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Harmony Medical Diet Clinic in Wood Green Good

Inspection Summary


Overall summary & rating

Good

Updated 21 June 2021

This service is rated as

Good

overall. (Previous inspection November 2019 – Requires improvement)

We carried out an announced focused inspection at Harmony Medical Diet Clinic in Wood Green to follow up on breaches of regulations.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services well-led? – Good

We did not inspect caring and responsive services because our monitoring did not indicate a change since the last inspection. The ratings from the last inspection have been carried forward.

Are services caring? – Good

Are services responsive? – Good

CQC inspected the service on 12 November 2019 and asked the provider to make improvements regarding safe care and treatment and good governance. We checked these areas as part of this focused inspection and found they had been resolved.

Harmony Medical Diet Clinic provides weight loss services for adults, including the provision of medicines for the purposes of weight loss under the supervision of a doctor.

The doctor 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.

Our key findings were:

  • Clear protocols were in place to support safe prescribing
  • The doctors provided information and advice to support weight loss
  • There had been improvements in medicines management and in monitoring risks
  • The premises and equipment were safe
  • Arrangements were in place to support social distancing and staff followed infection prevention procedures

The areas where the provider should make improvements are:

  • Improve arrangements for access to medical records in the event that they cease trading
  • Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available

Dr Rosie Benneyworth BM BS BMedSci MRCGP


Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas

Safe

Good

Updated 21 June 2021

We rated safe as Good.

Safety systems and processes

The service had clear systems to keep people safe and safeguarded from abuse.

  • The provider conducted safety risk assessments. It had appropriate safety policies, which were regularly reviewed and communicated to staff including locums. They outlined clearly who to go to for further guidance. The service had systems to safeguard children and vulnerable adults from abuse.
  • The service was aware of how to contact other agencies to support patients and protect them from neglect and abuse.
  • The provider carried out staff checks at the time of recruitment and on an ongoing basis where appropriate. Disclosure and Barring Service (DBS) checks were undertaken where required. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

  • All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns.
  • The service did not routinely offer a chaperone service. They would employ a trained chaperone via an agency if required but had not needed to do so.
  • At the last inspection we found that the provider had not determined whether it was necessary to carry out legionella testing. This time a risk assessment had been carried out. There was an effective system to manage infection prevention and control.
  • At the last inspection the provider had not ensured that equipment was maintained according to manufacturers’ instructions. This time systems were in place to ensure that facilities and equipment were safe.
  • The provider carried out appropriate environmental risk assessments which took into account the profile of people using the service and those who may be accompanying them.

Risks to patients

There were systems to assess, monitor and manage risks to patient safety.

  • The service operates a walk-in service staffed by one doctor at each session. The two doctors working at the service could cover for each other.
  • The service had a COVID-19 standard operating procedure aimed at reducing infection risk for staff and patients. It covered use of PPE, social distancing, checking for COVID symptoms and cleaning between patients. When the pharmacy was busy patients were asked to wait outside until the doctor was free.
  • There was an effective induction system for agency staff tailored to their role.
  • The provider had assessed that the risk of a medical emergency was low and they did not hold a stock of emergency medicines. The doctors were trained in basic life support and the policy for dealing with an emergency included contacting the emergency services and keeping the patient safe within the competence of the doctor.
  • When there were changes to services or staff the service assessed and monitored the impact on safety.
  • There were appropriate indemnity arrangements in place

Information to deliver safe care and treatment

Staff had the information they needed to deliver safe care and treatment to patients.

  • At the last inspection we found that records would not be clear to other healthcare providers if they needed to be shared. At this inspection we found that individual care records were written and managed in a way that kept patients safe. The provider had recently updated their procedures to ensure that information needed to deliver safe care and treatment was available to relevant staff in an accessible way.
  • The service had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.
  • The service had a system in place to retain medical records securely but had not developed a plan for continued access in the event that they cease trading.
  • Although the service did not make direct referrals, patients were encouraged to see their GP if for example they were found to have high blood pressure.

Safe and appropriate use of medicines

The service had reliable systems for appropriate and safe handling of medicines.

  • At the last inspection we found that the systems and arrangements for managing medicines, including controlled drugs, did not minimise risks. At this inspection we found that improvements had been made in policies for handling medicines.
  • At the last inspection the service did not audit prescribing against current standards. This time we found that regular audits were carried out to ensure prescribing was in line with best practice guidelines for safe prescribing.
  • The service prescribed Schedule 3 controlled drugs (medicines that have the highest level of control due to their risk of misuse and dependence). At the last inspection we found that there was no policy governing duration of supply or frequency of review. At this inspection the policy had been updated and where there was a reason to supply enough for more than 30 days, for example to reduce the frequency of attendance during COVID-19 restrictions, this was clearly recorded
  • At the last inspection we found that staff did not adhere to national guidance on prescribing for weight loss. At this inspection improvements had been made. There was a clear policy in place, and staff prescribed medicines to patients and gave advice on medicines in line with legal requirements and current national guidance.
  • Patients were asked to provide identification if they weren’t obviously aged 18 or over.

