We carried out an announced comprehensive inspection of Trailfinders Travel Clinic on 3 July 2018. The practice was found to be not to be providing safe care under regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. We issued a requirement notice for breaches of this regulation related to failure to adequately assess and mitigate risks associated with fire, legionella, substances hazardous to health and infection control.

Consequently, we carried out an announced focused inspection on 8 January 2019. 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 to check whether service was now fully meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. Specifically, we assessed whether or not the provider had taken action to address the breaches of regulation and to determine if the provider was complaint in respect of the key question: Are services safe?

Our findings were:

Are services safe?

We found that this service was now providing safe care in accordance with the relevant regulations

Our key findings were:

• The service had completed a fire risk assessment and had complied with most of the recommendations although testing of the fire alarm was done quarterly and not weekly as recommended in the risk assessment.
• The service had completed a legionella risk assessment but had yet to fully implement all of the recommendations including regular flushing of rarely used water outlets.
• The service had updated data sheets for hazardous substances kept on the premises and there was now a COSHH policy and COSHH risk assessment.
• Staff had received fire safety and infection control training.
• An infection control audit had been completed.

We also identified other issues at our last inspection which did not amount to breaches of regulation but where we recommended that the provider should take action. We found that the service had implemented most of these recommendations. For example:

• The service had undertaken an audit of the quality of clinical staff record keeping which included assessing whether or not consent was documented in the patient’s notes. A re audit was planned for later in 2019.
• We recommended that a formalised induction process be introduced for clinical staff. We were told that there was an informal induction of these staff members and that the service had yet to put a formal documented system in place as there had been no new clinicians that had been recruited since our last inspection. A structured documented induction was in place for non-clinical staff.
• The service had not made any changes to their business continuity plan as recommended at the last inspection. The plan still referred to a limited number of scenarios where alternative arrangements would need to be put in place to ensure the service continued to function. However, we asked staff at the service to outline what they would do in the event of a scenario not included within the policy and staff were able to provide a clear account of the action that would be taken to ensure the service continued.
• At the last inspection we recommended the service review systems for checking patient identity prior to treatment and sharing details of patient treatment with a patient’s GP. The service informed us that they did not routinely ask for identification unless the patient was a child. In these circumstances the identity of the attending adult would be verified to ensure that appropriate consent to treatment was obtained before treatment. We saw instances where the service would share details of treatment with a patient’s GP if they deemed this to be clinically necessary or relevant; for instance, if the patient had an underlying health condition which could be impacted by the treatment given at the service. All other patients were provided with a record of the treatment received which could be shared with their GP.
• The service had drafted a whistleblowing policy since our last inspection as recommended.

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

• Review induction process for clinical staff with a view to implementing formal recording systems.
• Review business continuity plans.
• Review recommendations from the legionella and fire risk assessment to ensure all recommendations are implemented or non implementation justified.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Trailfinders Travel Clinic on 3 July 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 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.

Trailfinders Travel Clinic provides private travel health services including travel immunisations in the Royal Borough of Kensington and Chelsea in London. Services are provided to both adults and children. This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by a medical practitioner, including the prescribing of medicines.

We received feedback from 44 people about the service, including comment cards, all of which were positive about the service and indicated that patients were treated with kindness and respect. Staff were described as empathetic, caring, thorough and professional.

Our key findings were:

• There were arrangements in place to keep patients safeguarded from abuse.
• Some health and safety and premises risks had not been assessed and managed effectively.
• The premises were clean and hygienic; however infection control systems were not appropriately monitored.
• There were safe systems for the management of medicines.
• Staff knew how to deal with medical emergencies. Appropriate medicines and equipment were available.
• The service had systems for recording, acting on and improving when things went wrong.
• Travel health assessments and treatments were carried out in line with relevant and current evidence based guidance and standards.
• There was evidence of some quality improvement measures.
• Staff had the specialist skills and knowledge to deliver the service.
• Staff treated patients with kindness, respect, dignity and professionalism.
• The appointment system was flexible and patients were able to access appointments when they needed them.
• The service had a clear procedure for managing complaints. They took complaints and concerns seriously and responded to them appropriately to improve the quality of care.
• The leaders had the skills and capacity to deliver the service and provide high quality care.
• Staff stated they felt respected, supported and valued. They were proud to work in the service.
• There were clear governance arrangements for the running of the service, however some systems to assess risk were not in place.
• The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.
• The service asked staff and patients for feedback about the services they provided.
• There was evidence that the service had contributed to external publications within the field of travel health.

Notable practice:

• Two clinical staff were fellows and one clinical staff was a member of the Faculty of Travel Medicine, part of the Royal College of Physicians and Surgeons of Glasgow. There was evidence that one of the doctors and the lead nurse were involved in setting examination questions for the Faculty of Travel Medicine.

• The lead nurse, lead doctor and a second nurse had been directly involved with contributing to the Royal College of Nursing, Female Genital Mutilation guidance for travel health services which was published in 2016.

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

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

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

• Monitor the systems for obtaining, recording and auditing consent for care and treatment provided.
• Review and improve the use of induction checklists to ensure an effective induction process for staff.
• Review and improve the business continuity plan for the service.
• Review and improve the systems for communicating with a patient’s GP and verifying a patient’s identity.
• Review the provision of a whistleblowing policy for staff.

We spoke with one person who used the service and looked at the results of numerous feedback surveys from 2012. People were satisfied with the care and treatment received. They felt that the procedures had been explained well and found the written information provided comprehensive. Consent had been obtained by the most appropriate person.

Care was planned in a way to ensure people's safety. People were assessed by the doctor to determine whether the requested vaccination or medication would be suitable. People were given advice and information. There were procedures in place to deal with medical emergencies.

The clinic was clean and well maintained. There were systems in place to reduce the risk of infection, including a policy on infection control.

There was a complaints policy in place and people were given information on how to make a complaint. The person we spoke with and the results from feedback forms were complimentary about staff.

We did not speak to people on this occasion. But Trailfinders sent us a copy of their most recent survey. People were positive about the information and service they received.