Howell Medical Group Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm. 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 59 (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 proactive and positive culture of safety, based on openness, honesty, and self-improvement. The provider showed us how they improved the service based on learning, this included learning from significant events, complaints and patient feedback. However, analysis to identify themes and implement action taken following patient complaints had not been carried out in a timely way. The provider had implemented better oversight of all patient correspondence linked to concerns and daily monitoring to prevent concerns escalating into complaints.

Learning was shared via a newsletter, which staff told us they found helpful, staff told us these had recently decreased in frequency and not all staff were aware of this or information from complaints.

The service offered a self-directed service where patients who met the criteria for weight loss medicines managed their own care but could ask for advice if they had any concerns and a nurse led service which gave patients a comprehensive initial assessment and regular reviews. Clinical treatment with weight loss medicines was only offered when people met the criteria in NICE guidance.

Staff asked patients for their consent to share information about their weight loss treatment with their GP and then shared this information directly with a patient's GP or provided information for the patient to share with their GP themselves.

The service had a strong focus on clinical safety and prescribing nurses routinely referred patient care to the lead consultant if they had any concerns about suitability, as well as all patients who had other conditions which affected their suitability for weight loss medicines. The consultant would contact other clinical professionals where required to inform safe care.

The service saw some people paying for one month or three months weight loss medicines but found that some patients opted in and out of the service intermittently, so the patient journey was not always linear.

The service had procedures and measures in place to safeguard patients, and protect them from harassment, abuse, discrimination, avoidable harm and neglect. It was noted the services were not provided to patients under 18 years of age. The provider had taken action to strengthen their safeguarding around patient identity as this had been identified in their risk register.

However, not all staff were aware of the potential risks for patients who did not speak English well and might require independent translation support. The provider began to mitigate this immediately following our inspection.

All staff were required to complete safeguarding training, and whilst all administrative staff had completed this, for nurses, the provider was only able to evidence that 81% of nurses had completed adult safeguarding and 75% of nurses had completed safeguarding training for children.

Whilst the provider informed patient’s GP practices of the weight loss service with patient consent, information from patients' GPs was not routinely requested which is recommended as best practice.

The service provided care and treatment to many patients remotely, around 90% opted for self-directed treatment, and 10% were on the clinician led treatment pathway. Information was made easily available to patients about how to use the medicines and the risks associated. The provider tried to ensure that patients had easy access for queries and support around side effects or other risks associated with weight loss medicines.

Nurses took patients on the clinician led pathway through all the risks associated with weight loss treatment and helped reassure patients around side effects and lifestyle changes. The provider ensured all risk information was shared with patients on the self-directed pathway.

Where patients had existing medical conditions which might impact on their care and treatment, the risks, potential side effects and benefits were discussed with them clearly during the video consultations.

Patients completed wellbeing surveys between each treatment dose and were able to access guidance.

The provider had good oversight of their premises and potential risks in the care environment. They made sure equipment, facilities and technology supported the provision of safe care. Personal protective equipment was in sufficient supply and located appropriately around the premises. The service was delivered from a premises shared with other businesses and from a shared consultation room in which a few patients attended face to face consultations.

We saw that the provider had undertaken health and safety, and fire risk assessments, and that necessary control measures were in place.

There was an accessible consulting room which could be accessed from the rear of the building, as the main consulting room was accessed via steps.

There was a business continuity plan in place should the service be interrupted for any reason.

Most patients were seen remotely via video conferencing, and the provider had contracted an IT company to set up and maintain the safety and security of their IT systems. However, the provider was unable to evidence that all information technology used by staff met all the of required security requirements to protect patient identifiable information. The provider began working with their IT provider to address this immediately.

The service had safe recruitment processes in place and policies for performance management. However, the provider had not maintained all staff records in line with the performance management policy. There was a probation policy but no clear induction policy and guidance on what was required for staff to be signed as competent for clinical or administrative staff. Leaders provided training for new staff around weight loss and the service. There were no formal records of this.

All administrative staff had completed all mandatory training; however, records of nurses (who had completed training in their other roles) was only 37%. The provider acknowledged this and began to address this risk following the inspection.Many clinical staff worked part-time hours around other employment and worked flexibly at home.

