Howell Medical Group Ltd

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• 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 followed evidence based guidance and involved people in decisions about their care and treatment and provided them with advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

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

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had introduced comprehensive assessment and review templates to follow national guidance, and staff took wider health concerns into consideration when making decisions.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, any other health problems, wellbeing and communication needs with them.

The service carried out an in-depth assessment of the patient which included patient's health history, and details regarding their hopes around weight loss. Nurses reviewed written information from patients and information during video consultations to ensure they could meet each patient's individual needs. This included patients who had other medical conditions that would usually exempt them from weight loss treatment due to the potential of increased risks. Nurses referred any patient with more complex needs into a clinical review team which included the consultant endocrinologist for additional medical oversight and decision making.

There were over 100 patients with diabetes which the service treated for weight loss whilst monitoring any impact on their diabetes. Nurses had frequent video calls with these patients to ensure their needs were being met appropriately.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this mostly in line with legislation and current evidence-based good practice and standards.

The medical lead was a consultant endocrinologist; he had embedded current clinical best practice into the service and shared this with staff via newsletters/ lessons learned updates. He made himself available to staff with queries and provided a large range of educational material for staff and patients.

The provider carried out comprehensive assessments and reviews of patient identity, weight, body fat risks and any existing medical conditions which could interact with their weight loss treatment. The provider obtained consent from patients to inform their GP they were starting weight loss medicines.

If a patient did not meet the criteria to be prescribed weight loss medicines, they were given advice and guidance to help them manage their condition and offered appointments with a nutritionist.

The provider had a focus on providing a holistic service and working with other relevant services. Staff fed back to us how teams supported each other and had improved working with their partners.

The consultant endocrinologist had contacts within the wider system around diabetes, obesity and weight loss care.

The service supported people to manage their health and wellbeing to maximise their wider health and wellbeing understanding. A large part of the service provided included regular updates with lifestyle and dietary advice to help patients move to healthier choices as part of their weight loss journey. Access to videos recorded by the consultant endocrinologist were available to help educate patients and encourage them with their weight loss journey.

All patients were advised that weight loss medication could not work in isolation and that they needed to make lifestyle change to reduce weight and achieve their goals. The website contained information in bite sized sections, and videos to help patients understand weight loss and lifestyle choices. The service sent out weekly updates and information about weight loss and healthy lifestyle, nutrition and hydration.

In addition to the information provided by nurses and via the website, the service offered nutritional therapy support with a dietician/ nutritionist and a wellbeing coach.

Some patient feedback included very positive outcomes about how losing weight had also improved other complex health conditions and made significant difference to their lives.

Nurses identified people who might need additional support through the additional self-assessment due to other health conditions or complexities.

Nurses reviewed individual patient care and treatment with monthly wellbeing reviews for all patients prescribed weight loss medicines.

The provider had a daily review meeting which staff from different departments joined and data for the service was used to inform this. This included call length and call waiting times, prescription and prescribing data, payment refund data for patients who were not accepted into the service and a range of metrics to monitor service.

The provider informed us they undertook clinical audits for all prescribers; however, they provided limited examples of this oversight to CQC. The provider had conducted an extraordinary audit of prescribing errors and identified improvement actions. There was no patient outcome data for the service available to ascertain how effective care and treatment was on the patient population using the service.

The provider did not have a cyclic clinical audit or quality improvement process in place, though they were very focused on improving patient outcomes and had a continual improvement focus which staff and leaders informed us of.

The provider and nurses clearly understood and applied legislation relating to consent. They told us that treatment and care was fully explained to patients. Patients were also asked for consent to share their slimming clinic information with their NHS GP and if the patient did not agree, gave the patient their consultation and treatment information to hand to their own GP directly.

The provider required staff to complete mental capacity act training so that they could identify where a patient might not have capacity to make all decisions themselves, however less than 70% of nurses had provided evidence to the provider that they had completed mental capacity training.

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 and worked with other services to achieve this.