We carried out an announced comprehensive inspection on 13 January 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not 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 with regard to ongoing clinical oversight.

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.

The CQC inspected the service on 20 May 2018 and 10 October 2018 and asked the provider to make improvements regarding safe care and treatment and good governance. A Notice of Decision with two conditions was issued as a result of findings during the May 2018 inspection. One condition was lifted after the October 2018 follow up inspection, but the condition relating to clinical oversight remained. We checked all areas as part of this comprehensive inspection and found that, whilst most areas of concern had been addressed, some of the issues highlighted at the previous inspections had not been resolved. The full reports for both inspections can be found by selecting the ‘all reports’ link for Poland Medical Coventry on our website at www.cqc.org.uk.

Poland Medical is an independent provider of medical services and treats both adults and children at their location in Coventry. Services are provided primarily to Polish people who live in the UK and who choose to access the services as an adjunct to the NHS services for which they are entitled to register.

The owner of the service 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 10 comment cards, all of which were complimentary about the standard of service provision.

Our key findings were:

• Clinical governance had improved. The Responsible Officer, who was the clinical lead, carried out annual performance audits for all doctors. These audits were supplemented by random audits which were carried out once a month. However, the level of improvement was not consistent across all medical records and more work needed to be done to ensure that the improvement in medical record keeping was consistently maintained. Therefore we found that the condition which related to the standard of clinical oversight had been partially met.
• A more comprehensive medical record template was in use. An additional gynaecological template had also been introduced.
• The collection of NHS details and the request to consent to share information with patients’ GPs were more consistent, however the actual sharing of information remained infrequent.
• All doctors had undertaken comprehensive training regarding Fraser guidelines and Gillick competency.
• The service did not have a separate quality improvement programme, or carry out targeted clinical audits.
• There was minimal evidence of learning from significant events.
• Communication methods with staff were more effective and embedded.
• The policies and procedures were working documents.
• Emergency medicines stocked were appropriate for the risks associated with the range of procedures carried out at the clinic.

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

• 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 the scope of quality improvement activities to include more clinical audits.
• Review the process for documenting learning points and actions as a result of discussions of significant events.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

The CQC inspected the service on 10 September 2017 and 20 May 2018. At the May 2018 inspection, we found that significant issues highlighted at the previous inspection in September 2017 had not been addressed. For example, the majority of the requirements of the warning notices issued after the previous inspection in September 2017 had not been met.

At the May 2018 inspection insufficient improvement had been made and we found that the service was not providing safe, effective or well-led services, so a Notice of Decision was served with two conditions which related to clinical oversight and training in Fraser guidelines and Gillick comptency. The full report on the May 2018 inspection can be found by selecting the ‘all reports’ link for Poland Medical Coventry on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 October 2018 to confirm that the service had complied with the conditions which were served in the Notice of Decision after the May 2018 inspection.

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.

Our findings were:

• The condition which related to the standard of clinical oversight had been partially met with evidence of clear improvement, but there was more work to be done to ensure that the trajectory of improvement was maintained.
• The condition which related to training in Fraser guidelines and Gillick competency had been fully met.

Poland Medical is an independent provider of medical services and treats both adults and children at their location in Coventry. Services are provided primarily to Polish people who live in the UK and choose to access the services as an adjunct to the NHS services for which they are eligible to register.

The owner of the service 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:

• Clinical governance had become more effective. The Responsible Officer carried out performance audits for doctors. These audits were supplemented by random audits which were carried out every month.
• The standard of medical record keeping showed improvement. The majority of the medical records (19 out of 20) we examined on the day were clear, accurate and legible, although some lacked sufficient detail in the recording of medical history and some were still written in Polish.
• A new medical record template had been developed and introduced since the last inspection. This was more comprehensive than the previous version. An additional gynaecological template had also been developed.
• All doctors had undertaken comprehensive training regarding Fraser guidelines and Gillick competency.
• The service did not have a separate quality improvement programme or carry out targeted clinical audits, although the new medical record template had led to improvement in record keeping.
• Communication methods were more effective.
• Emergency medicines stocked were in line with the risks associated with the range of procedures carried out at the clinic.

There were areas where the provider could make improvements and should:

• Continue to monitor the standard of clinical record keeping.
• Consider broadening the scope of quality improvement activities to include a prospective programme of clinical audit which is target based.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 20 May 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 not 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.

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.

The CQC inspected the service on 10 September 2017 and asked the provider to make improvements regarding safe care and treatment and good governance. We checked these areas as part of this comprehensive inspection and found that significant issues highlighted at the previous inspection had not been addressed. For example, the majority of the requirements of the Warning Notices issued after the previous inspection in September 2017 had not been met.

