We carried out an announced comprehensive inspection on 26 March 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 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.

The service had not been inspected before.

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. Some services are provided to patients under arrangements made by other health services where The Merlin Centre provide staff but do not have responsibility for planning or delivering patients’ care. These types of arrangements are exempt by law from CQC regulation. Therefore, at The Merlin Centre we were only able to inspect the services which are provided by The Merlin Centre in whole or in part.

The services provided which were within CQC’s powers to inspect were:

• Intermediate gynaecology clinics at five locations across Buckinghamshire. Each clinic sees adult female patients who may need minor procedures, such as coils which may present complications in fitting, also known as an intra-uterine device (IUD). Also the clinics may take samples of tissue from patients for diagnostics or those where their onward referral path is not clear.
• Phlebotomy (taking blood samples) is provided at one location for practices who do not have the capacity to undertake these themselves. The Merlin Centre only provides the samples but analysis is undertaken by the local practices.
• Minor surgery for removal of skin lesions. Only those lesions that would not be eligible to be removed under current NHS guidance are treated. Adult patients pay a fee to be assessed and treated. All patients are encouraged to see their own GP first to ensure the lesion is not eligible to be removed under an NHS service.

In addition the service provided staff, referral administration and streaming of patients to other services for cardiology and ENT. They also audited services delivered by other providers such as ear, nose and throat clinics, NHS Health checks and vaccination clinics.

There was a registered manager in post. 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.

We received 39 comment cards from patients and all of these contained positive feedback regarding patients’ experience of using services.

Our key findings were:

• There was a clear governance structure and leaders were available to staff, supportive and accountable.
• The provider identified and learnt from clinical practice in order to improve services where necessary.
• Risks associated with the provision of services were well managed.
• Medicines and related documentation were appropriately managed.
• The necessary checks required on staff who provided care were undertaken.
• Patients received full and detailed explanations of treatment including information enabling informed consent.
• The service was caring, person centred and compassionate.
• There were processes for receiving and acting on patient feedback.
• There were systems in place to respond to incidents and complaints.
• Staff received training relevant to their roles.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care