Northern Circumcision Clinic-Billingham

This service is rated as Good overall. The location was last inspected in December 2018 and was not rated at that time.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Northern Circumcision Clinic – Billingham as part of our inspection programme.

CQC had inspected the service on 12 December 2018, and whilst breaches of regulations were not identified, we asked the provider to make improvements and to:

• Review mandatory training needs and ensure staff received appropriate training as required.
• Review and improve the content and level of depth of the service health and safety risk assessments.

We checked these areas as part of this comprehensive inspection and found these issues had been resolved.

The service provided circumcisions to those under 18 years of age for both medical and cultural and religious reasons under local anaesthetic. The service also carried out post procedural reviews of patients who had undergone circumcision at the clinic.

One of the directors of the service 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.

How we inspected this service

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

During our inspection we:

• Looked at the systems in place relating to safety and governance of the service.

• Viewed key policies and procedures.

• Reviewed clinical records.

• Interviewed the lead clinician both by telephone and face to face.

• Received written feedback from staff.

• received and reviewed CQC comment cards completed by families of children who had used the service.

To get to the heart of patients’ experiences of care and treatment, we asked the following questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive?
• Is it well-led?

These questions formed the framework for the areas we looked at during the inspection.

Note: Within the report where we make reference to a parent or parents this also includes those who act as a legal guardian or legal guardians of an infant or child.

Our key findings were:

• Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
• There were systems, processes and practices in place to safeguard patients from abuse. We saw staff had received safeguarding training appropriate to their roles.
• The service had procedures in place regarding consent, and when required the formal identification of those with parental responsibility.
• The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
• The clinical and non-clinical facilities used in the host GP location were clean and well maintained.
• The service had developed materials for parents/service users which explained the procedure and clearly outlined the recovery process. This included information which had been translated into four languages. Information was also communicated to the GP of the patient after the procedure had been undertaken via letter.
• The service operated a 24-hour advice line which allowed service users to contact them with any concerns post-procedure.
• Patient records were detailed and noted important information such as details of anaesthesia used, including batch numbers and quantities administered. At the time of inspection batch numbers of circumcision devices used were not being recorded by the provider. However, we were sent evidence to show that immediately after the inspection the service had introduced the recording of batch numbers of devices.
• Quality improvement activity was undertaken by the service including clinical audit, and via the investigation of significant events and complaints.
• Staff performance monitoring was undertaken, and we saw that appraisals had been undertaken. We also heard that staff communication was effective and saw that meetings and debriefings were being held.
• The service sought feedback from a proportion of service users via a satisfaction survey. Feedback for the clinic showed high satisfaction rates. CQC service user comment cards also showed high satisfaction rates.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care