Poland Medical is an independent provider of medical services and treats both adults and children at their location in Coventry. Services are provided primarily to Polish people who live in the UK and who choose to access the services as an adjunct to the NHS services for which they are eligible to register.

The owner of the service 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 feedback through 18 comment cards.

Our key findings were:

• Clinical records were not always recorded in English and were not always legible. General Medical Council guidance on keeping records is that any documents that doctors use to formally record their work must be clear, accurate, legible and usable in a UK context.

• Information sharing with external providers and the patients’ NHS GPs was inconsistent.
• There was minimal evidence of quality improvement activities.
• The range of emergency medicines had not been risk assessed.
• One doctor we spoke with showed no awareness of Fraser guidelines or Gillick competency.
• Doctors had completed safeguarding training to the appropriate level.
• There was a broad range of policies and procedures, but they were not always working policies.
• Information about services, fees and how to complain was available.
• There were structured meetings, which were held mainly at the West London clinic. Few doctors were able to attend, due to the sessional nature of their work.
• The doctors were supported by the designated responsible officer, who was also the Medical Advisor for the clinic.
• Risks to patients were assessed and monitored.
• Patients said that it was easy to make appointments and were complimentary about the standard of service delivery.
• The premises were visibly clean and tidy.

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

• Ensure care and treatment is provided in a safe way to patients.
• Introduce 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 the emergency medicines held to ensure that they are in line with the risks associated with the range of procedures carried out at the clinic.
• Review the system for providing clinical oversight.
• Review the system for embedding policies into working practice.

We carried out an announced inspection on 10 September 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check on concerns we had received and whether the registered provider was meeting the legal requirements within the Health and Social Care Act 2008 and associated regulations.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).

Are services effective?

We found that this service was not 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. We have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).

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.

Poland Medical is registered with the Care Quality Commission (CQC) as an independent provider of medical services and treats both adults and children at the location in Coventry. Poland Medical is registered with the CQC to provide the regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury. Services are provided primarily to Polish people who live in the United Kingdom.

Services are available to people on a pre-bookable appointment basis. The clinic employs doctors on a sessional basis most of whom are specialists providing a range of services from gynaecology to psychiatry. Medical consultations and diagnostic tests are provided by the clinic. No surgical procedures are carried out.

The owner of the service is the registered manager. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The clinic employs 13 doctors all of whom are registered with the General Medical Council (GMC) with a licence to practice. The doctors work across both the West London and Coventry locations. Other staff include the registered manager and a team of reception staff. Poland Medical is a designated body (an organisation that provides regular appraisals and support for revalidation of doctors) with one of the specialist doctors as a responsible officer (individuals within designated bodies who have overall responsibility for helping with revalidation). The doctor is also medical advisor to the clinic.

Poland Medical is open from 10am until 6.30pm on Sundays. Appointments can be arranged on other days by prior arrangement via the West London clinic. The provider is not required to offer an out of hours service or emergency care. Patients who require emergency medical assistance or out of hours services are requested to contact NHS direct or attend the local accident and emergency department.

Our key findings were:

• Patients’ medical records that we viewed were handwritten, often illegible and of an inconsistent standard.
• Not all doctors had completed safeguarding training to the appropriate level.
• The system for sharing learning from significant events was not effective.
• The system for communicating and acting on patient safety alerts was not effective.
• There were very few formal meetings and no full practice meetings. This was considered by the service to be impractical, because the doctors worked on a sessional basis.
• There were no multi-disciplinary meetings.
• Staff were not supported by the provider in their clinical professional development.
• We did not see any evidence of clinical supervision.
• Doctors had completed training, but it was not always effective. For example, the doctors we spoke with were not aware of the provisions of the Mental Capacity Act (2005).
• Information about services, fees and how to complain was available.
• Not all risks to patients were assessed and monitored. For example, there were no infection control audits.
• Medicines and equipment for dealing with medical emergencies was available, but the systems for monitoring them were not always effective. For example, we found one medicine to be out of date.
• There was no system for the reconciliation of pathology results. We were told that results were sent directly to the patient from the laboratory, which meant that the clinic did not receive the results unless notified by the patient.
• There were limited formal governance arrangements.
• There was a broad range of policies and procedures, but individual documents were neither signed nor dated by the reviewer. The index was dated January 2015. We were told that policies and procedures were reviewed every three years.
• The health and safety policy, dated 2009, was overdue for review.
• The premises were visibly clean and tidy.
• A registered manager was in place, but they were not able to be on site on the day of the inspection.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

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 the emergency medicines held to ensure that they in line with the risks associated with the range of procedures carried out at the clinic.
• Review the system of managing communication with a patient’s NHS doctor.