The Care Quality Commission
  • Doctor
  • Independent doctor

Archived: The London Travel Clinic at Wandsworth

Overall: Good read more about inspection ratings

90-92 Garratt Lane, London, SW18 4DD

Provided and run by:
London Travel Clinic Limited

All Inspections

17 Feb 2020

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focused follow up inspection on 17 February 2020 at London Travel Clinic Wandsworth to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 August 2019. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

  • There were systems in place to assess, address and mitigate the risks associated with fire and legionella.
  • The business continuity plan included contact details of all staff working in the service.
  • There were systems in place to review and update Patient Group Directions (PGDs).

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

16/08/2019

During a routine inspection

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

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 London Travel Clinic at Wandsworth as part of our inspection programme. The London Travel Clinic at Wandsworth is part of The London Travel Clinic which provides travel immunisations, treatment and advice to fee paying patients.

We had previously inspected this service as part of our unrated programme of independent health inspections. At our last inspection undertaken on 16 July 2018 we found that the service was in breach of regulation 12 (safe care and treatment) and regulation 17 (good governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection we found that the provider had not risk assessed the need for all recommended emergency medicines and not all emergency equipment on site was ready for use, the service had not taken appropriate action to ensure vaccines were safe to use and infection control risks and those associated with legionella had not been assessed. In addition; there was no ongoing programme of clinical improvement activity, there was no mechanism in place to gather, assess and act on patient feedback, there were no documented business continuity plans in place and there were no clear governance arrangements for the undertaking of safety risk assessments and checks for the premises, fire safety and infection control, legionella, the management of medicines, waste management and safeguarding.

At this inspection we found that most of these concerns had been resolved; however, the provider was not monitoring risks associated with legionella, the systems and processes around the management of fire were not sufficient and two patient group directions (PGDs) had expired.

The clinical nurse lead for the service 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.

Five patients provided feedback to CQC about the service. All patients said that staff provided helpful advice and were friendly and welcoming.

Our key findings were:

  • The provider had systems in place in relation to safeguarding.
  • Some risks were not adequately mitigated. For example legionella temperature monitoring was not being completed, there was no information available regarding the service’s fire marshals or assembly point.
  • Appropriate emergency equipment was available on site.
  • There were systems in place to report and discuss significant events.
  • There were systems in place to respond to safety alerts and most medicines were issued in line with legislation and guidance. However we found that two Patient Group Directions (PGDs) had expired.
  • Care and treatment provided was effective and met patient needs.
  • There were systems to review consultations, feedback to staff and implement improvements where needed.
  • Feedback from patients was positive about access to treatment and the care provided and there was a system for managing complaints.
  • Services were designed to respond to the needs of patients.
  • Leadership was visible and staff said that they felt happy to raise concerns or issues that arose.
  • Governance systems were present in most areas although there were some instances where the provider did not have effective systems in place to oversee risk.

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

  • Ensure that care and treatment is provided in a safe way.

The areas where the provider should make improvements are:

  • Include details of all staff working at the site in the business continuity plan.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

16 July 2018

During a routine inspection

We carried out an announced comprehensive inspection on 16 July 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 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.

Dr Stephen Alex Bobak is the registered manager at The London Travel Clinic at Wandsworth. 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.

The London Travel Clinic at Wandsworth is an independent travel clinic in London and provides travel health services including vaccinations, medicines and advice on travel related issues to both adults and children. The service operates under a contract to provide travel health to the patients of a GP practice located within the same building. Prior to our inspection patients completed CQC cards telling us about their experiences of using the service. Six people provided feedback about the service. All were positive about the care provided by clinical staff but two comments related to difficulties making appointments.

Our key findings were:

  • There were limited systems in place to keep patients safeguarded from abuse. Information about who to contact with a concern was not accessible to staff. Staff had received safeguarding training.
  • The system for managing medicines did not ensure they were safe to use.
  • Not all risks were assessed or well-managed.
  • The premises were clean; however, no infection control audits had been completed.
  • Procedures for managing medical emergencies were lacking.
  • Although the service had a standard operating procedure for this location it did not contain all necessary information. Other policies and procedures available were generic and did not reflect day to day practice at the service.
  • The complaint system was not advertised but the service would provide patients with an email address which they could contact after their appointment, to provide feedback.
  • The service had systems in place to respond to incidents. When incidents did happen, the service learned from them and improved.
  • The service reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, there was no evidence of activity which aimed to improve the quality of clinical care provided.
  • The appointment system reflected patients’ needs. Two comment cards indicated that patients found it difficult to make appointments at the service. NHS patients would be sent to the provider by their local GP.
  • Staff involved patients in their care and treated them with compassion, kindness, dignity and respect.
  • There was a lack of effective managerial oversight and some areas of governance were not sufficient to ensure safe care and that quality of services improved.

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 could make improvements and should:

  • Advertise the service’s complaints procedure and keep appropriate records of complaints received.

Establish processes for sharing information when necessary with a patient’s GP in the absence of patient consent.