Archived: Registered Offices PrimaryCare-Scanning Ltd

Registered Offices Primary Care Scanning Limited is operated by Primary Care Scanning (PCS) Limited. The service provides rapid routine diagnostic ultrasound services for general practices within primary care settings in Worcestershire. Its focus is abdominal and gynaecological examinations. PCS Limited was established in 2006 and following a business case and tendering process: it was initially commissioned by Worcestershire Primary Care Trust to provide a routine ultrasound service for adult patients aged 18 years and above in Worcestershire. A rolling NHS standard contract for community services had been in place since 2009 and is managed by the Clinical Commissioning Group. The service does not have or own a physical location or mobile transport facility and provides out of clinical examination rooms in individual GP Practices. The service operates five days a week between the hours of 9am and 5pm.

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.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on 3 October 2018. This was the second inspection since registration. 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 service provided was diagnostic and screening procedures.

Services we rate

We previously did not have the authority to rate this service as legislation had not previously applied to all types of independent services, which meant that some providers had been inspected, but not rated. The department of Health had amended the performance assessment regulations to enable CQC rate almost all independent healthcare providers. We rated it as good overall.

We found the following areas of good practice:

• Staff were aware of their roles and responsibilities to report, investigate and learn from incidents, offering apologies and explanations to patients in an open and transparent manner.
• There was a system and process in place for identifying and reporting potential abuse. Staff could provide examples where they had needed to escalate concerns.
• There was a process in place for the escalation of unexpected findings during ultrasound scans. The service had links with a local acute NHS trust to enable a seamless onward referral for patients who had abnormal scans requiring urgent attention.
• Policies and guidance were largely based on national guidance and recommendations.
• The provider had systems of audits in place to enable them to monitor the quality of the service that people received.
• Effective procedures were in place to respond and learn from complaints.
• We observed a focused and individual approach to patient care. Staff were caring, kind and engaged with patients.
• Staff generally completed training appropriate to their roles and responsibilities.
• Staff had completed Mental Capacity Act training and were aware of their roles and responsibilities in ensuring consent and escalating concerns.
• Feedback from patients was overwhelmingly positive during our inspection and we observed some examples of high quality care and treatment provided to patients. Patients were engaged with and encouraged to be partners in their care and treatment provided.
• Appointments were scheduled to meet the needs and demands of the patients who required their services. Same day appointments were also available for patients who required them.
• The registered manager had the appropriate skills and experience to manage the business and was supported by clinical experts to provide a safe service.
• The service had a risk register, which detailed mitigation actions.

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

• Staff held weekly image quality peer review meetings. We found there was no record of image quality findings or actions taken following image quality meetings. We could not be assured that learning was always shared.
• There were no minutes of meetings held with GPs and other stakeholders.
• Staff did not wash their hands with soap and water between patients. This was not in line with the World Health Organisation (WHO) guidance, “Five moments for hand hygiene”. Hands are the main pathways of germ transmission and there was a risk of potential transmission of harmful germs. However, we observed staff using hand sanitising gel between patients.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)