Mount Pleasant Medical Centre

We carried out an announced, responsive unrated inspection at Mount Pleasant Medical Centre on 2 December 2021 to assess the safety of non-therapeutic male circumcision procedures following some information of concern.

Our previous inspection report of 15 June 2016 rated the practice as Good overall and Good for all the key questions and population groups. The June 2016 inspection did not inspect the non-therapeutic male circumcision service.

The full report of the previous inspection can be found by selecting the ‘all reports’ link for Mount Pleasant Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

The inspection was an announced, responsive site visit inspection to follow-up on information of concern about male circumcision services at the practice.

The focus of this inspection was the non-therapeutic male circumcision service only, which was provided by one of the male GP partners at the practice. The service provided circumcision services on a private, fee-paying basis to infants, under the age of one year old. The service is carried out under the practice’s Care Quality Commission (CQC) registration for the Regulated Activity surgical procedures.

Prior to the on-site inspection, we found that the practice’s registered manager had left the practice in July 2020. The registered manager had not been removed from the provider’s registration or another registered manager application submitted. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered people. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. At this inspection the practice demonstrated that a registered manager application had been submitted. It was proposed that the lead GP partner would be the registered manager.

How we carried out this inspection

Throughout the COVID-19 pandemic, the Care Quality Commission (CQC) has continued to regulate and respond to risk. We carried out a site visit inspection of this location. During the inspection we:

• Spoke with the GP who undertook the circumcisions to explore clinical oversight and how decisions were made.
• Spoke with the practice management team and reviewed facilities, premises, equipment and infection prevention and control.
• Reviewed a selection of patient records.
• Reviewed some key policies and procedures and systems and processes in relation to safety and governance of the service.

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

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

Our findings

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected.
• Information from the provider.

We found that:

• The service was offered on a private, fee paying basis only and was accessible to people who chose to use it. Patients did not have to be registered at the practice.
• Circumcision procedures were safely managed, which included patient support and aftercare.
• There were systems and processes in place to safeguard patients from abuse.
• The service had procedures in place to confirm the identity of the infant and that an adult accompanying the infant had parental authority.
• The service had a procedure in place regarding consent, which was documented.
• The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients.
• Staff had the relevant skills, knowledge and experience to deliver the care and treatment offered by the service.
• Some quality improvement activity was undertaken in relation to patient outcomes. However, this was limited as the service did not routinely undertake post-procedure follow-up.
• The service had developed an information sheet for parents/guardians which explained the procedure and outlined the recovery process. However, this was only available in the English language.
• The service gathered feedback from service users through a questionnaire.

The areas where the provider should make improvements are:

• Develop the practice’s safeguarding policies to include reference to safeguarding procedures in relation to the circumcision service.
• Undertake to record the patient clinical information obtained through the pre-assessment telephone consultation.
• Undertake to record on the practice’s clinical system if the infant is a registered patient of the practice.
• Provide the discharge summary directly to the infant’s GP where they are not a patient of the practice.
• Implement routine post-procedure follow-up with all parents/guardians to further drive quality improvement.
• Develop post-procedure information leaflets in other languages and include information about how to complain.

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