This inspection was a focused inspection to follow up on concerns identified previously at inspections conducted on the 10 May 2018 and 11 October 2018.

At the inspection on 10 May 2018 we found the practice was not meeting the regulations for providing safe, effective and well-led care. There were breaches in relation to the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Regulation 17 Good governance and Regulation 18 Staffing. Following the inspection, enforcement action was taken in respect of these regulations.

The inspection on 11 October 2018, was carried out to consider whether the provider had made sufficient improvements to meet the regulations in breach. At the inspection, we found insufficient evidence of improvement with continuing breaches of Regulation 17 Good governance and Regulation 18 Staffing. Following the inspection, we took further enforcement action and decided to begin the process of preventing the provider from operating the service. This inspection on 21 March 2019 was carried out to further assess whether any improvement had been made since the previous inspections. At the inspection, we found insufficient evidence of improvement with continuing breaches of Regulation 17 and 18.

Our key findings were:

• There were continuing shortfalls in safety systems and processes. Including those for safeguarding, recruitment, indemnity arrangements, medical emergencies, prescribing, identity checks and the safety netting of abnormal test results.
• We identified additional concerns in relation to assessing and triaging walk-in patients.
• There were continuing shortfalls in relation to effective needs assessment, staff training, the monitoring of clinical practice and parental consent to care and treatment.
• There had been no improvement in leadership or governance arrangements.
• Systems were in place to gather feedback from patients.
• The arrangements in respect of the duty of candour had improved.

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

We carried out an announced comprehensive inspection on 10 May 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led. We found the service was not meeting the regulations for providing safe, effective and well-led care. Following the inspection we issued warning notices for regulation 17 good governance and regulation 18 staffing.

This inspection was a focused follow-up inspection carried out on 11 October 2018 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches of regulations that we identified at our previous inspection on 10 May 2018. This report covers our findings in relation to those requirements.

At this inspection we found the provider had not made the necessary improvements to rectify the breaches in regulations identified at our previous inspection and therefore we will be taking further action in line with our enforcement procedures.

Our key findings were:

• There were no effective systems for reporting and recording significant events, safeguarding children and vulnerable adults.
• The provider did not have effective systems to minimise risks to patient safety.
• Locum staff could not provide evidence that they were aware of current evidence based guidance, their training requirements were not monitored, the provider could not demonstrate that they had received training to keep patients safe.
• There was inadequate leadership. We were not assured that the registered manager had the skills, knowledge and experience to run the service to ensure patients received safe and effective care.
• There were no effective governance arrangements in place.
• Systems were in place to gather feedback from patients.
• The provider was not aware of the requirements of the duty of candour.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 10 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.

Safeer Pharmacy is a high street pharmacy with a medical clinic for private GP consultations.

The service has a 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 did not get feedback through comment cards or by speaking with patients during the inspection.

Our key findings were:

• There were no effective systems for reporting and recording significant events and complying with national patient safety alerts.
• The provider did not have effective systems to minimise risks to patient safety.
• Locum staff were not aware of current evidence based guidance, their training requirements were not monitored, the provider could not demonstrate that they had received training to keep patients safe.
• There was inadequate leadership. The provider could not assure us that the registered manager had the skills, knowledge and experience to run the service to ensure patients received safe and effective care.
• There were no effective governance arrangements in place.
• There were no systems in place to gather feedback from patients.
• The provider was not aware of the requirements of the duty of candour.

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

• Introduce 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 the 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 arrangements for not requiring patients to provide identification when registering with the service and consent procedures in relation to adult attending with children.
• Introduce a locum induction pack to ensure locum doctors work safely at the service.

• Review arrangements for signposting the availability of a chaperone, provide more readily available information on consultation fees and arrange access to interpretation services.
• Develop a clear vision and set of values for the service including a strategy and supporting business plans to deliver them.
• Review policies and procedures.
• Implement systems to ensure compliance with a Duty of Candour.