Archived: Polmedics Limited - West Bromwich

Updated 18 April 2017

The inspection was carried out on 10 February 2017. Our inspection team was led by a CQC Lead Inspector and was supported by an Assistant Inspector, Inspection Manager, Deputy Chief Inspector of Primary Medical Services, GP Specialist Advisor, Leadership and Governance Specialist Advisor and an Enforcement Inspector. The team was also supported by a Polish translator.

Prior to this inspection, an announced inspection had been carried out at Polmedics Limited – Allison Street in Birmingham on 9 and 30 November 2016. On the 11 November 2016, the Commission served an urgent notice of decision to impose conditions upon the registration of this service provider in respect of a regulated activity. This notice of decision included the following condition:

• The registered person must not provide any services under the regulated activity of diagnostic and screening procedures, surgical procedures, maternity and midwifery and treatment of disease, disorder or injury until 11 January 2017.

Following the Commission’s decision to impose conditions upon Polmedics Limited – Allison Street, due to the serious concerns identified an unannounced focussed inspection was carried out at West Bromwich on 16 December 2016. Serious concerns were also found at Polmedics Limited – West Bromwich and on 16 December 2016, the Commission served an urgent notice of decision to impose conditions upon the registration of this service provider in respect of a regulated activity. This notice of decision included the following condition:

• The registered person must not provide any services under the regulated activity of diagnostic and screening procedures, surgical procedures, maternity and midwifery and treatment of disease, disorder or injury until 31 January 2017.

An unannounced focussed inspection was carried out at Polmedics Limited – Rugby on 17 December 2016 and serious concerns were found.

On the 19 December 2016, the provider took actions to temporarily close all Polmedics Ltd locations which included Polmedics Limited until 31 January 2017. This action negated the requirement for CQC to take urgent enforcement action as patient groups in relation to whom we had major safety concerns had their safety risks addressed by Polmedics Ltd suspending their services.

Following the actions taken by the provider to temporarily close all locations, we were informed by the provider of their intent to re-open locations with the exception of Polmedics Limited – Redditch and Polmedics Limited – Allison Street prior to the 31 January 2017 due to the provider confirming these locations were compliant with the Commissions fundamental standards.

During our visit on 10 February 2017 we:

• Used information gathered following inspections of three locations carried out during November and December 2016 to inform our inspection.

• We inspected the provider’s administrative head office in Rugby on 10 February 2017.

• We interviewed the board of directors, the nominated individual and two managers who were employed at the Ealing and Rugby locations.

• Additional inspection teams carried out unannounced focused inspections of Polmedics Limited – Bristol and Polmedics Limited – Wellingborough on 10 February 2017. (Separate inspection reports have been published for these inspections).

• We conducted a tour of the premises.

• We reviewed a range of information which included policies and procedures, patient care records and staff recruitment and training records. We also looked at the electronic appointments system.

• We did not speak to patients during our inspection.

• Following our inspections we spoke with other stakeholders such as NHS England and the General Medical Council about our concerns.

Updated 18 April 2017

We carried out an announced inspection on 10 February 2017 of Polmedics Ltd (the provider) at their administrative head office located at 36 Regent Place, Rugby CV21 2PN. (We were informed by the provider that all governance and management systems in place were located at this address in Rugby and not the provider address registered with the Commission which is located in Wellingborough. We obtained verbal and written consent from the provider to carry out this inspection at their administrative head office in Rugby).

At the same time, we also carried out unannounced focused inspections of Polmedics Limited – Bristol and Polmedics Limited - Wellingborough on 10 February 2017.

These inspections were carried out due to concerns raised following a series of inspections carried out at Polmedics Limited - Allison Street, Birmingham on 9 & 30 November 2016, Polmedics Limited - West Bromwich on 16 December 2016 and Polmedics Limited - Rugby on 17 December 2016 identifying serious concerns linked to the provider’s lack of governance and infrastructure arrangements.

We inspected the provider to assess their governance and leadership arrangements in respect of these concerns, therefore it was not necessary to use all key lines of enquiry.

Our findings were:

Are services safe?

We found that the provider 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 Enforcement section at the end of this report).

Are services effective?

We found that the provider was not providing effective care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the Enforcement section at the end of this report).

Are services well-led?

We found that the provider 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 Enforcement section 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 provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Polmedics Ltd was established in 2013 and is an independent provider of dental and medical services including gynaecology, sexual health screening and other services such as consultation services which includes the diagnosis and treatment of disease and prescribing of medicines. Consultation services are provided by doctors who are referred to as internists and treats both adults and children. (At the time of our inspection, the provider confirmed that all medical services had been suspended voluntarily based on concerns found during the Commission’s inspections of three other locations during November and December 2016. It was the intention of the provider to recommence the provision of medical services in the near future).

Services are provided across seven locations in Birmingham, Bristol, Ealing, Redditch, Rugby, West Bromwich and Wellingborough primarily but not restricted to Polish patients who reside in the United Kingdom (UK). Services are available to people on a pre-bookable appointment basis and we were informed during our inspection that patients book appointments by contacting a call centre located in Poland. The provider advertise a variety of other additional services on their website such as cardiology, dermatology, midwifery, psychiatry, paediatric and orthopaedic services however, we were advised prior to our inspection that these additional services are no longer provided. The range of services advertised on the providers website differs at each location. We were informed by the provider that there are approximately 33,000 registered patients across all Polmedics Ltd locations.

