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Inspection carried out on 15 June 2016 and 24 June 2016

During a routine inspection

British Pregnancy Advisory Service (BPAS) provides a medical and surgical termination of pregnancy service in Milton Keynes and Northampton.

BPAS Milton Keynes has contracts with clinical commissioning groups (CCGs) to provide a range of termination of pregnancy (TOP) services for patients of the Milton Keynes, Buckinghamshire, Bedfordshire, Oxfordshire and Northamptonshire area. This includes pregnancy testing, unplanned pregnancy counselling, early medical abortion, early surgical abortion, abortion aftercare, sexually transmitted infection testing and treatment, contraceptive advice and contraception supply.

Most patients are funded by the NHS, whilst some patients choose to pay for services themselves.

The Care Quality Commission (CQC) carried out an announced comprehensive inspection at the British Pregnancy Advisory Service (BPAS) Milton Keynes on 15 June 2016. We undertook an unannounced inspection of the satellite site at Northampton on 24 June 2016. These sites were inspected as part of a wider programme to inspect providers of acute independent healthcare. Our role is to ensure that people receive safe, compassionate and high-quality care. Although we do not currently have the powers to rate these services, we report on whether they are safe, effective, caring, responsive to people's needs and well led. We highlight areas of good practice and areas for improvement.

We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities which it provides.

Our key findings across all the areas we inspected were as follows:

Are services safe at this service?

  • Incidents and risks were reported and managed appropriately. Lessons learnt were communicated widely to support improvement in service delivery.
  • Staff complied with best practice with regard to cleanliness and infection control. Service cleanliness audit results were consistently high.
  • Equipment was maintained and checked regularly to ensure it was fit for purpose.
  • Medicines were generally stored and prescribed safely. If a doctor was not on site, prescription charts were signed remotely by doctors working at other BPAS sites. Nurses were trained to prescribe antibiotics, pain-relief medications and contraception under patient group directions (PGDs).
  • Nursing and medical staffing levels were sufficient and appropriate to meet the needs of patients.
  • Comprehensive risk assessments were carried out for people who used services and risk management plans were developed in line with national guidance.
  • There was a procedure in place to deal with a patient who may deteriorate.
  • Safeguarding vulnerable adults, children and young people was a priority for the organisation.
  • The clinic had a business continuity plan in the event of emergencies and staff were trained in how to respond to major incidents.

Are services effective at this service?

  • Policies were accessible to staff. Care was provided in line with national and statutory guidelines.
  • Patients were prescribed appropriate pain relief, prophylactic (preventative) antibiotics and contraception.
  • The clinic performed audits recommended by the Royal College of Obstetricians and Gynaecologists (RCOG) such as, infection control, consent to treatment, discussions about options for abortion and contraception.
  • All staff were appropriately trained and competent to carry out their roles safely and effectively, in line with best practice.
  • Pre and post-abortion counselling was provided.
  • A telephone advice line was available to patients 24 hours a day, seven days a week.
  • Collaborative working with external agencies, such as the local safeguarding team and drug and alcohol addiction services, were in place to meet the needs of vulnerable patients.
  • Service level agreements with neighbouring trusts were in place, which enabled the timely transfer of a patient to the local hospital in the event of a medical or surgical emergency.
  • Consent was gained in line with Department of Health guidelines. Written consent to treatment was obtained in all cases.

Are services caring at this service?

  • Staff treated patients with compassion, kindness, dignity and respect.
  • Staff adopted a non-directive, non-judgemental and supportive approach to patients receiving treatment for abortion.
  • All consultations were held in private rooms to maintain patients’ dignity and privacy.
  • The care co-ordinator met with all patients on their own to establish that the patient had not been pressured to make a decision against their will.
  • Patients who were undecided were given time to make a decision and there were processes in place to refer patients to other agencies who had changed their minds.

  • Patients’ preferences for sharing information with their partner or family members were established, respected and reviewed throughout their care.
  • All patients considering a termination of pregnancy were offered counselling at every stage of the care pathway. Post-abortion counselling was also provided.

Are services responsive at this service?

