Archived: The Private Clinic Limited - Bristol

Updated 18 January 2017

The Private Clinic Bristol is a small independent clinic, which is part of the larger organisation, The Private Clinic Limited. The Private Clinic Bristol offered minor cosmetic surgery services to private patients. They do not see any NHS patients. There are no inpatient beds and the clinic has one operating theatre. No surgical treatments or procedures are carried out on children or young people at The Private Clinic Bristol.

The clinic provided a range of treatments and procedures not all of which are subject to CQC registration. The clinic undertakes Vaser liposuction, Endovenous Laser Ablations (EVLA), and phlebectomies which are subject to CQC registration under the regulated activities: diagnostic and screening, surgical procedures and treatment of disease, disorder or injury.

The clinic had a registered manager who had been registered with the Commission since May 2016.

The Private Clinic had been judged compliant on our last inspection under the previous inspection methodology.

Updated 18 January 2017

Our summary of our key findings from our inspection are as follows;

• Consent forms for some procedures were not clearly labelled and contained information about all possible treatments which was not always edited to reflect which treatment a patient was undergoing.
• Safety cannulas were not being used, and a sharps injury had been reported as an adverse incident.
• The service did not routinely carry out venous thromboembolism (VTE) risk assessments for all patients undergoing surgical procedures.
• Resuscitation equipment was not stored in a  trolley with tamper evident tags.
• Medical gases were stored in a store room but did not have any warning signs on doors to the room.
• Patient records were not always complete or legible and surgeon’s summary letters were not included in patient notes.
• Risks associated with procedures were not always recorded, or were illegible.
• Staff were not up to date with some training and records were not up to date.
• Psychological assessments were not recorded in patient notes.
• There were no prescription audits which checked the quality of the prescriptions filled out.
• The clinic monitored some clinical outcomes from surgical procedures including ultrasound assessments of treatment effectiveness for  varicose vein treatments.
• There was no audit of consent forms.
• One treatment room was visible from the road, meaning consultations could be viewed from outside.
• Clinical staff were unaware of translation or interpretation services.
• Most staff were aware of the values for the clinic, however some staff were unaware of the vision for the clinic.
• Risk registers were held centrally and were accessible to all clinics, however, some staff were unsure how to access them.
• The clinic was not using coding for its surgical procedures.
• One doctor working under practising privileges at all clinic locations was not on the Voluntary General Medical Council specialist register, which was a condition of the Provider's granting of practising privileges.

However;

• Staff had a clear understanding of local safeguarding procedures which were clearly displayed.
• Safety data was collected centrally by the provider to look for trends and was shared with clinic managers through a structured governance framework.
• All staff had received a minimum of basic life support training.
• There was a detailed infection prevention control audit which showed good compliance.
• Agency nurses and anaesthetic staff had thorough inductions, and provided evidence of their clinical practice to the clinic.
• The clinic followed National Institute for Clinical Excellence (NICE) guidance for varicose veins treatment.
• The clinic had received good patient feedback and had started collecting Friends and Family Test data.
• The clinic benchmarked patient satisfaction data against other clinics within the business.
• Staff had undertaken specialist training to help enhance the aftercare given to patients.
• There was a thorough process for granting practicing privileges for doctors working at the Private Clinic Bristol, and the clinic held evidence of competencies on site.
• Staff were compassionate in their approach to patient’s needs.
• Patients could have multiple follow-up appointments and all patients were given a 24 hour emergency phone number.
• Staff treated anxious patients with kindness and compassion.
• Alternative treatment options were discussed with patients.
• Patients waited four to six weeks for their procedures.
• Operating lists had been adjusted to minimise delays following patient feedback.
• The clinic took account of patients’ individual needs including dietary requirements.
• The clinic was a member of the Independent Healthcare Sector Complaints Adjudication Service (ISCAS) and the Centre for Effective Dispute Resolution (CEDR).
• Leaders were very visible and approachable.
• The registered manager had a virtual forum for help and advice from their peers in other clinics.
• Doctor’s levels of indemnity insurance and skills were monitored both in clinic and centrally using a database.
• There was evidence of improvements made as a result of infection, prevention control audits.
• The clinic followed General Medical Council guidance on the marketing of cosmetic procedures.

Updated 18 January 2017

Our findings were:

• Consent forms were not clear and did not clearly say which procedure it was for.

• Safety cannulas were not being used.

• The service did not routinely carry out venous thromboembolism (VTE) risk assessments for all patients.

• Resuscitation equipment was not stored in a  trolley with tamper evident tags.

• Medical gases were stored in a store room but no warning signs were displayed on the door.

• Patient records were not always complete.

• Surgeon’s summary letters were not included in patient notes.

• Risks associated with procedures were not always recorded.

• Staff were not up to date with some training and training records were not up to date.

• Psychological assessments were not recorded in patient notes.

• There were no prescription audits.

• The clinic did not monitor outcomes from all surgical procedures.

• There was no audit of consent forms.

• One treatment room was visible from the road meaning consultations could be viewed from outside.

• Clinical staff were unaware of translation services.

• Most staff were aware of the clinics values for the clinic, however some were unaware of the vision.

• Risk registers were held centrally and were accessible, however, some staff were unsure how to access them.

• The clinic was not using coding for its surgical procedures.

• One doctor working under practicing privileges across all of the registered locations was not on the General Medical Council (GMC) specialist register.

However;

• Staff had a clear understanding of local safeguarding procedures.

• Safety data was collected centrally and was shared  through a governance framework.

• All staff had received a minimum of basic life support training.

• There was a detailed infection prevention control audit which showed good compliance.

• Agency nurses and anaesthetic staff had thorough inductions

• The clinic followed National Institute for Clinical Excellence (NICE) guidance for varicose veins treatment.

• The clinic had received good patient feedback.

• Staff had undertaken specialist training to help enhance aftercare.

• There was a thorough process for granting practicing privileges for doctors working at the Private Clinic Bristol.

• Doctors provided evidence of their clinical experience.

• Staff were compassionate in their approach to patient’s needs.

• The clinic collected Friends and Family Test data.

• Alternative treatment options were discussed with patients.

• Patients could have multiple follow-up appointments.

• All patients were given a 24 hour emergency phone number.

• Staff treated anxious patients with kindness and compassion.

• Patients waited four to six weeks for their procedures.

• Operating lists had been adjusted to minimise delays.

• The clinic took account of patients’ individual needs.

• The clinic was a member of the Independent Healthcare Sector Complaints Adjudication Service (ISCAS) and the Centre for Effective Dispute Resolution (CEDR).

• Leaders were very visible and approachable.

• The registered manager had a virtual forum for help and advice.

• There was evidence of improvements made as a result of infection, prevention control audits.

• The clinic followed GMC guidance on the marketing of cosmetic procedures.