Polmedics Ltd (the provider) is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The provider had not ensured that a registered manager was in place at each location. (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). At the time of our inspection, one of seven locations had a registered manager in place, registered manager applications were in progress for five locations.

We were told that the provider had made recent changes to staffing levels and confirmed that 50 members of staff were employed across all locations. The staffing structure included three directors (one director acted as company secretary and one director who is a dentist acted as medical director). We were told that recent changes had taken place within the board of directors, there were previously four directors in post however, we were verbally informed that one director was dismissed by the provider due to a referral being carried out to the General Dental Council (GDC) we were unable to see any documented evidence of the dismissal process followed during our inspection. Each director has a specific area of responsibility such as premises and maintenance management, appointments system and scheduling, IT and recruitment. The provider employed one nominated individual who carried out the role of operational manager to oversee the management of all seven locations. There is a finance and human resources department which we were informed is located on the ground floor of Polmedics - Allison Street, Birmingham consisting of four members of staff. We were informed of seven managers being in post, one at each location (some managers were still awaiting commencement of their post dependent upon either a DBS check being received or confirmation as a CQC registered manager being received). The provider also employed a number of dentists, trainee dental nurses and receptionists across all locations. Some clinicians including dentists working in the locations live in Poland and travel to England on a regular basis to carry out shifts at each location.

Our key findings were:

• There was an ineffective, governance framework in place to support the delivery of the strategy and good quality care. There was a lack of effective systems and processes in place for identifying, assessing and monitoring risks and the quality of the service provision across all locations.
• There was an ineffective leadership structure in place, there was a lack of suitably trained and experienced management support in place on a daily basis at each location and there was a lack of clinical leadership and oversight at both location and provider level.
• There was no process for ensuring that the board of directors were fit and proper persons to manage the service. This is a duty required by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Key documentation on the recruitment of individuals was missing from personnel files.
• The provider had not ensured that a registered manager was in place at each location. It is a requirement of registration with the Care Quality Commission where regulated activities are provided to have a registered manager in place.
• There was a lack of identification of risks and ineffective risk management processes in place at location and provider level to mitigate these through effective risk registers or appropriate discussion and acknowledgement of risk where highlighted by internal staff.

• The professional registration of clinical staff working at all locations were not all routinely checked at employment. The provider did not ensure that a system was in place within the organisation to ensure professional registration was routinely checked on an ongoing basis.
• The provider did not have an effective system or process within the organisation to ensure appropriate checks of current medical indemnity insurance had been carried out on all clinicians upon commencement of employment.
• There was not effective governance or monitoring processes in place to ensure that children and young people were safeguarded from abuse and improper treatment. The provider had not ensured a safeguarding lead was in place for each location. There was no policy in place in relation to female genital mutilation (FGM) and child sexual exploitation.
• There was poor quality monitoring of services in areas such as consent with clinicians having limited knowledge and understanding and not adhering to national guidance.
• The provider did not hold formal, structured, minuted meetings at either provider or location level. Meetings were either held informally or were ad-hoc. Staff we spoke with told us meetings at location level were not recorded.
• There was not an effective system in place for the reporting and investigation of incidents or lessons learned as a result. The provider did not have a process in place to ensure oversight of the reporting, recording and investigation of any incidents or significant events which may have either occurred or been reported across all locations.
• The provider had not ensured adequate arrangements were in place across all locations to respond to emergencies and major incidents as the provider had not acted upon all previous concerns raised in a timely manner during location inspections carried out during November and December 2016.

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

• Ensure an effective governance and leadership framework is in place to monitor the services provided and reduce the risk of harm.
• Ensure effective systems and processes are in place for identifying, assessing and monitoring risks and the quality of the service provision across all locations such as implementing a system of clinical audits and a system of clinical supervision/mentorship and clinical oversight for all clinical staff including trainee dental nurses. Ensure all clinical staff are competent to ensure the safety of patients using the service.
• Ensure appropriate systems are in place to properly assess and mitigate against risks including risks associated with infection prevention and control, legionella, managing emergency situations and premises and equipment.
• Ensure a review is undertaken of chaperone arrangements and that chaperone training is undertaken by staff who perform chaperone duties.

• Ensure arrangements to safeguard children and vulnerable adults from abuse reflect relevant legislation and local requirements.

• Ensure effective processes for timely reporting, recording, acting on and monitoring of significant events, incidents and near misses are in place across all locations.
• Ensure an effective process is in place to monitor patient care records so that patient information is recorded in line with the ‘Records Management Code of Practice for Health and Social Care 2016.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the provider is held.
• Ensure a registered manager is in place at each location. (It is a requirement of registration with the Care Quality Commission where regulated activities are provided to have a registered manager in place).
• Review processes in place in relation to clinicians medical indemnity insurance to show that appropriate checks of clinicians own insurance is carried out prior to commencement of employment.
• Ensure that staff taking consent have the appropriate knowledge, skills and competence. Ensure consent is sought from adults and children including those that are vulnerable in line with legislation and guidance.

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

• Ensure a system of appraisals is in place so all members of staff across the organisation receive an appraisal at least annually.

• Ensure appropriate policies and procedures are implemented, relevant to the organisation so all staff are aware of and understand them.

Enforcement action was taken against the provider on the 15 February 2017, when we issued an urgent notice of decision to immediately suspend their registration as a service provider (in respect of all regulated activities for which they are registered) for a period of six months. We took this action because we believed that a person would or might be exposed to the risk of harm if we did not take this action.