Archived: BPAS - Plymouth

Updated 6 December 2016

The British Pregnancy Advisory Service (BPAS) is a not-for-profit organisation formed in 1968. It has 44 registered locations and 21 satellite units across the UK. BPAS Plymouth is contracted to provide a Termination of Pregnancy service for the women of Plymouth and the surrounding area. The service is commissioned by three local clinical commissioning groups.

BPAS Plymouth provides a service at one site, the Local Care Centre, Mount Gould Hospital.

All initial visits, consultations and early medical terminations of pregnancy up to 10 weeks gestation take place at the BPAS Plymouth clinic. The clinics are held within the outpatient’s clinic area, on Wednesday and Friday evenings (4pm to 8pm) and Saturday mornings (9am to 2pm).

In the 12 months from1 January to 31 December 2015, the service completed 199 early medical abortions. Surgical abortions had been provided but had ceased at this service from January 2016 . The regulated activity of surgical procedures has since been removed from the location registration.

The registered manager for this centre was registered with the Care Quality Commission (CQC) since 2013 for BPAS Plymouth and is also the registered manager for another BPAS location.

We carried out this comprehensive inspection as part of the first wave of inspection of services providing a termination of pregnancy service. The inspection was conducted using the Care Quality Commission’s new methodology. We have not provided ratings for this service. We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities which it provides.

Updated 6 December 2016

British Pregnancy Advisory Service (BPAS) Plymouth provides a termination of pregnancy service within the outpatient department of the Local Care Centre, Mount Gould Hospital, Plymouth. This is a rented space from the current providers. Local Care Centre, Mount Gould Hospital, Plymouth

The service at BPAS Plymouth is commissioned by three local clinical commissioning groups.

BPAS Plymouth provides a range of termination of pregnancy services including :

Pregnancy testing, unplanned pregnancy counselling/consultation, early medical abortion, abortion aftercare, miscarriage management referral, sexually transmitted infection testing and contraceptive advice and contraception supply.

We carried out this comprehensive inspection as part of the first wave of inspection of services providing a termination of pregnancy service. The inspection was conducted using the Care Quality Commission’s new methodology. We have not provided ratings for this service. We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities which it provides

The inspection team comprised of two inspectors. The inspection took place on 3 May 2016.

Our key findings were as follows:

Are services safe at this service

• Staff were encouraged and supported to report incidents. Incidents were investigated and the learning, including learning from incidents at other BPAS locations, was shared with the staff. Staff were aware of their responsibilities under the duty of candour.

• The environment was visibly clean, staff followed BPAS infection control procedures and infection control rates were low.

• Medicines were appropriately managed to ensure they were safe to use. Drugs to induce abortion were appropriately prescribed by a doctor for women undergoing early medical abortion. Systems were in place to ensure the correct ordering and monitoring of stock.

• Patients’ records were completed, legible, up to date and stored securely. Accurate record keeping was monitored through audits.

• There were sufficient numbers of suitably trained staff available to care for patients.

• Safeguarding procedures were in place to protect both vulnerable adults and children from harm.

• Processes had been put in place to promote the safety and wellbeing of patients including eligibility criteria and risk assessments.

Are services effective at this service

• Patients had their needs assessed, and care planned and delivered, in line with evidence based guidance and recommendations, including Department of Health Standard Operating Procedures and professional guidance. Pain management was considered and action taken to ensure patients were comfortable.

• BPAS has a planned programme of monitoring with audit outcomes fed back to staff to promote good practice, develop skills, or address areas of poor practice.

• BPAS has competency training in place to support the development of staff. Staff received regular supervision and appraisals.

• Multidisciplinary working was undertaken with GPs involved when possible and pathways to transfer patients in place.

• Patients had access to information to inform their decisions and were provided with reference material. Contact was available out of hours by a telephone helpline for any further questions.

• Consent was obtained from the patient at each stage of the treatment and recorded in the patient’s record. Staff were clear about their roles and responsibilities to ensure patients with limited capacity or understanding were managed correctly and in line with best practice.

