We carried out an announced comprehensive inspection on 16 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 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.

CQC inspected the service on 20 April 2018 and asked the provider to make improvements regarding establishing effective systems and processes to ensure good governance, in particular relating to recruitment. We checked these areas as part of this comprehensive inspection and found this had been resolved.

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 National Slimming and Cosmetic Clinics, Bradford 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.

49 people completed CQC comment cards prior to our inspection, and these were all positive. Patients told us staff were friendly and helpful and treated them with respect, and the facilities were clean and comfortable.

Our key findings were:

• Staff were caring, supportive, and treated patients with dignity and respect.
• Doctors followed the clinic prescribing manual and recorded the rationale for prescribing decisions.
• There were arrangements in place to audit medical records and treatment outcomes, however the audit outcomes and any actions were not clearly documented and shared to promote continuous service improvement.
• There was a comprehensive set of policies and procedures governing all activities, these were kept under review.
• The clinic was clean and tidy and a legionella risk assessment had been undertaken
• Customer satisfaction surveys were completed to help ensure the service was responsive to peoples needs and there was a procedure in place for handling concerns and complaints

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

• Ensure that all prescribed medicines are labelled as part of the dispensing process prior to supply to each patient.
• Ensure that the medicines refrigerator maintains the appropriate temperature for the safe storage of medicines.

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 and update the patient medicine information leaflet to provide clarity around situations where urgent medical attention should be sought.
• Review the process for documenting and sharing actions and areas for improvement identified through audit, to promote continuous improvement.
• Review the electronic record keeping to ensure that accurate and up-to-date recruitment and training records are maintained for all staff in accordance with clinic procedures.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available and ensure that all dispensed medicines are fully labelled.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

This inspection was an announced focused inspection carried out on 20 April 2018 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 7 August 2017. This report covers our findings in relation to those requirements and any additional improvements made since our last inspection.

Our key findings were as follows:

• The manager had reviewed arrangements for chaperoning and had identified that it was not needed at this service.

• The Doctors Manual had been reviewed with regard to current guidance to consider additional patient risks, due to a combination of BMI (body mass index) and additional co-morbidities.
• The manager completed regular weight loss audits. There were plans to implement clinician sessions to support the sharing and implementation of  learning from these across the clinics.
• The provider told us they had reviewed their approach to medical emergencies due to the prescribing of a new medicine at the clinic. The clinic had an emergency resuscitation chart and clinic staff would call the emergency services should someone become unwell.
• The registered manager was the Safeguarding Lead and all clinical and reception staff had completed Adult and Children's Safeguarding training.

However, there were also areas of practice where the provider needs to make improvements.

At our previous inspection on 7 August 2017 we found that the provider had not established effective systems and processes to ensure good governance in accordance with the fundamental standards of care. This related in particular to recruitment, safeguarding and learning from clinical audit. At this inspection we found that governance arrangements were improving but effective systems and processes relating to recruitment had not been fully established.

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care in particular relating to recruitment.

In addition the provider should:

• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.
• Monitor and audit the implementation of Liraglutide prescribing to ensure that clinic protocols are consistently adhered to.

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

We carried out an announced comprehensive inspection on 9 August 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 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.

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.

National Slimming and Cosmetic Clinics – Bradford is a private slimming clinic for adults. The service operates from a ground floor consulting room, with separate reception and waiting area on North Parade in Bradford. The clinic was open on Wednesdays from 9am to 3:45pm and on Friday and Saturday mornings.

There were two receptionists and three part-time doctors, one doctor was available at each clinic session. The clinic manager was 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.

45 patients completed CQC comment cards to tell us what they thought about the service. All of the comments were positive about the cleanliness of the environment, and the support from the doctors and clinic staff.

Our key findings were:

• We found that feedback from patients was positive about the care they received, the friendly staff and the cleanliness of the premises.
• Patients were provided with a range of information on diet, exercise and any medicines that were prescribed.
• The provider had systems in place to deal with incidents and to monitor the quality of the service being provided.
• Prescribing was in line with an agreed clinical protocol and appropriate records were maintained.
• The clinic did not offer a chaperone service.

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 In particular relating to recruitment, safeguarding and learning from clinical audit.

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:

• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.
• Review the necessity for chaperoning at the service and staff training requirements if necessary.
• Review the Doctors manual to include reference to current guidance with regard to identifying patients at additional risk due to a combination of their BMI and additional co-morbidities and share findings from the clinical effectiveness audits with doctors to support review and learning.
• Complete a written risk assessment to support and evidence the Clinic approach to medical emergencies.