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Inspection carried out on 7 August 2019

During a routine inspection

We carried out an announced comprehensive inspection at Fast Medica Ltd to follow up on breaches of regulations.

We carried out an announced focused inspection on 24 April 2019. This was to follow-up on two warning notices the Care Quality Commission served following an announced comprehensive inspection on 19 December 2018 when the provider was not providing safe, effective and well-led care in accordance with the relevant regulations. The inspection on 19 December 2018 highlighted several areas where the service had not met the standards of regulations. We checked these areas as part of a focused inspection on 24 April 2019 and this comprehensive inspection on 7 August 2019 and found this had been resolved.

The previous inspection reports can be found by selecting the ‘all reports’ link for Fast Medica Ltd on our website at www.cqc.org.uk.

Fast Medica Ltd is an independent clinic in the London Borough of Ealing and provides private primary medical services. The service offers services for adults and children. Most of the patients seen at the service are from the Polish speaking community. Medical consultations and diagnostic tests are provided by the clinic; however, no surgical procedures are carried out.

One of the directors 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.

Twenty seven people provided feedback about the service, which was positive about the care and treatment offered by the service. They were satisfied with the standard of care received and thought the doctors were approachable, committed and caring. They said the staff were helpful and treated them with dignity and respect.

Our key findings were:

  • The service had demonstrated improvements in all areas highlighted in the previous inspection in December 2018.
  • The service had appointed a clinical lead to ensure the delivery of safe and effective care.
  • The service had reviewed and improved their clinical governance systems.
  • The service had implemented reliable systems for appropriate and safe handling of medicines and the ultrasound scans.
  • The service was involved in quality improvement activity.
  • The service had implemented systems to undertake quality monitoring of clinicians’ performance including the handling of ultrasound scans.
  • Consultation notes and the scan results were documented in the English language, which included complete, legible and accurate information in an accessible way.
  • The service had developed a clinical risk management template to consider how they would manage the risk when offering the baby scans when consent to share information with the woman’s NHS GP was not given.
  • Service specific policies were reviewed and updated. However, they had not always assured themselves that they were operating as intended. For example, some patients had not received coordinated care, because the service had not followed their own policy to encourage patients to share the details of their consultations with their registered GP or regular physician when required to ensure safe and effective delivery of care. The service had not communicated effectively when patients declined, as they had not recorded in the patient’s records that they had tried to persuade them to permit this, in situations in which this would be important.
  • The service had taken steps to improve recruitment processes.
  • Appointments were available on a pre-bookable basis. The service provided only face to face consultations.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Information about services and how to complain was available.
  • The service was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Carry out calibration of medical equipment according to manufacturers’ instructions.
  • Follow your own complaints policy and register with an appropriate organisation to ensure the complainant’s right to escalate the complaint if required.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 24 April 2019

During an inspection looking at part of the service

We carried out an announced focused inspection of Fast Medica Ltd on 24 April 2019. This was to follow-up on two warning notices the Care Quality Commission served following an announced comprehensive inspection on 19 December 2018 when the provider was not providing safe, effective and well-led care in accordance with the relevant regulations.

The warning notices, issued on 18 January 2019, were served in relation to regulation 12: Safe care and treatment, and regulation 17: Good governance, of the Health and Social Care Act 2008. The deadline given to meet the requirements of the warning notices was 16 April 2019.

The inspection on 19 December 2018 highlighted several areas where the provider had not met the standards of regulations. We found:

  • There was a lack of good governance and limited evidence of quality improvement activity to review the effectiveness and appropriateness of the care provided. There was a lack of effective clinical leadership.
  • The service did not have reliable systems for appropriate and safe handling of medicines and ultrasound scans.
  • The service was unable to provide evidence that the consultations of all clinicians were undertaken in line with accepted best practice in the UK or had a documented rationale for alternative treatment provided.
  • Prescribing was not audited or reviewed to identify areas for quality improvement.
  • There was insufficient quality monitoring of clinicians’ performance.
  • Appropriate recruitment checks were not always undertaken prior to employment.

