We carried out an announced follow up inspection on 28 November 2018 to ask the service the following key questions; Are services safe 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 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.

CQC inspected the service on 28 March 2018 and required the provider to make improvements regarding how they provided safe care and treatment and how they demonstrated good governance. We checked these areas as part of this follow up inspection, and found only the availability of records for ordering, receipt and disposal of medicines had been resolved. The other issues remained unresolved.

The Slimmingmedics High Wycombe clinic provides weight loss services, including prescribed medicines and dietary advice to support weight reduction. The clinic is located on the first floor of a shared building in the town centre. The clinic includes a reception area, a waiting room and one consulting room. The clinic is open for half a day twice a week, on Wednesdays and Saturdays.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner, including the prescribing of medicines for the purposes of weight reduction. At Slimmingmedics High Wycombe the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation. Therefore we were only able to inspect the treatment for weight reduction but not the aesthetic cosmetic services.

The Clinic 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.

Our key findings were:

• The provider lacked systems to monitor the quality of care delivered.
• The provider lacked systems to check that staff delivering the service had the appropriate training in place
• The provider lacked systems to monitor the safety of the clinic premises.

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 prescribing of medicines and only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 28 March 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 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 Slimmingmedics High Wycombe clinic provides weight loss services, including prescribed medicines and dietary advice to support weight reduction. The clinic is located on the first floor of a shared building in the town centre, and includes a reception area, a waiting room and one consulting room. The clinic is open for half a day twice week, on Wednesdays and Saturdays.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner, including the prescribing of medicines for the purposes of weight reduction. At Slimmingmedics High Wycombe the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation. Therefore we were only able to inspect the treatment for weight reduction but not the aesthetic cosmetic services.

Staff include a clinic manager, two doctors (one available at each session), and one receptionist. The clinic manager is also 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 collected feedback about the service from twenty patients through comment cards and speaking to patients during the inspection. The observations made were all positive, and patients told us they found staff to be friendly, professional and respectful. Patients said they felt supported to lose weight and were given lots of encouragement, guidance and advice.

Our key findings were:

• There were no effective systems and processes in place to prevent abuse of service users
• The provider did not have systems and processes in place to monitor and improve the quality of services being provided. This included a lack of incident reporting systems, risk assessments, safety alerts and clinical audit
• Patients were assessed and monitored before and during treatment, and were provided with support and information
• We found feedback from patients was positive about the friendliness of staff and the care they received at the clinic

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

• Ensure 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

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 need for chaperoning at the service and staff training requirements if necessary
• Improve the process for disposing of medicines so that it complies with the Misuse of Drugs Act 1971 and its associated regulations
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available
• Improve the training and appraisal requirements for all staff
• Review the arrangements necessary to meet the needs of patients with a disability, impairment or sensory loss and those needing translation

We carried out a responsive, focussed inspection on 27 April 2016. CQC received information from a patient via another organisation, that raised some concerns and prompted us to carry out a focussed inspection. During the inspection we looked at specific areas to establish if the service was safe for people with regards to the management of medicines.

Our findings were:

Are services safe?

We found that the service was providing safe care with regards to the management of medicines in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care with regards to the management of medicines in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care with regard to medicines management in accordance with the relevant regulations.

Background

The Slimmingmedics High Wycombe clinic provides weight loss treatment and services, including medicines and dietary advice to people accessing the service. The clinic is on the first floor of a shared building in a town centre location. The clinic is open for half a day on Wednesdays and Saturdays. 

The clinic is run by doctors and a clinic manager who is also 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 service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner, including the prescribing of medicines for the purposes of weight reduction. At the Slimmingmedics High Wycombe clinic the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation. Therefore we were only able to inspect the treatment for weight reduction but not the aesthetic cosmetic services.

Our key findings were:

• We did not find any evidence to support the concerns that prompted the focussed inspection.
• The provider did not always supply medicines in line with evidence based practice.
• There were appropriately qualified staff in the clinic to prescribe and supply medicines.

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

• Review the process for ordering and transferring controlled drugs to bring it in line with good practice.
• Review the policies and procedures to make sure they are up-to-date, reflect current practice and legislation, and encourage continuous improvement.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.
• Supply medicines in accordance with recognised clinical guidance and best practice.
• Review the information provided to patients so that it is clear, up to date and not misleading.
• Review the process for disposing of medicines so that it complies with the Misuse of Drugs Act 1971 and its associated regulations.

Patients told us options had been fully explained to them before they started any course of treatment. We spoke with three current patients who told us they had fully discussed their medical history, lifestyle and eating habits with the doctor. One patient described it as a "Very thorough" initial consultation.

Patients told us they knew about the likely costs of their treatment before it started. They said there had not been any unexpected additional costs in their experience. This meant consent to care and treatment was given with accurate information as to its cost.

Patients confirmed they had been advised they should not take appetite suppressant medication for long periods without breaks. They told us they were supported to achieve this. One patient told us they had stopped taking the medication for a period and were now taking only a short course to regain momentum in their weight loss programme.

We looked at eleven patient records. Each contained details of an initial assessment. This included height, weight, body mass index (BMI), blood pressure and target weight. This showed people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We looked at medication storage, administration and records. We found patients were not always fully protected against the risks associated with medicines. Appropriately secure storage of controlled drugs was not in place. Audit of medicines did not adequately identify or explain the reason for any discrepancies.

We spoke with the doctor on duty. They confirmed the medical director of Weight Medics was based at their head office. They provided professional support and advice to doctors at each location. The doctor told us they were able to consult the medical director by telephone if they needed any advice or guidance. They told us they felt adequately supported to provide safe and effective treatment to patients.

We talked to three patients. They said that they were very pleased with the service the clinic provided. "I would not have been able to get where I am now without them" was one comment. They told us they would raise any concerns with the manager or doctors directly if they had any. We saw there were processes in place to enable patients to make formal complaints if they wanted to.

We spoke to the registered managers for this and the Reading location and the doctor consulting on the day of the visit. We observed policies and processes, reviewed eight sets of records and spoke to seven people using the service to gain further insight of the care provided.

People using the service were very satisfied with the care provided and told us that staff were “really helpful” and “very accommodating”. One person said “They are really flexible with appointment times” and another said “I could not have lost the weight without them”. There was a general feeling that the service was provided around peoples’ needs and lifestyles.

We found the risks and benefits of treatment were explained to people in a way they could understand. Options were fully discussed and written information on diet and medication was provided.

Staff showed a good knowledge of the service. Doctors were registered with the General Medical Council (GMC) and appropriate criminal records bureau (CRB) checks were made. However, there were no records available to check that recruitment processes were followed and continuing professional development maintained.

We found evidence of quality management processes including complaints, compliments and incident management. There was evidence that doctors audit their patients quarterly and that the outcome of these audits are used to enhance services. We saw that medication audits are completed weekly but will be completed daily in the future.