Are services caring at this service

• We saw patients were treated with compassion, kindness, dignity and respect. Patients and those attending with them were treated with respect and consideration.

• Staff respected patient confidentiality and ensured patients’ dignity was maintained.

• Patients’ beliefs and faiths were respected and their choices supported.

Are services responsive at this service

• The service was planned and delivered to meet patients’ needs. Patients could access the service within a short timescale and were given options to attend alternative clinics. This included a fast track appointment system to prioritise patients with a higher gestational age and more complex needs or circumstances. The service monitored its performance against the waiting time guidelines set by the Department of Health.

• The service took into account patients’ specific needs to support them through the treatment including patients with complex needs. Staff recognised patients’ personal, cultural, social and religious needs.

• Patients’ complaints were listened and responded to. Learning was taken from complaints and used by staff to reflect and change their practice.

However :

• BPAS should advise patients’ that staff only provide impartial, non-directive advice and are trained as counsellors but not to a Diploma level. If therapeutic counselling is required, BPAS will refer patients on to external services with appropriately trained pregnancy counsellors.
• The provider should audit those patients who exceed the 10 working days to treatment to evidence patient choice.

Are services well led at this service

• Staff followed the vision for the service by treating all patients with dignity and respect in a non-judgemental way. The development strategy for this service was on-going.

• There was an established governance structure at both national, regional and local level to manage risk and quality including an established process for sharing learning.

• Staff spoke positively about how they enjoyed their work and felt a strong sense of family and teamwork.

• Public and staff engagement was encouraged to develop the service provided.

However, there were also areas of where the provider needs to make improvements.

The provider should:

• BPAS should advise patients’ that staff only provide impartial, non-directive advice and are trained as counsellors but not to a Diploma level. If therapeutic counselling is required, BPAS will refer patients on to external services with appropriately trained pregnancy counsellors.
• The provider should audit those patients who exceed the 10 working days to treatment to evidence patient choice.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 6 December 2016

• The termination of pregnancy service at BPAS Plymouth followed procedures to provide safe care for patients. The environment was visibly clean, staff followed BPAS infection control procedures. Incidents were investigated and the learning, including learning from incidents at other BPAS locations, was shared with the staff. Medicines were managed and used safely. There were sufficient numbers of suitably trained staff available to care for patients. Safeguarding procedures were in place to protect both vulnerable adults and children from harm.

• There were appropriate procedures to provide effective care. Patients had their needs assessed and care planned and delivered in line with evidence based guidance and recommendations. Pain management was considered and action taken to ensure patients were comfortable. BPAS has a planned programme of monitoring. Audit outcomes were feedback to staff to promote good practice. Staff received regular supervision and appraisals. Multidisciplinary working was undertaken with GPs involved when possible and pathways to transfer patients in place. Consent was obtained from the patient at each stage of the treatment.

• The service provided was caring and compassionate. Staff respected patient confidentiality and ensured patients dignity was maintained. The patient’s beliefs and faiths were respected and their choices supported. Patients were provided with appropriate and timely support and information to cope emotionally with their care and treatment.

• The service is planned and delivered to be responsive to patient’s needs. Patients could access the service within a short timescale. This included a fast track appointment system to prioritise patients with a higher gestational age and more complex needs or circumstances. The service takes into account the different needs of people to support them through the treatment. Patient’s complaints were listened and responded to.

• However : BPAS advise patients’ that staff only provide impartial, non-directive advice and are trained as counsellors but not to a Diploma level. If therapeutic counselling is required, BPAS will refer patients on to external services with appropriately trained pregnancy counsellors. The provider should also audit those patients who exceed the 10 working days to treatment to evidence patient choice.

• The service provided was well led. Staff followed the vision for the service by treating all patients with dignity and respect in a non-judgemental way. There was an established governance structure at national, regional and local level to manage risk and quality including an audit programme, and an established process for sharing learning. Staff spoke positively about how they enjoyed their work and felt a strong sense of family and teamwork. Public and staff engagement was encouraged to develop the service provided.