Cleveland Clinic London Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service provided excellent care and treatment, delivered by highly trained, professional staff who undertook specialist development. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available flexibly and at short notice.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, and wellbeing needs with them. Feedback from people using the service was positive and they felt involved in assessments of their needs. Patients felt confident that staff understood their individual circumstances, such as relating to the impact of travel, work, and lifestyle.

Reception staff were aware of the needs of patients and were trained to respond discreetly to potential risk. They used digital flags in the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews.

GPs used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to specialist services.

GPs assessed needs on an individual basis and depending on whether they were seeing a patient for a one-off review or as part of ongoing care. They worked closely with specialists to ensure planned care was complementary to other treatment underway. The team had access to services in the provider such as pain management, stoma care, and physical therapy. Processes were in place to refer patients to mental health and psychiatry services with another provider.

The provider had carried out a case study looking at how they assess people with opioid addiction so they could receive support. This was a Multidisciplinary Team approach led by the clinical teams and managed via outpatients and especially the GP service. The MDT approach was crucial in supporting the patient throughout the opioid weaning process.

Care and treatment were based on the most up to date national and international guidance. Governance structures, staff training, and policies were underpinned with a continuous understanding of changes to practice from key organisations such as the National Institute for Health and Care Excellence (NICE) and the Medicines and Healthcare products Regulatory Agency (MHRA). The primary care chairperson reviewed updates to guidance issued by NICE and MHRA weekly with patient safety colleagues and applied them to internal policies.

Each GP undertook an annual continuing professional development (CPD) study week for an area of clinical and professional interest to them. This was in additional to scheduled training days throughout the year and a weekly medical education case discussion.

Each GP had a clinical specialism and based their CPD on this. Specialisms included women’s health, men’s health, mental health, skin care, functional medicine, and palliative care. The team worked closely with consultants and other professionals in the hospital to coordinate care for patients with complex needs and comorbidities.

Staff monitored internal standards of care through a programme of 10 quarterly, bi-annual, and annual audits common to each of the provider’s London locations.

Policies, standard operating procedures (SOPs), training, and staff practices were based on up-to-date guidance from professional bodies and organisations including the Royal College of General Practitioners (RCGP).

The senior team recognised the need for greater benchmarking in the independent sector as a tool to measure patient outcomes and identify good practice as well as areas for improvement. The GP service contributed data to the Private Healthcare Information Network (PHIN) in relation to standards of care and patient outcomes. PHIN is an independent organisation, mandated by the government, that collects data from the private sector to monitor patient care.

In addition to improve greater benchmarking, the GP service introduced an audit of Controlled Drug prescribing. The audit was shared across the whole of the Cleveland Clinic organisation and adopted as a standard benchmark. The provider sent us a case study to evidence this.

GPs worked effectively across teams and services to support people. They made sure patients only needed to tell their story once by sharing their assessment of needs when they move between different services. The provider’s digital communication and records platform facilitated this and enabled GPs to order tests and access results easily with other teams.

GP services were integrated into the hospital’s wider medical care provision and doctors referred patients to consultants and diagnostic imaging. Some health screens included a CT (computed tomography) or MRI (magnetic resonance imaging) scan and GPs worked with radiologists to make sure the scan was appropriate for individual needs.

Staff had access to an electronic patient records system shared with NHS services and GPs nationally. This enabled staff to access comprehensive medical histories and provided onward information where patients remained under the long term care of other specialists across different health systems.

Multidisciplinary working was embedded throughout the service and provided expanded access by incorporating seamless care between all 3 London locations. Staff convened multidisciplinary meetings across clinical specialties and departments, which enabled staff to effectively review patients with complex needs.

The service had service level agreements (SLAs) in place with other providers in the event a patient could not be treated in the primary care setting. This included a rapid referral process to an oncology provider and a similar process to refer patients experiencing poor mental health. We saw evidence the SLAs were effective for supporting patients, and staff could refer them quickly, including on the same day.

All patients had access to MyChart, a secure online health management tool that enables patients to:

Manage appointments
Communicate with the medical team regarding non-urgent concerns like medical questions, prescription queries, test results, and visit follow-ups.
Access health information including viewing medical records, past visit summaries, and available test results.
Visit a doctor virtually from home through video consultations.

GPs supported people to manage their health and wellbeing so they could maximise their health outcomes, choice, and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

GPs provided travel advice and immunisations in line with the latest government guidance, including in relation to yellow fever. The team undertook travel medicine training to ensure they were up to date with the latest requirements.

The team provided ad-hoc lifestyle advice, including fitness, cholesterol management, nutrition, weight loss, and smoking cessation during assessments. The service provided ongoing care and support for the management of diabetes, high blood pressure, chronic obstructive pulmonary disease (COPD), heart disease and digestive disorders.

The GP team offered a dedicated women’s health service. Targeted at specific stages of life, GPs with specialist training offered breast and gynaecological exams, cervical smear tests and HPV vaccines. They also provided menopause support and guidance and a fast referral service to another provider that offered mammograms, breast ultrasound, and bone density scanning.

As part of health promotion and long-term health improvement support, the GP service offered sexual health screening, prostate checks, and infertility care. The team had implemented such services to meet increased demand from patients.

The service routinely monitored people’s care and treatment to continuously improve it. GPs facilitated positive, consistent outcomes that met both clinical expectations and the expectations of people themselves.

Patient outcomes in the GP service focused on patient-defined outcome measures (PROMS). GPs provided care to patients presenting with a wide range of clinical needs. They provided care and treatment during a single assessment and offered patients onward referral or repeat appointments based on individual needs. GPs were integrated with the wider outpatient service and supported multidisciplinary treatment plans, such as long term care for post-operative patients.

Staff used audits to measure outcomes. For example, in the previous 12 months the service achieved 100% compliance with a monthly pain audit and 96% compliance with a quarterly documentation audit. The results were specific to this location and shared with the outpatient department.

The provider had a clear focus on staff development as a strategy to drive continuous improvement in patient outcomes. This was reflected in the extent of CPD undertaken by the GP team. For example, GPs took part in hospital ‘grand rounds’. Grand rounds are multidisciplinary educational sessions in which a wide range of staff discuss a clinical case and identify best practices. Most recently these had included the management of endometriosis and a session on types of polio and vaccine management.

Staff valued patient-defined outcomes highly and sought feedback regularly to measure each person’s satisfaction with the outcome of their care and treatment. In the previous 12 months, 100% of patients seen at this location said they were satisfied with their experience.

GPs made sure people knew their rights around consent and respected them when delivering person-centred care and treatment.

Consent processes were tailored to the type of appointment. For example, corporate health checks were often a mandatory condition of an individual’s employment, and the GP was required to complete a minimum set of tests. They made sure the patient understood the tests included and provided the opportunity to opt-out at any time. This ensured GPs maintained professional separation from each patient’s employment contract, enabling them to focus on clinical care. For self-referring patients, GPs obtained consent at the beginning of each session and whenever a test or examination was required.

We saw the consent process in practice during our onsite assessment. Staff gave patients time and space to ask questions and made sure they fully understood their planned treatment.

The provider’s minor operations policy required staff and patients to countersign an electronic consent form before treatment proceeded. Staff discussed the potential risks of treatment and made sure patients understood how they could support their own recovery afterwards.

Where GPs also worked in NHS practice, they did not see patients in this private setting who were registered with them elsewhere. This avoided a conflict of interest for patients seeking treatment in more than 1 location.