  • Some of the medicines this service prescribes for weight loss are unlicensed. Treating patients with unlicensed medicines is higher risk than treating patients with licensed medicines, because unlicensed medicines may not have been assessed for safety, quality and efficacy. These medicines are no longer recommended by the National Institute for Health and Care Excellence (NICE) or the Royal College of Physicians for the treatment of obesity. The British National Formulary states that ‘Drug treatment should never be used as the sole element of treatment (for obesity) and should be used as part of an overall weight management plan’.

Track record on safety and incidents

The service had a good safety record.

  • There were comprehensive risk assessments in relation to safety issues.
  • At the last inspection the service did not monitor and review activity to understand risks. At this inspection activity was monitored and gave a clear, accurate and current picture that led to safety improvements.

Lessons learned and improvements made

The service learned and made improvements when things went wrong.

  • At the last inspection we found there was no clear system for handling significant events. This time a system for recording and acting significant events had been introduced. Staff understood their duty to raise concerns and report incidents and near misses. Leaders and managers supported them when they did so. Two incidents had been recorded since the last inspection and records showed that they were investigated and action taken.
  • There were adequate systems for reviewing and investigating when things went wrong. The service learned and shared lessons across all their locations and took action to improve safety in the service. For example following an incident, visors were made available at all locations for patients unable to wear a face mask.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The provider encouraged a culture of openness and honesty. The service had systems in place for knowing about notifiable safety incidents
  • When there were unexpected or unintended safety incidents:

    • The service gave affected people reasonable support, truthful information and a verbal apology. There were no examples of written apologies.
    • They kept written records of verbal interactions but there were no examples of written correspondence.

  • The service had a mechanism in place to receive patient and medicine safety alerts.

Effective

Good

Updated 21 June 2021

We rated effective as Good

Effective needs assessment, care and treatment

The provider had systems to keep clinicians up to date with current evidence based practice. We saw evidence that clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance (relevant to their service)

  • At the last inspection we found that the provider did not have a clear policy to define eligibility for treatment and was prescribing to patients with a body mass index below the minimum advised in national standards. At this inspection we found that the provider assessed needs and delivered care in line with relevant standards and prescribed weight loss medicines as part of a weight loss programme to patients who met defined criteria.
  • Patients’ immediate and ongoing needs were fully assessed. Where appropriate this included their clinical needs and their mental and physical wellbeing. Some patients were reluctant to be weighed at every visit, but the doctor ensured that their weight was recorded on a regular basis and waist circumference was also recorded when appropriate. For some patients an initial weight loss target was agreed rather than a final target.
  • We saw no evidence of discrimination when making care and treatment decisions.
  • A clear protocol was in place to deal with repeat patients. For example, when patients were unable to visit regularly during COVID-19 restrictions, medicines were only supplied when the doctor had sufficient up to date information to ensure it was safe to prescribe.

Monitoring care and treatment

The service was actively involved in quality improvement activity.

  • At the last inspection we found that the provider did not audit the quality of care. At this inspection processes were in place to audit record keeping, monitoring and safe prescribing and the service used information about care and treatment to make improvements. For example an audit of clinical records across two of the provider’s locations in March 2021 showed that 8 out of 20 patients refused to supply their GP contact details. The service displayed posters reminding patients of the benefits of up to date healthcare records and explained to patients that it was helpful to have the details in case of emergency. They intend to review the effectiveness of this approach after six months. The audit programme included a review of weight loss and there were plans to add further details to improve understanding of the effectiveness of treatment.

Effective staffing

Staff had the skills, knowledge and experience to carry out their roles.

  • All staff were appropriately qualified. The provider recruited staff through an agency and ensured they had completed the relevant training.
  • The doctors were registered with the General Medical Council and were up to date with revalidation
  • The provider understood the learning needs of staff and provided protected time and training to meet them. Up to date records of skills, qualifications and training were maintained. Staff were encouraged and given opportunities to develop.

Coordinating patient care and information sharing

Staff worked together, and worked well with other organisations, to deliver effective care and treatment.

  • Patients received coordinated and person-centred care. Staff did not make direct referrals but advised patients to contact their GP when needed for example when found to have high blood pressure.
  • Before providing treatment, doctors at the service ensured they had adequate knowledge of the patient’s health, any relevant test results and their medicines history. The patient completed a paper form which was scanned and filed. Although the original form was not readily accessible after filing, relevant information was transcribed on to the clinical record during the first consultation.
  • Doctors were aware of current General Medical Council guidance on information sharing. All patients were asked for consent to share details of their consultation and any medicines prescribed with their registered GP on each occasion they used the service, but few patients had provided GP contact details. The service had identified this through their audit programme and encouraged patients to provide GP details although none had consented to information sharing.

Supporting patients to live healthier lives

Staff were consistent and proactive in empowering patients, and supporting them to manage their own health and maximise their independence.

  • Where appropriate, staff gave people advice so they could self-care. New patients were given a leaflet and diet sheet and encouraged to exercise. Pictures of meal suggestions were available in the clinic.
  • Patients were informed about the risks and possible side effects of the medicines and given information on the best time to take them.
  • Where patients’ needs could not be met by the service, staff redirected them to the appropriate service for their needs.

Consent to care and treatment

The service obtained consent to care and treatment in line with legislation and guidance.

  • Staff understood the requirements of legislation and guidance when considering consent and decision making.
  • Staff supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.

Caring

Good

Updated 21 June 2021

Responsive

Good

Updated 21 June 2021

Well-led

Good

Updated 21 June 2021