Winnersh

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

We looked for evidence that staff involved people in decisions about their care and treatment and provided them with advice and support. Staff regularly reviewed people’s care to achieve this.

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

This service scored 54 (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 made sure people’s care was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The service had strict inclusion criteria and would not accept patients who did not meet these criteria. Leaders in the service told us that they did not often need to refer patients to other medical services based on the nature of the service they delivered but when it was appropriate they referred or signposted patients.

The CBPMs prescribed in the service were unlicenced. Unlicensed medicines are medicines which have not been assessed for safety, quality and efficacy by the Medicines and Healthcare Regulatory Agency (MHRA). Unlicenced medicines can be prescribed to meet an unmet clinical need of a patient where other licenced treatments have not worked. Cannabis-based products for medicinal use (CBPMs) were legalised in the UK on 1 November 2018, but the regulations around their use and supply remain strict. The CBPMs prescribed in the service were unlicenced. They were prescribed to meet the needs of people whose needs had not been met by other licenced treatments. The service planned peoples care and treatment with them including what is important and matters to them. However, the delivery of this care was not always done in line with legislation as the processes did not allow for effective oversight of peoples care by the specialist doctors. Since our assessment the service has told us they have made some improvements to their service, including a mandatory annual review with a consultant for all patients.

Staff told us they normally had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support. Some clinical staff told us that they did not always have access to a patient’s summary care record when they carried out their initial consultation and administrative staff confirmed this.Specialist doctors told us they were not routinely invited to attend multi disciplinary team (MDT) meetings to discuss patients under their care. The MDT process did not allow for effective collaboration of specialists to review the needs of patients and ratify prescribing decisions. The service informed us that this process was under review.

The clinic had a process where they delegated care through a ‘shared care’ protocol. This was in place to ensure all relevant staff, teams and services were involved in assessing, planning and delivering people's care and treatment and staff work collaboratively to understand and meet people's needs. However, this model did not ensure that the CBPMs were prescribed in line with legislation and good practice guidance. The decision to initiate CBPMs was not discussed with a peer clinician also on the GMC specialist register. The parameters of the shared care were not always patient specific. We saw that significant changes were made to patients’ prescriptions without specialist input. Furthermore, specialists did not routinely review patients’ needs as part of their shared care.

Winnersh is an independent health service. They are a private clinic that provides medical treatment for patients focused on cannabis-based products for medicinal (CBPMs) use only. This quality statement is not relevant for this service.

The service routinely monitored patients’ care and treatment to support improvement. It aimed to ensure that outcomes were positive, consistent, and aligned with both clinical standards and patient expectations. To help keep patients safe, the service required them to remain actively engaged. This included attending follow-up appointments every three months or after every two repeat prescriptions, during which their treatment with cannabis-based medicinal products was reviewed and evaluated. Whilst we found the service did routinely monitor patients, we were not assured it was done effectively under the direction of specialist prescribers.

Leaders told us that patient consent to treatment was documented at the beginning of the care journey and discussed during multidisciplinary team (MDT) meetings. In order to become a patient of the service, people had to provide their summary care record from their NHS GP and give consent for information to be shared with their NHS GP. However, this consent was not clearly documented in all the records that we reviewed. People were given the choice of whether they chose to share their treatment with other medical practitioners, such as consultants, involved in their care. In addition, it was not always clearly documented that patients had been informed that CBPMs were unlicensed, or given the risks and benefits, which may impact decision-making. The service told us that their consultation template was under review and they intended to add a section regarding unlicensed medicines.