We carried out an announced comprehensive inspection on 1 November 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 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.

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.

Regent Street Clinic Leicester is an independent provider of GP services. The service offers a range of specialist services and treatments such as facial aesthetics, travel vaccinations, sexual health screening, occupational health and offshore medical services. The service does not offer NHS treatment. It is an accredited yellow fever centre which is registered with NATHNaC (National Travel Health Network and Centre).

The provider told us the breakdown of the services they provided at Regent Street Clinic, Leicester in the last year were:

• Private general GP work 19%
• Travel vaccines and advice 48%
• Facial aesthetics 23%
• Sexual health 6%
• Occupational health 2%
• Medical examinations 2%

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 exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regent Street Clinic Leicester provides a range of non-surgical cosmetic interventions, for example dermal fillers and botox treatments which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

Our key findings were:

• Fourteen people provided feedback about the service and all were positive about the service they received.

• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines. There was evidence of quality improvement through clinical audits which were relevant to the service.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients told us they could access care and treatment from the service in a timely way.
• There were clear responsibilities, roles and systems of accountability to support good governance and management.

• The service used a number of policies and procedures to govern activity.
• There was a focus on continuous learning and improvement at all levels of the organisation.

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

• Review the arrangements relating to medicines held for use in an emergency and carry out a risk assessment where required.
• Review Patient Group Directions to ensure they are countersigned.
• Review the system for recording refrigerator temperatures to ensure rationale is recorded when temperature out of range and appropriate action taken.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced desk based follow up inspection on 12 January 2017 to follow up concerns we found at Regent Street Clinic Leicester on 2 March 2016.

Our findings were:

Are services safe?

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

Background

We carried out a desk based inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Regent Street Clinic Leicester is an independent provider of GP services owned by FBA Medical Ltd and also offers a range of specialist services and treatments such as facial aesthetics, travel vaccinations, sexual health screening and occupational health services to people on both a walk-in and pre-bookable appointment basis. The clinic is based close to the city centre of Leicester. It is an accredited yellow fever centre which is registered with NATHNaC (National Travel Health Network and Centre). The practice is also registered with the British College of Aesthetics Medicine (BCAM).

The provider which is FBA Medical Limited is registered with the Care Quality Commission to provider services at Regent Street Clinic Leicester, 108 Regent Road, Leicester, Leicestershire, LE1 7LT which is a four storey grade II listed property. FBA Medical also provide services at other locations in Nottingham, Leeds, Sheffield and Derby The property consists of a patient waiting room and reception area on the ground floor and consulting rooms which are located on the first and second floor of the property. There is a private car park available for patients with a separate entrance for disabled access.

The practice does not hold a list of registered patients and offers services to patients who reside in Leicester and surrounding areas but also to patients who live in other areas of England who require their services. The practice has a high number of patients who are overseas visitors from foreign countries who require medical assistance whilst visiting the UK and also students and international students of local Universities within Leicester who require GP services whilst residing within Leicester.

The practice 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.

This practice is a member of the Independent Doctors Federation (IDF). The IDF is a designated body with its own Responsible Officer.

The practice employs one lead GP, one practice manager who is also the registered manager, one office manager and a team of reception staff.

The practice is open from 9am-6pm Monday to Friday. Extended opening hours are available on a Thursday evening until 8pm. The practice is open on a Saturday from 2pm until 5pm. The practice does not provide mobile services or home visits.

The practice is not required to offer an out-of-hours service. However, the practice offers a home visiting and hospital admission service which is available 24 hours a day, full details of this services is advertised on the practice website.

Our key findings were:

Our key findings across the areas we inspected were as follows:

• Risks to patients were assessed and well managed. The practice had carried out a risk assessment regarding legionella.
• There was a process in place to check and record vaccination fridge temperatures on a daily basis. There was a cold chain policy in place which had been reviewed in May 2016. (cold chain is the maintenance of refrigerated temperatures for vaccines).

We carried out an announced comprehensive inspection on 2 March 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 not providing safe care in accordance with the relevant regulations.

The impact of our concerns is minor for patients in terms of the quality and safety of clinical care.  The likelihood of this occurring in the future is low once it has been put right.  We have told the provider to take action.  (see full details of this action in the Requirement Notices at the end of this report).

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.

Our key findings were:

• There was an effective system in place for reporting and recording significant events.
• The practice had a number of policies and procedures to govern activity. However, they were not always following the guidance in relation to cold chain management.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Not all risks to patients were assessed and well managed. The practice did not have a risk assessment in place for the control of Legionella. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).  Following our inspection, we were provided with evidence of a site visit report to confirm that a risk assessment had been carried out by an external specialist in June 2016.
• The practice kept records of Hepatitis B status for all clinical members of staff who had direct contact with patients’ blood for example through contact with sharps.
• The provider actively encouraged patient feedback and acted upon it.
• The provider was aware of and complied with the requirements of the Duty of Candour.

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

• Ensure adequate arrangements are in place in relation to the risk of legionella.
• Ensure appropriate arrangements are in place for the storage of vaccinations and immunisations.

You can see full details of the regulations not being met at the end of this report.

This inspection was carried out to see if improvements had been made following our inspection of 12 December 2013. During this inspection, we spoke with the GP, practice manager and two members of staff. We did not speak with patients using the service.

We found that appropriate arrangements were in place to deal with medical emergencies. We found the emergency equipment and monitoring checks to ensure the equipment was safe and in working order. Members of staff had received training in basic life support and dealing with medical emergencies.

There were systems in place to ensure the surgery was kept clean and the standard of the cleanliness was regularly monitored.

The provider had some systems in place to monitor the on going quality of the service provided. We found the provider had used feedback forms and surveys. This enabled people using the service to express their views about how the service was being run.

We spoke with three people using the service as part of our inspection. Two people regularly used the service and one person was new to the practice. None of the people we spoke with had any concerns about the practice and how it was being run. One person we spoke with told us, "It's brilliant, fantastic." We observed a consultation with someone using the service and found that their consent was obtained prior to them receiving treatment and that their medical history was obtained and recorded by the service.

We spoke with all of the staff working at the practice during our visit. This was the provider, the registered manager and the receptionist on shift at the time. The registered manager told us that there were improvements to be made in relation to the arrangements for infection control at the practice. We found that the policies in place had not been reviewed for some time and that there were not adequate procedures in place to ensure that people using the service were protected from the risk of infection.

There were not adequate mechanisms in place to allow people using the service to feedback on the care and treatment they had received. The service did not have systems in place to ensure that people using the service were able to express their views about how the service was being run.