Total Access Medical Diagnosis

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care, supported learning and innovation whilst promoting an open, fair culture.

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

The service was in breach of legal regulation in relation to good governance.

The provider did not have effective systems or processes to assess, monitor and mitigate the risks to people who used the services because:

• There was limited functionality to search the clinical systems to audit systems to identify prescribing that was outside of protocol or best practice guidance.
• There was a lack of oversight of risks to safe staffing and premises.

We have asked the provider for an action plan in response to the concerns found at this assessment.

This service scored 62 (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 had a shared vision, strategy and culture. This was based on putting patients first and developing innovative care.

Staff told us how they had been involved in developing the values, and we saw evidence of how these were implemented. For example, we saw patients’ care needs being put first through an understanding of their emerging needs. The provider carried out research and scoping through online platforms, so they were aware of unmet patient health needs. They were working with experts and other providers to address these issues.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff told us leaders in the service were approachable and responded to any concerns raised.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Adjustments had been made to ensure all staff were valued, for example staff told us about flexible working policies which enabled them to fulfil their caring responsibilities.

The service did not have clear systems of oversight and good governance. They did not have effective functionality to ensure they had up to date, available information about risk, performance and outcomes through clinical searches. Oversight tools did not support findings on inspection.

During the course of the inspection, we identified numerous examples where prescribing was outside of best practice and provider protocols. The provider had not identified instances where there was ongoing prescribing for patients with long-term conditions, who had not received the necessary monitoring to ensure this practice was safe. The lack of effective functionality to search the clinical systems impeded the ability to carry out effective and efficient audit and improvement.

We found a number of clinical policies that had yet to be finalised and signed off, as these evolved to meet changing priorities. Staff told us that there were instances whereby they had not been advised of policy updates. However, good quality protocol updates were made following our feedback.

Oversight tools indicated compliance with recruitment checks, training and audit, which did not accord with our findings on inspection. We requested staff training certificates to be sent to us following the inspection, but these were limited and did not evidence robust systems and processes to ensure effective completion of training and learning.

The service did not demonstrate adequate oversight of health and safety. We requested a health and safety audit and legionella risk assessment to be sent to us following the inspection, but this was not provided.

Documentation relating to the safety of premises was not instantly accessible. It was unclear during the inspection what risk assessments and actions had been undertaken. Whilst evidence was sent to us after the inspection of actions taken following the fire risk assessment, this information was not immediately understood or available.

The service was proactive in their collaboration and partnership working, so services worked seamlessly for people.

Total Access Medical Diagnosis shared information and worked with clinical experts to improve and innovate treatment approaches. This included seeking specialist advice to develop treatment guidelines for men with low testosterone. As a result, the service formed partnerships with laboratories and other providers to deliver a comprehensive care pathway.

The service had a strong focus on continuous learning, innovation and improvement across the organisation. They actively contribute to safe, effective practice and research.

The service actively sought expert input to improve clinical care and develop innovative treatment pathways. For example, it employed a specialist doctor in women’s health to enhance protocols for HRT and sexual dysfunction, recognising these symptoms as potential early indicators of cardiovascular disease. They also sought specialist advice to develop treatment guidelines for men with low testosterone. As a result, the service formed partnerships with laboratories and other providers to deliver a comprehensive care pathway.

In response to concerns about overprescribing certain medications for general anxiety, the service engaged a specialist to develop a scoring system and decision-making protocol to better identify situational anxiety and determine safe alternatives.

The team continues to explore emerging technologies, including facial blood pressure analysis and pilot tools for motion-based heart rate monitoring. They were in the process of collaborating with a fashion company to assess the Body Roundness Index as a more suitable alternative to Body Mass Index (BMI).