The provider had identified that more administrative staff were required and taken action to recruit these, however they did not have clear guidance on what administrative staff roles included and how to perform the roles.

The provider employed several diabetic specialist nurses who were able to provide care for patients with type 1 or type 2 diabetes who wanted to lose weight, and this was overseen by the consultant endocrinologist who specialised in diabetic care. The clinical lead was an endocrinology consultant, and all staff informed us how accessible and supportive they and other leaders were to help them manage patient care safely.

For full time staff, some appraisal was embedded, but for nurses who worked flexible hours each week, this had not yet been introduced, the provider was already aware and had arranged appraisal training for senior staff to support wider implementation of appraisal and supervision. The service held daily meetings to share concerns and performance, and important updates. Nurses were invited to join evening meetings where learning and development was shared, and they could meet some of the administrative team.

The service assessed and managed the risk of infection which was minimal due to the limited patient numbers attending in person. The environment of the consultation room for patients was clean and well maintained, and the headquarters which many staff worked out of was clean and hygienic.

The provider carried out regular risk assessments and infection prevention and control audits. Staff had been provided with training in infection prevention and control.

A cleaning company provided cleaning 3 times a week for the consultation rooms, which were used infrequently for patient consultations. We saw clinical waste was safely handled, stored and disposed of. The provider had a waste disposal contract with a licenced waste disposal organisation; we highlighted to the provider the Environmental Protection Act 1990 requirement to ensure that hazardous waste is attributed to the correct legal entity as the consulting room was used by 2 different legal organisations. The provider did not maintain records of occasional premises checks or evidence of sharing concerns with their cleaning contractor.

As a slimming and weight loss service, Howell Medical Group predominantly assessed patients to be treated with licensed weight loss medicines, as well as occasions when these were used off-licence. The service made sure medicines and treatments were safe and met people’s needs, including carefully reviewing any existing conditions or where the patient was already prescribed medicines which may indicate weight loss medicines were not suitable.

All medicines were prescribed by non-medical prescribers or the consultant endocrinologist. All prescriptions were electronic, and no paper prescriptions were held.

Nurses shared details of patients who required additional consultant input through a multi-disciplinary meeting and the consultant endocrinologist reviewed all clinical care to ensure it could be provided safely. Staff involved patients in planning and understanding their care and how to use their medicines, including providing demonstrations of self-injection, and videos for patients to refer to.

The provider had introduced clear check lists for nurse prescribers to follow and had rejected over 10% of patient requests for weight loss medicines during the previous 3 months which demonstrated a strong focus on safety around prescribing weight loss medicines.

Patients on self-directed treatment had to provide an update of their health and wellbeing monthly which nurses reviewed to ensure their medicines remained safe for them and establish whether higher or lower doses should be prescribed. Nurses could also prescribe limited medicines to support with any side effects.

Howell Medical Group provided weight loss treatment for patients with other complex conditions including diabetes and carefully discussed potential risks and side effects of medicines with patients, to ensure that prescribing remained safe. Staff reported incidents of incorrect prescribing or doses, and the provider reviewed these, including completing an audit to identify how and why errors had been made, and supported staff with learning to prevent future medicines errors. The provider had taken action following patient complaints about incorrect medicines, doses and delayed arrival to reduce these incidents, and leaders now monitored concerns daily to address potential risks. Staff had also made several yellow card alerts (a government scheme for reporting issues related to medicines) where significant incidents around the medicines had occurred, including pregnancy.

National best practice guidance for weight loss medicines administration was that the patient's first injection should be given in the presence of a clinician. This was not possible with a remote service. Whilst a minority of patients attended for face-to-face appointments, where a patient was particularly anxious about self-administering their medicine, nurses offered to conduct a video call with patient for their first injection.

The service had appropriate emergency equipment and medicines in place should they be required. Staff checked these regularly to ensure they were in date and remained fit for use and recorded the checks.

The provider did not have a clear process or records of action taken relating to patient safety alerts, though they prescribed a very small breadth of medicines.