We carried out an announced inspection on 10 September 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check on concerns we had received and whether the registered provider was meeting the legal requirements within the Health and Social Care Act 2008 and associated regulations.
Our findings were:
Are services safe?
We found that this service was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).
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 have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).
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.
Poland Medical is registered with the Care Quality Commission (CQC) as an independent provider of medical services and treats both adults and children at the location in Coventry. Poland Medical is registered with the CQC to provide the regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury. Services are provided primarily to Polish people who live in the United Kingdom.
Services are available to people on a pre-bookable appointment basis. The clinic employs doctors on a sessional basis most of whom are specialists providing a range of services from gynaecology to psychiatry. Medical consultations and diagnostic tests are provided by the clinic. No surgical procedures are carried out.
The owner of the service is the registered manager. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The clinic employs 13 doctors all of whom are registered with the General Medical Council (GMC) with a licence to practice. The doctors work across both the West London and Coventry locations. Other staff include the registered manager and a team of reception staff. Poland Medical is a designated body (an organisation that provides regular appraisals and support for revalidation of doctors) with one of the specialist doctors as a responsible officer (individuals within designated bodies who have overall responsibility for helping with revalidation). The doctor is also medical advisor to the clinic.
Poland Medical is open from 10am until 6.30pm on Sundays. Appointments can be arranged on other days by prior arrangement via the West London clinic. The provider is not required to offer an out of hours service or emergency care. Patients who require emergency medical assistance or out of hours services are requested to contact NHS direct or attend the local accident and emergency department.
Our key findings were:
- Patients’ medical records that we viewed were handwritten, often illegible and of an inconsistent standard.
- Not all doctors had completed safeguarding training to the appropriate level.
- The system for sharing learning from significant events was not effective.
- The system for communicating and acting on patient safety alerts was not effective.
- There were very few formal meetings and no full practice meetings. This was considered by the service to be impractical, because the doctors worked on a sessional basis.
- There were no multi-disciplinary meetings.
- Staff were not supported by the provider in their clinical professional development.
- We did not see any evidence of clinical supervision.
- Doctors had completed training, but it was not always effective. For example, the doctors we spoke with were not aware of the provisions of the Mental Capacity Act (2005).
- Information about services, fees and how to complain was available.
- Not all risks to patients were assessed and monitored. For example, there were no infection control audits.
- Medicines and equipment for dealing with medical emergencies was available, but the systems for monitoring them were not always effective. For example, we found one medicine to be out of date.
- There was no system for the reconciliation of pathology results. We were told that results were sent directly to the patient from the laboratory, which meant that the clinic did not receive the results unless notified by the patient.
- There were limited formal governance arrangements.
- There was a broad range of policies and procedures, but individual documents were neither signed nor dated by the reviewer. The index was dated January 2015. We were told that policies and procedures were reviewed every three years.
- The health and safety policy, dated 2009, was overdue for review.
- The premises were visibly clean and tidy.
- A registered manager was in place, but they were not able to be on site on the day of the inspection.
We identified regulations that were not being met and the provider must:
- Ensure care and treatment is provided in a safe way to patients.
- Ensure that patients are protected from abuse and improper treatment.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
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 the emergency medicines held to ensure that they in line with the risks associated with the range of procedures carried out at the clinic.
- Review the system of managing communication with a patient’s NHS doctor.