We carried out an announced comprehensive inspection on 17 January 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. This was a joint dental and medical inspection of an independent healthcare service. This report relates to the medical service only. A separate report has been written for the dental service provided by the clinic. You can read the dental report by selecting the ‘all reports’ link for Top Medical Clinic at our website at www.cqc.org.uk.

The provider offers specialist services including aesthetic medicine, cardiology, dentistry, dermatology, endocrinology, gynaecology, neurology, orthopaedics, paediatrics and psychology. Services were primarily provided to Polish patients.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example the aesthetic cosmetic treatments that are provided by the service are exempt by law from CQC regulation.

We received 34 Care Quality Commission comment cards from patients who used the service and spoke to two patients during the inspection; all were all positive about the service experienced. Many patients reported that the service provided high quality care.

Our key findings were:

• The service had systems in place to manage risk; however this required further improvement. When incidents happen, the service did not always learn from them and improve their processes. The service did not have a clear system in place to manage significant events and did not have a comprehensive business continuity plan. The practice had not made any arrangements to ensure what happens to patient records when they cease to trade.
• The service did not have systems in place to review the effectiveness and appropriateness of the care it provided. It did not ensure that care and treatment was always delivered according to evidence- based guidelines; the provider did not have a clear system in place to keep clinicians up to date with current evidence-based practice.
• There was limited evidence of quality improvement and they had not undertaken any clinical audits.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The clinic had limited accessibility to the patients who are physically disabled and did not have an accessible toilet suitable for disabled patients.
• Information on how to complain was available and easy to understand.
• There were some governance arrangements in place; however there was limited clinical leadership within the service.

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

• The provider had not ensured that care and treatment is provided in a safe way for service users. They did not have a system in place to manage significant events, medicines and safety alerts and emergency medicines; chaperones are appropriately trained; all clinical equipment is regularly calibrated; there is a comprehensive business continuity plan for major incidents such as power failure or building damage, and the identity of patients is checked before registering new patients. Introduce a policy to ensure communication with patients’ NHS GP where appropriate.
• The provider had not ensured that effective systems and processes are in place to ensure good governance in accordance with the fundamental standards of care. They did not have a system to demonstrate quality improvement including for example clinical audits; medicines are appropriately prescribed; governance arrangements in place to improve clinical leadership within the service and learning from incidents, significant events and complaints.
• The provider had not ensured that all staff have received appraisal and training to enable them to carry out the duties that they are employed to perform.

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 practice procedures to ensure improved access to patients who are disabled.