The Thyroid Clinic

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 Good.

This service scored 75 (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 and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Leaders encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learned from clinical issues. Staff felt there was an open culture, and that safety was a top priority. The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There were systems for processing information relating to new people using the service.

The service encouraged people who used the service and were prescribed thyroid hormone replacement therapy and hormone replacement therapy, to share information with their NHS GP. Where clinical risk had been identified during consultations, these were shared with people using the service and onward referrals were made as necessary. For people prescribed weight loss medication, they made sure that the person’s GP was aware of treatment prescribed and consultations, which ensured continuity of care.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

Safeguarding policies were known to staff, who were appropriately trained in safeguarding procedures. The service had systems to record and share concerns quickly and appropriately with the appropriate authorities. Contact numbers for local authority safeguarding teams nationally were easily accessible.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Although the service did not see people who were acutely unwell, staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. Staff had completed a range of training to manage medical emergencies. All treatments that we assessed showed people received full medical assessments to determine they were of good health to undertake the treatments. We saw the assessment contained sufficient information to determine treatment was safe, including past medical history, current medicines and allergies. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The Thyroid Clinic is an online independent health service. This quality statement is not relevant for this service and did not form part of the assessment.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles in the service. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working in their agreed areas of competence. Clinical staff included General Practitioners (GPs), Advanced Nurse Practitioners (ANPs) and Registered Nurses (RNs). Competency assessments of clinical staff were completed annually. Safe recruitment practices were followed. All staff had received a DBS (Disclosure Barring Service) check.

The service assessed and managed the risk of infection.

People who used the service were provided with information about safely using and disposing of needles and a suitable bin for disposal. The service had systems and processes to ensure people followed the infection prevention and control guidance included in home blood test kits (provided by an external service). For example, providing information on when the test should be taken and when false positive results were returned, exploring reasons as to why this had been so.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

The service followed protocols to ensure the safe management and prescribing of medicines. For each condition treated, there were clinical guidance documents to refer to. The service conducted prescribing audits, and the results were shared with staff. Recommendations for action were identified as necessary.

The service ensured appropriate checks were conducted to ensure prescribing was appropriate. For example, people had their physical health monitoring confirmed at their initial consultation and at later review appointments.

There were clinical governance meetings where staff reviewed cases and shared learning with colleagues, and this was evidenced in meeting notes.

The service had a process for issuing prescriptions to a nominated pharmacy, by the provider, who were responsible for supply of medicines to people.

Where off-label (medicines prescribed for indications outside of their marketing authorisation) or unlicensed medicines (medicines without marketing authorisation in the UK) were prescribed, this was fully communicated to people, with their consent and documented in their notes. There was a process to share information with other healthcare professionals with people’s consent. The records we reviewed had evidence of an initial consultation with a clinician and people’s medical histories were clearly verified and documented with an up-to-date allergy status.