This inspection was an announced focused inspection carried out on 3 January 2019 to confirm that the practice had made the recommended improvements that we identified in our previous inspection on 10 October 2018. This report covers our findings in relation to those improvements made since our last inspection.

We carried out an announced comprehensive inspection at Thornhill Clinic – Luton on 10 October 2018. We found that this service was not providing safe care in accordance with the relevant regulations. The full comprehensive report on the October 2018 inspection can be found by selecting the ‘all reports’ link for Thornhill Clinic - Luton on our website at www.cqc.org.uk.

Our findings were:

Are services safe?

We found that this service was providing safe 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.

Thornhill Clinic – Luton provides private circumcision services to infants, aged five days onwards, children and adults. The clinic also provides a private GP service, including medical health checks and occasional minor surgery such as mole removals.

The Thornhill Clinic – Luton is registered with the Care Quality Commission (CQC) under the Health and Social Care Act 2008 to provide the following regulated activities:

• Surgical procedures
• Treatment of disease, disorder or injury

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.

Our key findings were:

• All staff had now received essential training for their roles that included infection prevention and control, fire safety and basic life support.
• Systems were in place for the sterilisation of equipment used during operations and for the pathology testing of tissue samples.
• A risk assessment was in place to determine which emergency medicines the practice needed to stock.
• Appropriate risk assessments, in relation to safety issues, had been undertaken and identified actions completed.

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

We carried out an announced comprehensive inspection on 10 October 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 as they had not completed some risk assessments and staff training.

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.

Thornhill Clinic – Luton provides private circumcision services to infants, aged five days onwards, children and adults. The clinic also provides a private GP service, including medical health checks and occasional minor surgery such as mole removals.

The Thornhill Clinic – Luton is registered with the Care Quality Commission (CQC) under the Health and Social Care Act 2008 to provide the following regulated activities:

• Surgical procedures
• Treatment of disease, disorder or injury

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.

As part of our inspection, we reviewed CQC comment cards where patients and members of the public shared their views and experiences of the service. There were 25 completed CQC comment cards and they all contained positive comments regarding the service received. Users of the service commented that the staff were friendly and polite and they were made to feel at ease. There were comments that the doctors were professional and answered questions clearly and that the environment was clean and hygienic.

Our key findings were:

• There were effective processes in place to manage significant events and complaints and ensured that lessons were learnt and shared when things went wrong.
• The provider had developed their own best practice guidelines for the circumcision service following the World Health Organisations (WHO) recommendations.
• There was a comprehensive programme of clinical audits in place.
• There were clear procedures in place for consent that included checks to establish parental responsibility.
• The facilities and premises were appropriate for the services delivered.
• Risk assessments in relation to patient safety were lacking in some areas. For example, for legionella, fire safety, and health and safety. There was no risk assessment in place to determine which emergency medicines the practice needed to stock.
• Non-clinical staff had not received all essential training for their roles. For example, infection prevention and control, fire safety and basic life support.

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

• Ensure care and treatment is provided in a safe way to patients.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 20 January 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 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.

Background

Thornhill Clinic - Luton is an independent doctors’ treatment and consultation service in Luton. The service provides privately funded circumcision procedures to males of all ages with a focus on babies and children.

The service carries out approximately 1500 circumcisions each year. In 2015, 1715 were undertaken.

All doctors at Thornhill Clinic have state registered qualifications, are registered with the GMC and are on a national performer list of recognised General Practitioners or Specialists.

The core opening hours for the service are Monday to Friday 9am-5pm. The clinic also offers appointments on Saturdays during holiday times, for example at Easter.

The clinical staff team consists of a paediatric surgeon/urologist who is the clinical director, two consultant urologists, two GPs, a trainee GP and seven nurses. All clinical staff work on a part time basis and are registered to practice in other NHS hospitals and GP surgeries. The clinical team is supported by the practice manager who is also an executive director, and two administrative staff.

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. 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.

During our visit to Thornhill Clinic on 20 January 2016, we spoke with the parents of three children using the service. They told us that they received a very good explanation about their children's procedures from the doctor. This included being informed of the potential risks or complications before being asked to consent to the procedures. They told us the staff appeared competent and qualified and treated them and their children with respect. They said they had no complaints or concerns about their children's care at the service.

As part of our inspection we also asked for CQC comment cards to be completed by patients or parents, prior to our inspection. We received 12 comment cards which were all positive about the standard of care received and that the staff always treated patients and their families with respect and explained treatment well and that the reception staff were polite and kind.

Our key findings were:

• There was a transparent approach to safety with demonstrably effective systems in place for reporting and recording incidents.
• Patients and parents said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.

• All treatment rooms were well organised and equipped with good light and ventilation.
• There were systems in place to check all equipment had been serviced regularly.
• Doctors regularly assessed patients according to appropriate guidance and standards such as those issued by the National Institute for Health and Care Excellence (NICE) and the World Health Organisation.
• Staff maintained the necessary skills and competence to support the needs of patients.
• Staff were up to date with current guidelines and were led by a proactive management team.
• Risks to patients were well managed, for example there were effective systems in place to reduce the risk and spread of infection.
• Staff were kind, caring, and competent and put patients at their ease.

The provider was aware of, and complied with, the requirements of the Duty of Candour. 

During our visit to Thornhill Clinic - Luton on 25 June 2013, we spoke with the parents of some of the children using the service. They said they received a very good explanation about their children's procedures from the doctor. This included being informed of the potential risks or complications before being asked to consent to the procedures. They told us the staff appeared competent and qualified and treated them and their children with respect. They said they had no complaints or concerns about their children's care at the service. One person said: "Overall, I'm perfectly satisfied with the experience." Another person said: "It's very good for my child here."

During our visit we found that each person had their medical history and any risk factors specific to them reviewed and recorded. We saw that arrangements were in place to deal with foreseeable emergencies, including the provision of items for use in an emergency. We found that staff were appropriately qualified and registered and receiving professional development relevant to their roles. Staff were trained in and knowledgeable about such things as safeguarding children and vulnerable adults from abuse.

We found the service had a complaints system in place and people had their complaints responded to appropriately. Information about the complaints procedure was readily available to people who use the service.