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Archived: The Slimming Clinic Good

The provider of this service changed - see old profile

Inspection Summary

Overall summary & rating


Updated 27 March 2020

This service is rated as Good overall. (Previous inspection February 2018 - Not rated)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at The Slimming Clinic, Hounslow to rate the service for the provision of safe, effective, caring, responsive and well-led services as part of our current inspection programme.

The Slimming Clinic, Hounslow provides weight loss services, including prescribed medicines, and dietary and lifestyle advice to support weight reduction under the supervision of a doctor.

The clinic manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

17 people provided feedback about the service via comment cards. The comments were all positive. Comments about the staff included being polite, helpful and encouraging. The comments about the clinic included providing an encouraging service, ease of access to appointments and being delivered in a clean and tidy environment.

Our key findings were:

•Prescribing and record keeping were in line with the parent company’s policies.

•The clinic was in a good state of repair, clean and tidy.

•Learning from other services within the parent company was shared and implemented.

The areas where the provider should make improvements are:

•Make arrangements to improve privacy in the consultation room during a consultation.

•Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas



Updated 27 March 2020

We rated safe as Good because:

Safety systems and processes

The service had clear systems to keep people safe and safeguarded from abuse.

•The provider conducted safety risk assessments. It had appropriate safety policies, which were regularly reviewed and communicated to staff including locums. They outlined clearly who to go to for further guidance. Staff received safety information from the service as part of their induction and refresher training. The service had systems to safeguard children and vulnerable adults from abuse. The provider has also appointed an organisational safeguarding lead who is available to support each of the registered locations.

•Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect.

•The provider carried out staff checks at the time of recruitment and on an ongoing basis where appropriate. Disclosure and Barring Service (DBS) checks were undertaken where required. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

•All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns. Staff who acted as chaperones were trained for the role and had received a DBS check.

•There was an effective system to manage infection prevention and control. The service had undertaken a Legionella risk assessment which had not identified any necessary actions.

•The provider ensured that facilities and equipment were safe, and that equipment was maintained according to manufacturers’ instructions. There were systems for safely managing healthcare waste.

•The provider carried out appropriate environmental risk assessments, which considered the profile of people using the service and those who may be accompanying them.

Risks to patients

There were systems to assess, monitor and manage risks to patient safety.

•There were arrangements for planning and monitoring the number and mix of staff needed.

•There was an effective induction system for agency staff tailored to their role.

•Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. They could tell us the actions that they would take in a medical emergency.

•The provider had carried out a risk assessment to identify the medicines and equipment needed to deal with medical emergencies. They had also identified the location of other nearby emergency equipment.

•When there were changes to services or staff the service assessed and monitored the impact on safety.

•We saw that the provider had made suitable insurance arrangements for both professional practice and for public liability cover.

Information to deliver safe care and treatment

Staff had the information they needed to deliver safe care and treatment to patients.

•Individual care records were written and managed in a way that kept patients safe. The care records we saw showed that information needed to deliver safe care and treatment was available to relevant staff in an accessible way.

•The service had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.

•The service had a system in place to retain medical records in line with Department of Health and Social Care (DHSC) guidance in the event that they cease trading.

Safe and appropriate use of medicines

The service had reliable systems for appropriate and safe handling of medicines.

•The systems and arrangements for managing medicines, including vaccines, controlled drugs, emergency medicines and equipment minimised risks. The service kept prescription stationery securely and monitored its use.

•The service carried out regular medicines audit to ensure prescribing was in line with the provider’s guidelines for prescribing.

•The service prescribed and handled Schedule 3 controlled drugs (medicines that have an additional level of control due to their risk of misuse and dependence) correctly.

•Staff prescribed, administered or supplied medicines to patients and gave advice on medicines in line with legal requirements and current national guidance. Processes were in place for checking medicines and staff kept accurate records of medicines. Where there was a different approach taken from the providers guidance there was a clear rationale for this that protected patient safety. We saw that where people fell outside of the guidance they were provided with dietary and lifestyle advice.

•There were effective protocols for verifying the identity and age of patients to ensure that only adults over the age of 18 are treated, in line with the provider’s registration.

•Some of the medicines this service prescribes for weight loss are unlicensed. Treating patients with unlicensed medicines is higher risk than treating patients with licensed medicines, because unlicensed medicines may not have been assessed for safety, quality and efficacy. These medicines are no longer recommended by the National Institute for Health and Care Excellence (NICE) or the Royal College of Physicians for the treatment of obesity. The British National Formulary states that ‘Drug treatment should never be used as the sole element of treatment (for obesity) and should be used as part of an overall weight management plan’.

Track record on safety and incidents

The service had a good safety record.

•There were comprehensive risk assessments in relation to safety issues.

•The service monitored and reviewed activity. This helped it to understand risks and gave a clear, accurate and current picture that led to safety improvements.

Lessons learned and improvements made

The service learned and made improvements when things went wrong.

•There was a system for recording and acting on significant events. Staff understood their duty to raise concerns and report incidents and near misses. Leaders and managers supported them when they did so.

•There were adequate systems for reviewing and investigating when things went wrong. The service learned and shared lessons identified themes and acted to improve safety in the service. The clinic manager showed us the local service incident log, and how learning was shared locally. This also included learning across the provider’s other services shared via a weekly managers group telephone call.

•The provider was aware of and complied with the requirements of the Duty of Candour. The provider encouraged a culture of openness and honesty. The service had systems in place for knowing about notifiable safety incidents.

•The service acted on and learned from external safety events as well as patient and medicine safety alerts. The service had an effective mechanism in place to disseminate alerts to all members of the team including sessional and agency staff.



Updated 27 March 2020

We rated effective as Good because:

Effective needs assessment, care and treatment

The provider had systems to keep clinicians up to date with current evidence-based practice. We saw evidence that clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance (relevant to their service)

•Patients’ immediate and ongoing needs were fully assessed. Where appropriate this included their clinical needs and their mental and physical wellbeing. We saw that during initial consultations a medical and medicines history was taken. We saw from the 11 sets of records that we reviewed that information about height, weight and blood pressure was recorded.

•Clinicians had enough information to make or confirm a diagnosis

•We saw no evidence of discrimination when making care and treatment decisions.

•Arrangements were in place to deal with repeat patients. We saw from the medical records that patients were given appropriate treatment breaks during their weight loss programme.

Monitoring care and treatment

The service was actively involved in quality improvement activity.

•The service used information about care and treatment to make improvements. For example, the service sampled patient records to review the levels of weight loss achieved and to review the quality of completion of the patient records. The service made improvements through the use of clinical reviews. Clinical reviews had a positive impact on the quality of care and outcomes for patients. There was clear evidence of action to resolve concerns and improve quality. Clinical reviews had highlighted some patients not achieving the targeted weight loss. These patients were provided with additional support through telephone calls, prior to the completion of the 12-week treatment course.

Effective staffing

Staff had the skills, knowledge and experience to carry out their roles.

•All staff were appropriately qualified. The provider had an induction programme for all newly appointed staff.

•Relevant professionals (medical) were registered with the General Medical Council (GMC and were up to date with revalidation.

•The provider understood the learning needs of staff and provided protected time and training to meet them. Up to date records of skills, qualifications and training were maintained. Staff were encouraged and given opportunities to develop.

Coordinating patient care and information sharing

Staff worked together, and worked well with other organisations, to deliver effective care and treatment.

•Patients received coordinated and person-centred care. Staff referred to, and communicated effectively with, other services when appropriate. We saw for one patient that they had been referred to their GP for treatment of an underlying medical condition before treatment could be commenced.

•Before providing treatment, doctors at the service ensured they had adequate knowledge of the patient’s health, any relevant test results and their medicines history.

•All patients were asked for consent to share details of their consultation and any medicines prescribed with their registered GP on each occasion they used the service. However we saw that this was not recorded on each occasion.

•The provider had risk assessed the treatments they offered. Where patients agreed to share their information, we saw evidence of letters sent to their registered GP in line with GMC guidance. Where a patient had not consented to share the information a copy of the letter was given to them and they were encouraged to share this with their GP.

Supporting patients to live healthier lives

Staff were consistent and proactive in empowering patients and supporting them to manage their own health and maximise their independence.

•Where appropriate, staff gave people advice so they could self-care. This included the provision of dietary and lifestyle advice. However we did not see any signposting to local services to support the lifestyle changes.

•Risk factors were identified, highlighted to patients and where appropriate highlighted to their normal care provider for additional support. We saw from records that where a patient’s blood pressure was not well controlled, that they were referred to their GP before treatment was offered.

•Where patients needs could not be met by the service, staff redirected them to the appropriate service for their needs.

Consent to care and treatment

The service obtained consent to care and treatment in line with legislation and guidance.

•Staff understood the requirements of legislation and guidance when considering consent and decision making.

•Staff supported patients to make decisions. We saw that there were arrangements in place where appropriate, to assess and record a patient’s mental capacity to make a decision.

•The service monitored the process for seeking consent appropriately.



Updated 27 March 2020

We rated caring as Good because:

Kindness, respect and compassion

Staff treated patients with kindness, respect and compassion.

•The service sought monthly feedback on customer satisfaction. We saw that the provider looked at this feedback and reviewed if changes could be made.

•Feedback from patients was positive about the way staff treat people. Patients told us that they felt relaxed having a discussion with the doctor.

•Staff understood patients’ personal, cultural, social and religious needs. They displayed an understanding and non-judgmental attitude to all patients.

•The service gave patients timely support and information. Patients told us that they could get support over the telephone if needed between appointments.

Involvement in decisions about care and treatment

Staff helped patients to be involved in decisions about care and treatment.

•Interpretation services were available for patients who did not have English as a first language. We saw notices in the reception areas, including in languages other than English, informing patients this service was available. Patients were also told about multi-lingual staff who might be able to support them. Information leaflets were available in easy read formats, to help patients be involved in decisions about their care.

•Patients told us through comment cards, that they felt listened to and supported by staff. They also told us they had sufficient time during consultations to make an informed decision about the choice of treatment available to them.

•Staff communicated with people in a way that they could understand, for example, communication aids and easy read materials were available.

Privacy and Dignity

The service respected patients’ privacy and dignity.

•Staff recognised the importance of people’s dignity and respect. However, the doors to the consultation rooms had clear glass panels. There were no screens available in the consultation room to obscure the view into the room. This was acknowledged during the inspection by the provider’s representative.

•Staff knew that if patients wanted to discuss sensitive issues or appeared distressed they could offer them a private room to discuss their needs.



Updated 27 March 2020

We rated responsive as Good because:

Responding to and meeting people’s needs

The service organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

•The provider understood the needs of their patients and improved services in response to those needs. The provider had reviewed their patient information leaflets and provided a quarterly magazine with appropriate seasonal guidance about lifestyle and healthy eating.

•The facilities and premises were appropriate for the services delivered. Where patients were not able to use the stairs to access the clinic the provider would direct them to other local clinics where step free access could be provided.

•Reasonable adjustments had been made so that people in vulnerable circumstances could access and use services on an equal basis to others. The parent company had made arrangements for an on-line translation service which included support for sign language.

Timely access to the service

Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

•Patients had timely access to initial assessment, test results, diagnosis and treatment.

•Waiting times, delays and cancellations were minimal and managed appropriately.

•Patients with the most urgent needs had their care and treatment prioritised.

•Patients reported that the appointment system was easy to use.

Listening and learning from concerns and complaints

The service took complaints and concerns seriously and responded to them appropriately to improve the quality of care.

•Information about how to make a complaint or raise concerns was available. Staff treated patients who made complaints compassionately.

•The service informed patients of any further action that may be available to them should they not be satisfied with the response to their complaint.

•The service had complaints policy and procedures in place. The service learned lessons from individual concerns, complaints and from analysis of trends. It acted as a result to improve the quality of care.



Updated 27 March 2020

We rated well-led as Good because:

Leadership capacity and capability;

Leaders had the capacity and skills to deliver high-quality, sustainable care.

•Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.

•Leaders at all levels were visible and approachable. They worked closely with staff and others to make sure they prioritised compassionate and inclusive leadership.

•The provider had effective processes to develop leadership capacity and skills, including planning for the future leadership of the service.

Vision and strategy

The service had a clear vision and credible strategy to deliver high quality care and promote good outcomes for patients.

•There was a clear vision and set of values. The service had a realistic strategy and supporting business plans to achieve priorities.

•The service developed its vision, values and strategy jointly with staff.

•Staff were aware of and understood the vision, values and strategy and their role in achieving them.

•The service monitored progress against delivery of the strategy.


The service had a culture of high-quality sustainable care.

•Staff felt respected, supported and valued. They were proud to work for the service.

•The service focused on the needs of patients.

•Leaders and managers acted on behaviour and performance inconsistent with the vision and values.

•Openness, honesty and transparency were demonstrated when responding to incidents and complaints. The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.

•Staff told us they could raise concerns and were encouraged to do so. They had confidence that these would be addressed.

•There were processes for providing all staff with the development they need. This included appraisal and career development conversations. All staff received regular annual appraisals in the last year. Staff were supported to meet the requirements of professional revalidation where necessary. Clinical staff were considered valued members of the team. They were given protected time for professional development and evaluation of their clinical work. We saw that arrangements were in place to hold regular clinical staff meetings. Information from these was shared with those members of the clinical team who were not able to attend.

•There was a strong emphasis on the safety and well-being of all staff.

•The service actively promoted equality and diversity. It identified and addressed the causes of any workforce inequality. Staff had received equality and diversity training. Staff felt they were treated equally.

•There were positive relationships between staff and teams.

Governance arrangements

There were clear responsibilities, roles and systems of accountability to support good governance and management.

•Structures, processes and systems to support good governance and management were clearly set out, understood and effective. The governance and management of partnerships, joint working arrangements and shared services promoted interactive and co-ordinated person-centred care.

•Staff were clear on their roles and accountabilities

•Leaders had established proper policies, procedures and activities to ensure safety and assured themselves that they were operating as intended.

Managing risks, issues and performance

There were clear and effective processes for managing risks, issues and performance.

•There was an effective, process to identify, understand, monitor and address current and future risks including risks to patient safety.

•The service had processes to manage current and future performance. Performance of clinical staff could be demonstrated through audit of their consultations, prescribing and referral decisions. Leaders had oversight of safety alerts, incidents, and complaints.

•Clinical audit had a positive impact on quality of care and outcomes for patients. There was clear evidence of action to change the service to improve quality.

•The provider had plans in place and had trained staff for major incidents.

Appropriate and accurate information

The service acted on appropriate and accurate information.

•Quality and operational information was used to ensure and improve performance. Performance information was combined with the views of patients.

•Quality and sustainability were discussed in relevant meetings where all staff had sufficient access to information.

•The service used performance information which was reported and monitored, and management and staff were held to account.

•The information used to monitor performance and the delivery of quality care was accurate and useful. There were plans to address any identified weaknesses.

•The service submitted data or notifications to external organisations as required.

•There were robust arrangements in line with data security standards for the availability, integrity and confidentiality of patient identifiable data, records and data management systems.

Engagement with patients, the public, staff and external partners

The service involved patients, the public, staff and external partners to support high-quality sustainable services.

•The service encouraged and heard views and concerns from the public, patients, staff and external partners and acted on them to shape services and culture. We saw that the clinic carried out regular feedback surveys.

•Staff could describe to us the systems in place to give feedback. The clinic carried out regular patient feedback surveys and there is also the opportunity to leave feedback about the clinic on the provider’s website. We saw evidence of feedback opportunities for staff and how the findings were fed back to staff. We also saw staff engagement in responding to these findings.

•The service was transparent, collaborative and open about performance.

Continuous improvement and innovation

There were systems and processes for learning and continuous improvement.

•There was a focus on continuous learning and improvement.

•The service made use of internal and external reviews of incidents and complaints. Learning was shared across all the provider’s locations and used to make improvements.

•Leaders and managers encouraged staff to take time out to review individual and team objectives, processes and performance.

•There were systems to support improvement work.