Archived: Fitzrovia Medical Clinic

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

This is the first inspection for this service since its registration with CQC. This key question has been rated as Inadequate.

The service was in breach of legal regulations in relation to safe care and treatment and good governance.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The service did not always have effective systems to assess patient’s needs and plan care appropriately. There was no mechanism within the clinical records system to identify or flag high-risk patients. During our clinical records review of patients, we did not always see evidence that appropriate clinical assessments had been carried out. The service did not have effective systems in place to ensure that clinical records were completed fully and consistently, including documenting adequate clinical assessment and clear, safety-netting advice. We reviewed a sample of 5 patient records during our on-site visit. In 3 of the patient records there was no documentation of adequate clinical assessment, in line with NHS guidelines, including the absence of basic observational checks such as general appearance, breathing or level of distress. The service could not demonstrate safety-netting advice was consistently documented or sufficiently detailed. Of the 5 records we reviewed, 3 consultations included safety-netting advice, however, this was non-specific and not tailored to the presenting complaint. In cases of upper respiratory tract infections, clinical records we reviewed did not include clear advice on ref flag symptoms such as worsening cough, shortness of breath and drowsiness or confusion. Two of the 5 consultations reviewed had no documented safety-netting advice. The service could not demonstrate that adequate clinical assessment and safety-netting advice was being provided consistently to patients, which increased the risk that signs of patient deteriorate may not be identified or appropriately managed. There was also limited recorded evidence to show whether patients had been asked about, or were able to provide, physiological observations where relevant to their presenting conditions.

The service did not have effective systems in place to ensure that patient identification was consistently verified in line with NHS guidelines and documented within clinical records. During our site visit, we reviewed a sample of 5 patient records and did not see evidence in any of these records that patient identification checks had been undertaken or documented within clinical records. The provider told us identification checks were undertaken during video consultations, however, these were not recorded in clinical records. We were told by staff that identification was not routinely requested or documented at the point of registration. We did not see evidence of a patient identification policy. The service told us, for child patients, identification was checked, however this was not recorded within the clinical records and identification checks and parental responsibility verification were based on verbal confirmation. The absence of a consistent and documented approach to verifying patient identity increased the risk of misidentification and inappropriate treatment.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service did not have effective systems to ensure care and treatment was delivered in line with current evidence-based guidance and safety information.

The service did not have effective systems to identify, assess and mitigate risks to patients. During our on-site assessment, the provider told us there was no formal system in place for receiving, reviewing and actioning patient safety alerts, including Medicines and Healthcare Products Regulatory Agency (MHRA) safety alerts. The provider told us they relied on memory to recall relevant alerts which were not documented, systematically recorded or routinely communicated to staff. We were not assured the provider was consistently aware of, or acting on, relevant national safety guidance. During our interview, the provider did not demonstrate awareness of MHRA safety advice relating to nitrofurantoin, an antibiotic used to treat urinary tract infections (UTI), including the risk of pulmonary and hepatic adverse effects. There was no evidence that patients prescribed this medicine were routinely informed of these risks. When asked to provide examples of prescribing where MHRA alerts had been considered, communicated and documented, the provider was unable to demonstrate this.

The service did not work well across teams and services to support people.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The provider told us people could be referred to the wider Fitzrovia Hospital for additional investigations, diagnostics and specialist support where required. However, we did not see evidence of formal multidisciplinary working arrangements, documented referral pathways or consistent systems to support joined-up care. During our review of clinical records, we did not see any evidence of communication with individual patient GP’s and onward referrals to secondary care had been completed. The provider also told us they followed up test results with patients. However, we did not see any clarification that patients had received and were able to act on results, putting patients at risk of harm.

The provider told us vaccinations and injections were available through the service and patients could be referred to the wider Fitzrovia Hospital for additional investigations, diagnostics and specialist support where required.

The service did not have systems in place to monitor outcomes and the quality of care provided. From our review of patient clinical records, we found that records were generally clear and contemporaneous. Significant past medical history was recorded and consultations included clear histories to support clinical decision making. Appropriate follow-up arrangements had been made in four of the five records reviewed. However, we were not assured that there were sufficient systems to monitor and improve outcomes for patients. The service did not have effective systems or processes in place to assess, monitor and improve the quality and safety of the services provided. During our on-site assessment, the provider was unable to provide us with any evidence of audits to monitor and improve people’s outcomes.

The service did not always have effective systems to ensure consent to care and treatment was consistently sought and recorded.

The clinic primarily provided acute care consultations and did not manage long term conditions or provide services involving Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. We did not see evidence that consent for video consultations had been consistently recorded within patient records for remote consultations.