Archived: Elms Medical Practice

Updated 7 December 2018

Elms Medical Practice is an independent diagnostic service based in Harpenden, Hertfordshire, and is operated by STAHMS Ltd. It serves the communities of Harpenden, St. Albans, and the surrounding areas. STAHMIS Ltd was established approximately 10 years ago in response to some of the health economy’s most pressing challenges. The aim of the service was to help reduce waiting times, speed up diagnoses, improve patient pathways and enhance the overall patient experience.

STAHMIS Ltd operates three locations across Harpenden and St. Albans, including Elms Medical Practice, The Colney Medical Centre, and the Hertfordshire Clinic.

STAHMIS Ltd is commissioned by the local clinical commissioning group (CCG) to provide diagnostic imaging services (ultrasound scans) to NHS patients who attend the local GP practices. The aim of Elms Medical Practice is to see patients within their local community to prevent them from waiting for an NHS appointment and to reduce the pressures faced by the local NHS trusts. Services are provided from a clinic room, situated in a GP surgery, which is managed by a different provider.

The service has not had a registered manager in post since September 2017. However, at the time of our inspection, a new manager had recently been appointed and had applied to register with the CQC.

Elms Medical Practice is registered with the CQC to undertake the regulated activity of diagnostic and screening procedures. This was the first inspection of the service since it registered with the CQC in 2015.

Updated 7 December 2018

Elms Medical Practice is operated by STAHMIS Ltd. The service is consultant-led and provides diagnostic imaging services (ultrasound scans) to NHS patients who attend GP practices within St. Albans, Harpenden, and the surrounding areas. The aim of the service is to see patients within their local community to prevent them from waiting for an NHS hospital appointment.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 8 October 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by Elms Medical Practice is diagnostic ultrasound scans.

Services we rate

We have not previously inspected this service. At this inspection in October 2018, we rated the service as good overall.

We found the following areas of good practice:

• Staff were caring, kind and engaged well with patients.

• Services were planned in a way that met the needs of patients and the local community. Patients were offered a choice of appointments in three locations within their local community.

• Staff recognised incidents and knew how to report them. All incidents were investigated and lessons learned were shared across the team.

• Managers promoted a positive culture that supported and valued staff. Staff confirmed they felt respected and valued.

• The service had arrangements in place to manage risks to patients. Patient referrals were screened against set criteria, which had been shared with local GPs.

• Staff understood their responsibilities regarding consent, and consent was undertaken in line with national guidance and the service’s consent policy.

However, we found areas of practice that the service needed to improve:

• There was no evidence that peer review audits of the ultrasound images and reports were undertaken, as recommended by the British Medical Ultrasound Society (BMUS).

• Personnel files for the consultant radiologists were incomplete, which meant we could not be assured that the radiologists were suitable and competent for their role. This was addressed by the service following our inspection.

• There was no formal arrangement in place to ensure STAHMIS Ltd was informed of any performance problems or other concerns relating to a consultant’s practice. Following our inspection, the service improved their management of practising privileges.

• The service did not have a robust governance framework. Clinical governance and director meetings were not held consistently and the service did not review and share audit results.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)

Updated 7 December 2018

The provision of ultrasound scanning services, which is classified under the diagnostic imaging core service, was the only core service provided at this service.

We rated the service as good overall because staff were aware of their roles and responsibilities to report, investigate and learn from incidents. There was a system and process in place for identifying and reporting potential abuse. Processes were in place for the escalation of unexpected findings during ultrasound scans. Feedback from patients was very positive. Appointments were scheduled to meet the needs and demands of patients who required their services and the STAHMIS manager had the appropriate skills and experience to manage the business.

However, we identified concerns with the process of managing, reviewing and granting practising privileges. There was also not a system in place to ensure risks to the service were regularly reviewed. There was no evidence that peer review audits were completed, as recommended by the British Medical Ultrasound Society.