We undertook a comprehensive inspection of The Medical Centre on the 20 December 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found that the service was providing effective, caring, responsive, care however, they were not providing safe care in accordance with the relevant regulations and well led required improvements.

The full comprehensive report following the inspection on 20 December 2017 can be found by selecting the ‘all reports’ link for The Medical Centre on our website at www.cqc.org.uk.

We undertook an announced focused inspection of The Medical Centre carried out on 10 January 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 20 December 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection. At the inspection we found that:

Are services safe?

We found that this service was providing safe 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.

Our key findings were as follows:

• Safeguarding policies and procedures were up to date to ensure patients were protected from abuse and improper treatment. All staff had received safeguarding training at an appropriate level to their role.

• The arrangements for enabling doctors to work at the centre on a consultancy basis had been reviewed. Each doctor had a comprehensive recruitment file with all the required information to demonstrate their on-going fitness to practice.

• New systems had been put into place to share information relevant to significant event reporting.

• The service was in the process of developing a programme of quality improvement activity. Regular sports injury audits and reviews took place to improve medical services.

• The patients’ views and concerns were encouraged, heard and acted on. A new patient complaint leaflet had been implemented and all complaints were investigated by the medical leadership team.

• Patients who used the medical team for advice, support and treatment were given a questionnaire to complete about their experiences. The results were shared with the medical team to improve services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 20 December 2017 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 some areas 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 care 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 but improvements were needed in this area, in accordance with the relevant regulations.

The Medical Centre is registered with CQC as an independent healthcare provider with independent consulting services. The registered provider is Manchester City Football Club Limited. The Medical Centre provides services for the football First Team players, the Under 21 team players and the Women’s team players. The Medical Centre provides services to children as students of the clubs football academy, which could include children from the age of four years. The services included responsive and primary health care and treatment for the first team and women’s teams. The children and their families are encouraged to register with an NHS GP. The cost of the service is covered by the football club as part of the benefits package for the players.

The Medical Centre employs two full time doctors and is split into two areas, one covers the First Team and one covers the Academy and Women's Team. The doctors travel with the First Team to provide care and treatment as needed during and following matches. The centre also employs four doctors on a consultancy basis and one consultant sports physician, who is also a trainee sports medicine doctor. All other staff are employed by the company. This includes physiotherapists, sports therapists and administration staff.

The Medical Centre has a senior management team with two CQC registered managers. A registered manager is a person who is registered with the Care Quality Commission to be responsible for 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.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection. We received 19 comment cards which were overall very positive about the standard of care received.

The centre is registered with CQC to provide the following regulated activities:

• Diagnostic and screening procedures
• Treatment of disease, disorder or injury
• Surgical procedures

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

• There were systems in place to report, analyse and learn from significant events, incidents and near misses. However, improvements were needed for how such information was shared across the service.

• The provider carried out recruitment checks, including checks of professional registration where relevant, on recruitment and on an on-going basis. However, there were no formal arrangements in place to undertake such checks for doctors working under a consultancy arrangement.

• Systems and practices were in place for the prevention and control of infection to ensure risks of infection were minimised.

• There were policies and procedures in place for safeguarding patients from the risk of abuse. Staff demonstrated they understood their responsibilities and had received safeguarding training from the Football Association. However, on the day of inspection we were unable to establish the level of safeguarding training staff had undertaken for children. Some staff had not completed safeguarding training for adults at risk. Following inspection, the provider confirmed that dates had been set to ensure medical staff completed level three children's safeguarding training. 
• The service had adequate arrangements in place to respond to emergencies and major incidents.
• Systems were in place to ensure appropriate and safe handling of medicines.

• The provider had systems to keep clinicians up to date with current evidence-based practice.

• Staff felt supported. They had good access to training and development opportunities.

• Patients commented that they were treated with compassion, dignity and respect. Patients were given good verbal information regarding their treatment in a way they understood. Written information was available in different languages.

• Access to the service was very good and patients were able to see a doctor at any time.

• There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk. Improvements were needed for the use of clinical audits to monitor patient outcomes.

• There was a clear vision to provide a safe and high quality service. Staff felt supported by management and worked well together as a team

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

• Ensure patients are protected from abuse and improper treatment.

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

• Review the information held to demonstrate the suitability of doctors working at the centre on a consultancy basis.
• Review the training for staff who act as chaperones.
• Develop an action plan for the infection control risk assessment undertaken.
• Review the systems in place for sharing information relating to significant event reporting.
• Review the clinical audits undertaken to ensure they include effective monitoring of patients’ outcomes.
• Review the information available to patients and families when making a formal complaint.
• Review the systems in place for collecting the views of patients.