  • Services were planned and delivered in a way that met the needs of the local population. The importance of flexibility, choice and continuity of care was reflected in the services provided.
  • Patients could book appointments through the national BPAS appointment line, which was open 24 hours a day, seven days a week.
  • Patients who were not suitable for treatment at BPAS were referred to a specialist placement team. This was a seven day service. Patients were referred to the most appropriate private or NHS provider to ensure patients received treatment in a timely and safe way.
  • From January 2015 and December 2015, over 83% of patients had been treated below 10 weeks gestation. This is significantly better than the national average.
  • Interpreting and counselling services were available to all patients and the clinic was accessible to those with a mobility disability.
  • There was a range of information that nursing staff and care co-ordinators could give to patients as needed. This information could be requested in different languages if required.
  • There were effective systems in place for managing complaints and lessons learned were shared throughout the service and wider organisation.

Is this a well led service?

  • The BPAS organisation had a clear vision and values, which were driven by quality and safety.
  • There was strong leadership of the service and senior management was visible and held a regular presence in the clinic.

  • Staff felt well supported by senior managers and were confident to raise concerns.
  • Staff spoke positively about the high quality and services they provided for patients and were proud to work for BPAS.
  • There was an effective governance structure in place to manage risk and improve quality.
  • Risk management arrangements were in place to make sure that the certificate(s) of opinion, HSA1, were signed by two medical practitioners in line with statutory requirements.
  • Patient engagement was encouraged and the results were feedback to staff, with a focus on shared learning. The satisfaction surveys showed high patient satisfaction with care.
  • There was a focus on continued learning and development within the clinic.

We saw several areas of outstanding practice including:

  • Patients could be offered a provisional same day service, where they were booked on the same day for an appointment, assessment, ultrasound scan and treatment. This allowed patients to access the clinic and termination services quickly if required. Patients were assessed for their suitability for this service.

  • There was a clearly defined referral process for patients who required a specialist service. Such referrals were managed by a specialist referral placement team that operated a seven day service. Patients were referred to the most appropriate NHS provider to ensure they received treatment in a timely and safe way.

However, there were also areas where the provider needs to make improvements.

Action the clinic SHOULD take to improve:

  • Ensure staff are trained in the duty of candour and are aware of their responsibilities to be open and honest with patients when things go wrong.
  • Staff should avoid wearing clean theatre attire in public areas as this may draw attention to the clinic and could compromise patient confidentiality.
  • The treatment room should be soundproofed to ensure that patients undergoing surgical termination of pregnancy cannot be overheard by other patients and members of the public.
  • The keys to the medicine cupboards should be stored separately from other clinic keys and should not be accessible to unauthorised members of staff.
  • Intravenous fluids (IV) should be stored in line with national guidance for prescription only medicines.
  • All pre-prepared injections should be labelled in line with the National Patient Safety Agency (NPSA) guidelines.
  • The surgical safety checklist should include a numerical swab count to enhance current safety measures in place, to prevent a swab being unintentionally retained following surgical treatment.
  • Ensure all entrances to the clinic are secure to reduce the risk of unauthorised persons gaining entry to the clinic.
  • Ensure the complaints folder is stored in a locked cupboard to maintain patient confidentiality.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 29 January 2014

During a routine inspection

We were unable to speak with people at the time of inspection but we looked at the feedback given by people who received treatment that day. All the feedback we saw was positive, they all said that they had discussed their treatment options and found the information provided to be helpful.

We found that British Pregnancy Advisory Service (BPAS) Milton Keynes provided information and support for people making decisions about their pregnancies. The treatment options were explained and people had time to think about their options and gave informed consent for the procedures.

We saw that people had been assessed for risks and management plans were in place to reduce their risks. There were systems in place to ensure that people were protected from the risks of infections. The provider had processes in place to manage the risks associated with the management of medicines.

Staff received training that improved their knowledge and skills. Staff received supervision and appraisals which supported them in their role.

Inspection carried out on 6 February 2013

During a routine inspection

We saw completed surveys from people that used the service which provided positive comments about the service.

We found that the service was very well organised and treated people with respect and dignity. We found that the clinicians had comprehensive training and they received close supervision and support.

Inspection carried out on 22 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.