with the service that they received from the centre. We saw comments such as "Excellent consultation. Took lots of time with me" and "A positive experience with competent and personable individuals". People were involved in discussions about their health and were able to make informed choices about what to do next.

Care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare. Strenuous health assessments did not take place unless a person's fitness had first been assessed. Staff responded to people who used the service in a friendly and considerate manner and they had been trained and managed so that they could carry out their roles effectively. We could see that people's dignity was maintained and their privacy protected.

There was a system in place to monitor the quality of service provided. We saw evidence that comments were listened to and that further investigation took place if necessary. Information gained from audits was analysed and used to make any improvements indicated.

This service is rated as Good overall. (Previous inspection January 2016 - independent healthcare services were not rated at that time)

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 inspection at Nuffield Health Bristol Fitness and Wellbeing on 3 May 2019. This was a routine inspection with the purpose of rating this independent health service for the first time.

The Senior General 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.

Eight people using the service provided feedback about their experiences at Nuffield Health Bristol Fitness and Wellbeing Centre during the inspection. Their comments were strongly positive about the quality of the service and appointment length and scope. Staff were described as engaging and motivating providing helpful guidance and a supported plan for the person to improve their health and wellbeing.

Our key findings were:

• There was positive patient satisfaction about all aspects of the service.
• Organisational safety systems facilitated oversight of reporting, recording and learning from incidents.
• Information about services and how to complain was available and easy to understand.
• All three health assessment rooms were well organised, equipped and clean.
• The service had systems in place to check all equipment was serviced regularly, including the blood screening equipment.
• Clinicians referred to appropriate guidance and standards such as those issued by the National Institute for Health and Care Excellence providing a framework for assessment of patients.
• Staff worked within their competencies and demonstrated they maintained the necessary skills and competence to support patients.
• Experiential learning was used to raise awareness about safety and emergency events, without notice. These were evaluated with the team so learning could be used proactively to improve quality and safety at the service.
• The provider worked with other NHS organisations and charities to provide services to vulnerable or hard to reach individuals.
• Quality assurance systems were monitored through clinical and non-clinical audit and provided assurance of adherence to policy and reduced potential risks to patients.
• Staff were highly motivated, and patients said they were kind, caring, competent and put them at ease.
• The provider was aware of, and complied with, the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

Review safeguarding competencies and training with all staff to ensure these are in line with national guidelines.

Review the standard operating procedure covering duty of candour to ensure patients receive a written apology after verbal contact when affected by an incident.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care