Broadgate Spine & Joint Clinic Limited

This service is rated as Good overall. Previous inspection 17 January 2019, when we found the provider was meeting the relevant standards.

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

Broadgate Spine & Joint Clinic Limited (the provider) offers private general practice appointments, including blood tests; dietary advice; psychiatric support; flu vaccinations; travel clinic, providing travel vaccinations; sexual health, such as pregnancy and sexually transmitted disease testing; and health screening including cervical and breast cancer screening. Services are provided only to adults, aged over 18 years.

We last inspected the service in January 2019, using our previous methodology. We found the provider was meeting the requirements of regulations, but we did not apply a rating. We carried out this announced comprehensive inspection on 30 September 2019, as part of our current inspection programme, to apply a rating.

Our key findings were:

• The provider had good systems to manage risk so that safety incidents were less likely to happen. There were processes in place to ensure when incidents did occur they were investigated and learned from.
• Patients could access care and treatment from the provider within an appropriate timescale to meet their needs. Patients received coordinated and person-centred care.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• The provider had implemented appropriate policies for safeguarding of vulnerable adults and children, and all staff had received up-to-date safeguarding training appropriate to their role.
• Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention.
• We saw no evidence of discrimination when making care and treatment decisions.

We received feedback from 50 patients using the service. Patients were consistently positive about the service they received, telling us that: they found it easy to access care, all staff treated them with dignity and respect and they felt involved in all decisions about their care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive follow-up inspection on 17 January 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, in respect of issues we found at the previous inspection.

CQC inspected the service on 18 October 2018 and as a result asked the provider to make improvements regarding the following issues: there were no policies for safeguarding of vulnerable children and adults, or infection prevention and control; not all staff had received up to date safeguarding training and no guidance or training had been given to identify the signs of sepsis and to inform staff of appropriate action to take in cases where sepsis was suspected; There were no risk assessments in respect of general health and safety at the premises, staff workstations and emergency medicines; no adequate infection prevention and control protocols and no adequate infection prevention and control audit had been undertaken within the last 12 months; there was no written guidance on sharps injuries; patients were not informed of the availability of chaperones; there was no locum handbook, to provide locums with information about the service and its policies and procedures; there was limited evidence of quality improvement activities within the last 12 months, such as clinical audits; there was a lack of systems in place to monitor and improve the quality and safety of the services or to identify and mitigate risks to people’s health safety and welfare; administrative staff had not received appraisals for several years; the provider had not established a full range of written governance policies or consistently reviewed and updated its existing policies; there was no business continuity plan in place.

We issued requirement notices for breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We checked these areas as part of this comprehensive inspection and found the service had resolved most issues and was working on those remaining.

Broadgate Spine & Joint Clinic Limited provides private general practice appointments, including blood tests; dietary advice; psychiatric support; flu vaccinations; travel clinic, providing travel vaccinations; sexual health, such as pregnancy and sexually transmitted disease testing; and health screening including cervical and breast cancer screening. Services are provided only to adults, aged over 18 years.

We received feedback from 42 patients using the service. Patients were consistently positive about the service they received, telling us that: they found it easy to access care, all staff treated them with dignity and respect and they felt involved in all decisions about their care.

Our key findings were:

• The service had implemented appropriate policies for safeguarding of vulnerable adults and children, and all staff had received up-to-date safeguarding training appropriate to their role.
• Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. They knew how to identify and manage patients with severe infections, for example sepsis.
• Patients received coordinated and person-centred care. Staff referred to, and communicated effectively with, other services when appropriate, for example when referring patients to specialist services.
• The service had a hearing loop in the reception area to assist patients with a hearing impairment.
• Waiting times, delays and cancellations were minimal and managed appropriately.
• We saw no evidence of discrimination when making care and treatment decisions.
• Leaders at all levels were visible and approachable. They worked closely with staff and others to make sure they prioritised compassionate and inclusive leadership.
• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.

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

• Revise the practice business continuity plan to ensure it includes all relevant contact details.
• Display sharps injury guidance in the clinical rooms for the benefit of any staff who may suffer such an injury.
• Ensure all staff are supported by a programme of regular appraisals.
• Introduce regular staff meetings and record meetings for the benefit of learning and sharing of decisions and information to all staff.
• Carry out a suitable premises health and safety risk assessment detailing any issues and rectification needed with review and completion dates.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice