The Silverthorn Centre

Updated 6 June 2019

The service is provided by ESS Primary Care which runs dermatology clinics in the Waltham Forest area, a local authority in the North East of London. It provides NHS funded treatment through referrals by local GP practices. The service holds contracts with Waltham Forest Clinical Commissioning Group (CCG) and Barts Health. Referrals are made by email from Barts Health Outsourcing Team or by E-referral from GPs. Services provided include face to face consultations, examinations and minor surgery (skin biopsies, curettage and cautery, excisions and cryotherapy).

The service is located within The Silverthorn Centre, an NHS owned property which houses a number of other services including a GP practice, a phlebotomy service and an eyecare service. The provider operates services from another local GP practice and its own premises from which it provides private dermatology, minor surgery and aesthetic treatments. These premises were not visited as part of this inspection.

The service’s booking office is open Monday to Friday from 9am to 4.30pm. Clinical sessions are held from the Silverthorn Centre on Wednesdays from 9am to 4.30pm and Thursdays from 8.30am to 12pm. Dermatology surgical sessions also take place on a Tuesday and Thursday.

The provider consists of three company directors, one of whom is also the registered manager of this service and also oversees the day to day functions of the service. A registered manager is a person who is registered with the CQC 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. There is a multidisciplinary team consisting of three consultant dermatologists, 12 GPs with special interest in Dermatology (male and female), three healthcare assistants and 10 administrative/secretarial staff.

The service is registered with the CQC to provide the following regulated activities: Diagnostic and screening procedures, Surgical procedures and Treatment of disease, disorder or injury.

Our inspection team was led by a CQC lead inspector who was supported by a GP specialist adviser.

The inspection was carried out on 24 April 2019. During the visit we:

• Spoke with the nominated individual who is also the registered manager of the service (a nominated individual is a person who is registered with the CQC to supervise the management of the regulated activities and for ensuring the quality of the services provided).

• Spoke with clinical and non-clinical team members.
• Reviewed a sample of patient care and treatment records.
• Reviewed comment cards in which patients shared their views and experiences of the service.

How we inspected this service

We asked for CQC comment cards to be completed by patients prior to the inspection. We received 47 completed comment cards about the service. Comments were almost all positive; describing an efficient, professional and friendly service. During the inspection we interviewed staff, carried out observations of the premises and reviewed patient records and other service related documents.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 6 June 2019

This service is rated as Good overall.

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 Silverthorn Centre as part of our inspection programme. The service had not been previously inspected.

The service is a specialist dermatology clinic which provides NHS funded treatment through referrals by local GP practices. The service is commissioned by Waltham Forest Clinical Commissioning Group.

We received 47 completed comment cards about the service. Comments were almost all positive; describing an efficient, professional and friendly service. One patient commented about confusion caused by lack of clear signs directing patients to where the service is located. Another patient reported to have experienced long waits between appointments and perceived lack of availability of urgent appointments, however this was not representative of the overall patient experience.

Our key findings were:

• The service had systems to assess, monitor and manage risks to patient safety, and reliable systems for appropriate and safe handling of medicines. The service learned from, and made changes as a result of, incidents and complaints.
• The service assessed need and delivered care in line with current legislation, standards and evidence based guidance, and reviewed the effectiveness and appropriateness of the care provided through clinical audits.
• The service treated patients with kindness, respect and compassion, and patient feedback was positive about the service experienced.
• The service organised and delivered services to meet patients’ needs.
• There was a clear leadership structure in place, and staff told us that they felt able to raise concerns and were confident that these would be addressed.
• The service had a governance framework in place, which supported the delivery of quality care, and processes for managing risks, issues and performance.

The areas where the provider should make improvements are:

• Review the stock of emergency medicines available and carry out a risk assessment of which drugs are or are not necessary to be held.

• Review consent processes in respect of minors to ensure consistent recording of their relationship to their accompanying adult.

• Review translation procedure of written information to ensure service used provides accurate translation, particularly in the case of medical terminology.

• Review protocol for laboratory requests to ensure it reflects the agreed updated procedure.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care