Private Medical Clinic

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture
This is the first inspection for this service since its registration with CQC. This key question has been rated as requires improvement.
The service was in breach of legal regulation in relation good governance. The provider did not have effective systems in place to monitor clinical fridge temperatures and ensure vaccines were stored within the correct temperature range. Systems to ensure other medicines were stored at the correct temperature were not effective across all sites. The provider was unaware that NHS PGDs were not valid for use in independent healthcare settings. There was a lack of effective risk management systems to identify, assess and mitigate environmental risks.
 

This service scored 61 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion and engagement.

Leaders had a clear vision and the capability to lead the service. The leadership team were approachable, accessible and supportive. There was an emphasis on safety, clinical excellence and the development and supervision of staff however, this did not always translate into safe and effective systems of care and treatment. We found gaps in risk management and governance which had the potential to impact patient safety which had not been identified by the leadership team. The service had grown rapidly, adding 7 satellite locations in 18 months and management oversight had not kept pace with this expansion. There was a lack of management capacity as the leadership team comprising the clinical lead and the practice manager had not grown in line with the demands of the business. Although the leadership team had experience of both NHS and independent healthcare settings there was insufficient understanding of the full breadth and depth of the governance requirements. Leaders recognised the importance of developing their workforce but in doing this, may not have ensured that all staff had the required skills for the leadership responsibility they were given. We discussed this with the provider who told us, that they had recognised the need for experienced managerial support and that some staff in lead roles required further development. They had taken action to recruit suitable people who would be able to support and develop existing staff.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. The service had established Freedom to Speak up arrangements and staff were aware of how to raise concerns. Staff we spoke with were confident to raise concerns and that they would be acted upon.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them. Policies and procedures to promote diversity and equality were in place. There was equality of opportunity for staff regarding continuing professional development and career opportunities.

The service had governance processes in place and was building a bespoke IT system to support its governance arrangements. However, these were not operating effectively as we identified numerous gaps in governance which had created significant risks to patient safety. Incorrect monitoring of fridge temperatures over the previous 18 months meant that the provider could not be assured that vaccines which had been administered to patients, had been stored within the correct temperature range whilst in the clinic fridges. The staff who had responsibility for cold chain safety did not have the requisite knowledge and skills to effectively manage the system and this had not been identified by the provider when this responsibility was delegated. Furthermore, given that the error was occurring across multiple sites, no other clinical staff who were carrying out daily fridge temperature monitoring identified or raised the issue indicating that staff did not have a thorough and effective understanding of cold chain management.
Staff were administering vaccines without valid PGDs and both staff and leaders were unaware that NHS PGDs could not be used in an independent healthcare setting. This meant there had been no valid, legal authority in place for the delegation of the administration of medicines to staff who were not qualified prescribers.
We found there was a lack of awareness and understanding on the part of the leadership team of some governance requirements for example, the requirement for a COSHH risk assessment and the need to maintain oversight of risk assessments carried out by the landlords of premises used by the service to ensure that required actions were completed in a timely manner. The current systems to maintain clear oversight and compliance regarding premises rented by the provider were not effective and required closer collaboration with landlords to ensure that premises and equipment were safely maintained. Following agreement with a landlord of the SLA there was a lack of ongoing monitoring and information sharing. For example, building work at one site impacting patient access had not been appropriately risk assessed. On some sites staff employed by the landlord acted as fire wardens however, the provider did not have evidence of their training.
The provider did not have clear and effective systems in place to ensure safety when external contractors such as builders were working on site. For example, they were unaware that flammable liquids with the potential to harm health had been brought onto and left on the premises.
The provider was aware of the old furniture and equipment stored in the basement of their main site. This equipment belonged to their tenant however, they had not identified it as a fire risk or taken appropriate action to ensure the tenant disposed of it. On the day of our inspection a fire door to reception at the main site was held open with a doorstop. The provider told us this had not been raised as a risk during their fire risk assessment however, it was custom and practice to facilitate easy access for people. This risk could have been proactively resolved prior to our inspection had the provider had an appropriate level of governance oversight.

The leadership team was very responsive to feedback and took action to rectify the concerns we raised however, this demonstrated a reactive rather than proactive approach to risk management.
They demonstrated a transparent approach, for example completing a significant event report when on the day of inspection temperatures in the clinical room where emergency drugs were stored rose above 25 degrees Celsius.
There were clear lines of accountability, but the current leadership team had insufficient capacity to maintain effective oversight of multiple sites, staff and services.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. The service worked effectively with other independent health services to whom they referred people. Information was shared with NHS services, with people’s consent and shared care agreements were created with people’s GP where it facilitated safe ongoing care and treatment.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. There was a program of audit and staff were encouraged to carry out their own audits where they had identified a potential service improvement. However, we found the provider’s approach to quality monitoring and audit to be somewhat reactive. A proportion of audits that had identified some significant medication issues had been only carried out in response to a complaint, rather than identified through internal review. Whilst this was a positive response to a complaint, it illustrated limitations in the provider’s own quality and safety monitoring. We also found significant knowledge gaps for some staff for example, in correctly monitoring fridge temperatures which indicated that learning and development may be insufficient or not well embedded. The provider had a clear business plan to expand and develop services in the future. For example, recruiting psychiatric nurses into their dementia service.