The comprehensive report from the December 2018 inspection can be found by selecting the ‘all reports’ link for Fast Medica Ltd on our website at www.cqc.org.uk and should be read in conjunction with this report.

At the inspection on 24 April 2019, we found that actions had been taken to improve the provision of safe, effective and well-led care services in relation to the warning notices. Due to the focussed nature of this inspection, we have not rated the service. We will conduct a further comprehensive inspection within six months of publication of the report of the inspection undertaken in December 2018.

Our key findings were:

  • The service had demonstrated improvements in all areas highlighted in the warning notices.
  • The service had appointed a clinical lead to ensure the delivery of safe and effective care.
  • The service had reviewed and improved their clinical governance systems.
  • The service had implemented reliable systems for appropriate and safe handling of medicines and the ultrasound scans.
  • Service specific policies were reviewed and updated.
  • The service was involved in quality improvement activity.
  • The service had implemented systems to undertake quality monitoring of clinicians’ performance including the handling of ultrasound scans.
  • Consultation notes and the scan results were documented in the English language, which included complete, legible and accurate information in an accessible way.
  • The service had developed a clinical risk management template to consider how they would manage the risk when consent to share information was not given.
  • The service had taken steps to improve recruitment processes.
  • The service had implemented a formal monitoring system to ensure that regular safety checks had been undertaken by the host who was responsible for managing the premises.
  • We noted that the previous Care Quality Commission inspection report had not been shared on the service’s website. However, the service informed us that it was shared on the service’s website a day after the inspection and we noted it was shared on the website.

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

Inspection carried out on 19 December 2018

During a routine inspection

We carried out an announced comprehensive inspection on 19 December 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Fast Medica Ltd is an independent clinic in the London Borough of Ealing and provides private primary medical services. The service offers services for adults and children. Most of the patients seen at the service are from the Polish speaking community. Medical consultations and diagnostic tests are provided by the clinic however no surgical procedures are carried out.

One of the directors is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (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.

Twenty eight people provided feedback about the service, which was positive about the care and treatment offered by the service. They were satisfied with the standard of care received and thought the doctor was approachable, committed and caring. They said the staff were helpful and treated them with dignity and respect.

Our key findings were:

  • There was a lack of good governance and limited evidence of quality improvement activity to review the effectiveness and appropriateness of the care provided. There was a lack of effective clinical leadership.
  • The levels of risk found at this inspection was a direct result of the provider not ensuring appropriate systems had been implemented to effectively identify, manage and mitigate risk.
  • Information needed to deliver safe care and treatment was not always available to the relevant staff in a timely manner.
  • The service did not have reliable systems for appropriate and safe handling of medicines and ultrasound scans.
  • The service was unable to provide evidence that the consultations of all clinicians were undertaken in line with accepted best practice in the UK or had a documented rationale for alternative treatment provided.
  • Prescribing was not audited or reviewed to identify areas for quality improvement.
  • There was insufficient quality monitoring of clinicians’ performance.
  • Patient identity was not always verified.
  • Appropriate recruitment checks were not always undertaken prior to employment.
  • Some policies and protocols did not include sufficient information.
  • Appointments were available on a pre-bookable basis. The service provided only face to face consultations.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Information about services and how to complain was available.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • The provider demonstrated a willingness to work with CQC to improve the quality and effectiveness of the service.

We identified regulations that were not being met and the provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider should make improvements:

  • Review systems to verify a patient’s identity on registering with the service.
  • Review the policy for offering the baby scans when consent to share information with the woman’s NHS GP is not given.
  • Arrange an active signposting training for the non-clinical staff members.
  • Review contents of the registration questionnaire regarding administration charges for sharing information with the NHS GP.
  • Implement a system for the effective management of blank prescription pads.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice