Archived: Well-One Clinic

Updated 5 July 2021

Well-One Clinic, Jacobs Well Yard, Swinemoor Lane, Beverley, HU17 0JX is an independent provider of medical services. The provider provides a fee-paying service consisting of consultations and treatment for a range of conditions; mainly Lyme disease. The service has a website where people can access information, www.welloneclinic.org.uk. Services are available to people (from toddler age upwards) on a pre-bookable appointment basis. The service is based in a single-story building and consists of a reception, waiting area, consultation room and two RIFE treatment rooms.

The clinic team consists of one GP (CQC registered manager), a practice manager and up to five volunteers who act in both an administrative and patient facing role. During the inspection we engaged (face-to-face and electronically) with the GP, practice manager, four volunteers and five patients. We looked at practice policies and procedures and other records about how the service is managed.

The clinic is open 9am to 5pm on a Monday and Tuesday, Wednesday 9am to 3pm, Thursday 9am to 3pm and Friday 10am to 12pm. Appointments are generally offered with the GP between 10am and 12pm on Mondays, Tuesdays and Thursdays although there is some flexibility with these times. Patients normally attend the clinic on a Wednesday for RIFE between 10am and 2.30pm staggered every 40 minutes. We were told that service times offered were now much less than this. Well-One Clinic also offers a RIFE service in a location in Dumfries. We were told patients who have attended Well-One Clinic in Beverley are only able to attend the clinic in Dumfries if it is more convenient for them. We were told activity and prescribing was managed and overseen by the provider.

How we inspected this service

Before visiting the clinic, we reviewed a range of information we hold about the service including information we requested that the provider send us. We informed the Clinical Commissioning Group (CCG) that we were inspecting the service; the CCG does not commission any services with Well-One Clinic and therefore has no information to share with us.

During our inspection we:

• Visited the clinic
• Spoke with the registered manager and the practice manager.
• Reviewed a wide range of documents at the practice.
• Observed patients arriving at the clinic.
• Received feedback from five patients.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 5 July 2021

This service is rated as Inadequate overall.

Key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Well-One Clinic on the 26 May 2021, as part of our inspection programme. We visited their site at Jacob’s Well Yard, Swinemoor Lane, Beverley, HU17 0JX.

The previous inspection and follow-up inspection in March and December 2018 were unrated. At the previous inspection in March 2018 we identified breaches of the regulations in respect of:

Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment

Regulation 17 HSCA (RA) Regulations 2014 Good governance

At the follow up inspection in December 2018 we identified the breaches of the above Regulations had largely been addressed.

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.

Well-One Clinic is an Independent Health clinic. The clinic provides general practice, consultation and treatment without accommodation. The provider offers services across a range of areas but largely relating to Lyme disease treatment. Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by the Borrelia bacterium which is spread by ticks. Well-One Clinic advertise on their website that they also provide a range of other services such as private GP services, private medical examinations and psychological therapies. We were told that the additional services currently being offered related to private medical examinations.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. This service is registered in respect of the following regulated activities; Transport services, triage and medical advice provided remotely, treatment of disease, disorder or injury, Diagnostic and Screening, Family Planning, Maternity and Midwifery Services, Services in slimming clinics and surgical procedures by, or under the supervision of, a medical practitioner. There are some exemptions from regulation by CQC which relate to types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At Well-One Clinic a service is provided called RIFE treatment. The machine delivers low electromagnetic waves, like radio waves. At Well-One Clinic the RIFE treatment that is provided is exempt by law from CQC regulation. Therefore, we were not able to inspect the RIFE treatment element of the service. It should be noted that RIFE forms part of the patient’s combined treatment package.

The GP at Well-One Clinic 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.

Five people provided feedback about the service. All the feedback was positive in respect of the impact attendance at the clinic had had on their lives in terms of their health and well-being. Patients were known to travel from all parts of the UK to attend the clinic.

Our key findings were:

• Systems and processes did not always ensure that care was provided in a safe way and that risks to patients were mitigated.
• There was insufficient assurance in place to demonstrate that people received effective care in line with current guidance.
• The provider was not actively involved in quality improvement activity.
• Staff did not always have the skills, knowledge and experience to carry out their roles.
• Patients told us and we saw evidence that patients were treated in a caring way.
• There was evidence the provider endeavoured and was passionate about providing a responsive service to meet people’s needs and preferences.
• Processes were not established to identify and monitor risks.

We found the service to be in breach of Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing of the Health and Social Care Act 2008

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure that care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

I am placing this service in special measures. We are taking action in line with our enforcement procedures. The provider has 28 days to appeal the enforcement decision. At the end of that time we will publish a supplementary report detailing the action we have taken.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care