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Inspection carried out on 14 August 2019

During a routine inspection

This service is rated as Good overall.

The service was previously inspected in September 2011 and January 2013 and found to be meeting the standards in place at the time. At an inspection in April 2018, inspectors found the provider had breached Regulation 12 (1) Safe Care and treatment because arrangements for premises hard wiring safety and fire safety were either not in place or not sufficiently effective, medicines and vaccines were not well managed and a number of blood sample bottles were out of date. A requirement notice was served in respect of this breach of regulation. The service was re-inspected in October 2018 to confirm the provider had taken actions to address the breach of regulations and had met the legal requirements.

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 Doctor Today on 14 August 2019 as part of our ratings inspection programme for independent health services.

Doctor Today is an independent health service based in the Finchley Road and Frognal area of North West London that provides patient consultations, treatment and referrals for adults and children. Dr Marissa Vassilliou is the registered manager and a partner doctor in the business. 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.

The provider supplies private general practitioner services predominantly to private fee-paying patients. The provider also provides services to staff employed by corporate clients.

We received 6 CQC comments cards. All comment cards were positive with patients referring to the high standard of care provided by knowledgeable and supportive staff.

Our key findings were:

  • The provider had systems in place to keep people safe and to review, act and learn from significant events. We reviewed examples where the provider had made contact with the patient’s NHS GP to pass on information that was clinically necessary with the patient’s consent. We were told that, when necessary to ensure patient safety, the service would contact the patients NHS GP without consent.
  • There were processes in place to effectively handle emergencies and risks were managed appropriately. Recruitment checks had been completed for the staff whose files we reviewed.
  • Systems were in place for the safe management of medicines and we saw the provider had processes in place to review prescribing.
  • Staff at the service assessed patients in accordance with best practice and current guidelines and had systems in place to monitor and improve the quality of care provided to patients.
  • There was evidence of effective joint working and sufficient staffing to meet the needs of their patient population.
  • Feedback indicated patients were treated with dignity and care and the service had systems to support patients to be involved with decisions about their care and treatment.

  • The service met the needs of their targeted patient demographic and there were systems in place for acting on feedback and complaints.
  • The service had adequate leadership and governance in place.
  • There was clear strategy and vision which was tailored to patient need and staff and patients were able to engage and feedback to the service provider.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 11 October 2018

During an inspection to make sure that the improvements required had been made

We carried out an announced focused inspection on 11 October 2018 to ask the service the following key question; Are services safe?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Background

Doctor Today is an independent health service based in the Finchley Road and Frognal area of North West London that provides patient consultations, treatment and referrals for adults and children. Dr Marissa Vassilliou is the registered manager and a partner doctor in the business. 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.

We carried out a previous announced comprehensive inspection at Doctor Today on 16 April 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. Overall, the service was providing care in accordance with relevant regulations except for some considerations relating to safe services and we found three areas where the provider should improve. The full comprehensive report on the 16 April 2018 inspection can be found by selecting the ‘all reports’ link for Doctor Today on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 October 2018 to assess whether the provider was meeting legal requirements and areas it should improve that we identified in our previous inspection. This report covers our findings in relation to improvements that have been made since our last inspection.

Overall we found that this service was providing care in accordance with the relevant regulations.

Our key findings were:

  • Arrangements were in place for fire and fixed wiring safety.
  • Medicines and blood sample bottles were fit for use and managed appropriately.
  • Nursing staff received appropriate clinical oversight and training, including quarterly consultation reviews, and wound care and immunisation training and updates. Nursing staff did not undertake patient’s cervical screening (“smear”) tests.
  • Communication and access arrangements were available for patients with sensory impairment or needing translation services, including a hearing loop and a telephone translation service.
  • Systems to ensure good governance were implemented and reviewed and there was a culture of continuous improvement, including from NHS services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 16 April 2018

During a routine inspection

We carried out an announced comprehensive inspection on 16 April 2018 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 not 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

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 service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Doctor Today is an independent health service based in the Finchley Road and Frognal area of North West London that provides patient consultations, treatment and referrals for adults and children. Dr Marissa Vassilliou is the registered manager and a partner doctor in the business. 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:

  • There were gaps in some safety arrangements that the service dealt with during or after our inspection, including medicines management, fire safety, and out of date blood sample bottles.
  • Systems were in place to protect people from avoidable harm and abuse. When mistakes occurred lessons were learned and action was taken to minimise the potential for reoccurrence. Staff understood their responsibilities under the duty of candour.
  • The service had arrangements in place to respond to medical emergencies.
  • The service implemented clinical governance systems and had put processes in place to ensure the quality of doctors and non-clinical service provision
  • Arrangements for oversight and verification of training for nursing staff were limited.
  • Staff we interviewed were aware of current evidence based guidance. Staff were qualified and had the skills and experience to deliver effective care and treatment.
  • The service’s patient survey information and patient feedback we received indicated that patients were very satisfied with the service they received.
  • Information about services and how to complain was available, lessons were learned and improvements made following complaints.
  • There was a clear leadership structure and staff felt supported by management and worked well together as a team.
  • There was a clear vision to provide a personalised, high quality service.

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

  • Ensure care and treatment is provided in a safe way to patients.

You can see full details of the regulations not being met at the end of this report.

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

  • Review and improve arrangements to ensure appropriate training and embedded clinical oversight of nursing staff.
  • Review and improve communication and access arrangements for patients with a sensory impairment or requiring translation services.
  • Review and improve systems to ensure good governance in accordance with the fundamental standards of care such as checking for gaps or weaknesses in existing systems and processes.

Inspection carried out on 28 January 2013

During a routine inspection

People who used the service told us they felt confident about using the service. People said " I felt my child was in safe hands, they (the doctors) answered my questions, were very thorough and I felt they knew what they were doing".

Staff were friendly but discreet when greeting people or handling telephone enquiries to ensure confidentiality. All consultations and treatments were held in private rooms.The rooms were clean, well equipped and maintained.

People needs were assessed and fully documented. Proposed tests and treatment were discussed with people and information was provided to allow people to make informed choices. With peoples agreement their general practitioners were kept informed of tests and treatment to ensure continuity of care.

Staff were qualified and trained to provide safe care. They were trained to recognise and respond appropriately to safeguarding concerns. The quality of the service was monitored through the use of audits and peoples feedback.

Reports under our old system of regulation (including those from before CQC was created)