All inspections: Qualified Circumcision Clinic

We carried out a review of the data available to us about Qualified Circumcision Clinic on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Qualified Circumcision Clinic, you can give feedback on this service.

This service is rated as Good overall. The service was last inspected on 8 February 2020 when it was rated Good overall, with a rating of Requires Improvement for the key question of Safe, and Good for all other key questions.

The key question inspected was rated as:

Are services safe? – Good

We carried out an focused desktop inspection at Qualified Circumcision Clinic to follow up on breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014. As a result of our inspection undertaken in February 2020, we issued the provider with a requirement notice under Regulation 17: Good governance due to areas of non-compliance we found. At this inspection, we looked across the key question of Safe in order to assess the improvement, and to review compliance with the requirement notice.

The service provided a circumcision service for children and adults for therapeutic and non-therapeutic reasons. The service is offered on a private, fee paying basis only, and is accessible to people who choose to use it.

The provider is the sole clinician for this service and carries out all of the circumcision procedures at the clinic.

At the previous inspection in February 2020 we found that in relation to the breach of Regulation 17: Good governance:

On the day of procedure, no checks were undertaken to formally verify and record the identity of parents, or those with legal parental authority, who had brought in a child to receive a circumcision.
Quality improvement and clinical audit activity was limited and lacked depth.
Information held in personnel and staff recruitment files was not sufficient to fully evidence staff suitability for their roles, and to identify any possible issues or concerns. Issues identified included a lack of references, and limited evidence of training attainment.

In addition, as part of this inspection we told the provider that they should make improvement to:

Undertake to update the consent policy to include references to mental capacity.

We checked all of these areas as part of this focused desktop inspection and found that the majority of these issues had been resolved. The only area which still required further improvement related to clinical audits, which although improved since the last inspection still lacked depth, scope and detail.

How we inspected this service

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This was a focused desktop inspection which looked at the key question;

Is it safe?
Clinicians and non-clinical staff were up to date with necessary training. This included basic life support.
The level of information held in staff personnel and recruitment files had increased and clearly showed information such as staff training attainment.

The inspection was undertaken via telephone interviews with the provider and physical review of documents on 23 January 2022.

Note: Within the report where there is reference to a parent or parents this also includes those who act as a legal guardian or legal guardians of an infant or child.

Our key findings were:

Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
The service had procedures in place regarding consent, and when required the formal identification of those with parental responsibility.
The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
There were systems, processes and practices in place to safeguard patients from abuse. We saw staff had received safeguarding training appropriate to their roles. In addition, consent procedures had been updated and included reference to individual mental capacity.
The service had increased the quality improvement work that had been undertaken by the service. However, it was noted that this activity was limited in scope, depth and detail in respects of methodology and improvements identified and made.

The area which the provider should make improvement is:

Improve the depth, scope and detail within clinical audits used to assess outcomes for patients and compliance with service standards.

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

This service is rated as Good overall. However, the service was rated as requires improvement for the provision of safe services.

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 Qualified Circumcision Clinic as part of our inspection programme.

The service provides circumcision to children and adults for both therapeutic and non-therapeutic reasons, and carries out post procedural reviews of patients who have undergone circumcision at the clinic.

Mr Altaf Mangera is the registered provider of the service and has the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

On the day of inspection we made the decision not to speak directly to service users. However, we received seven comment cards from people who had used the service. All these comment cards were positive about the care and treatment received. We were also able to view results of the provider’s own survey. This survey showed high levels of satisfaction.

Our key findings were:

The service was offered on a private, fee paying basis only and was accessible to people who chose to use it.
Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
The service had procedures in place regarding consent. We saw that 100% of records examined showed that they had obtained consent from both parents in the event that the circumcision was carried out on a child. However, whilst consent was discussed and verbally given when possible at the time of the booking consultation, there were no formal checks to verify the identity of those who brought children in for circumcision on the day of the procedure. The provider has since introduced formal identity checks, and this was confirmed during an inspection of another clinic operated by the provider which was carried out shortly after this inspection.
The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
There were systems and processes in place to safeguard patients from abuse. However, it was noted that following a change in national guidance in 2019, that some staff had not yet received child safeguarding training appropriate to their roles. We have since the inspection seen that child safeguarding training had been undertaken, and that staff had received training to the appropriate level.
The service communicated with the GP service which patients were registered with via letters sent post-procedure. This correspondence notified the GP of the procedure, and also contained information and advice on supporting the recovery process.
The service had developed materials for parents/service users which explained the procedure and outlined clearly the recovery process.
The service operated a 24-hour advice line which allowed service users to contact them with any concerns post-procedure.
Some quality improvement activity was undertaken. However, this was limited to logging retrospective complications which were raised by service users, and via an in-house satisfaction survey which was sent to a proportion of those who had used the service.
The provider corresponded with the host GP practice from which the service operated and gained assurance through this that the host practice had carried out necessary checks and controls for health, safety and welfare purposes.
There was a clear leadership structure. To give added oversight the service had established a governance board which examined key decisions and areas of work such as changes in practice, and complaints and incidents.
Staff personnel files were kept. However, it was noted that these did not contain information regarding the suitability of staff members for the role on recruitment. In addition, we were unable to verify that all non-clinical staff had received training in basic life support.
The service valued feedback from service users. Comments and feedback for the clinic showed high satisfaction rates.
Communication between staff was effective and we saw that meetings and post- sessional debriefings were being held.

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 area where the provider should make improvement is:

Improve the consent policy to include references to mental capacity.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Qualified Circumcision Clinic

All Inspections

6 July 2023

During a monthly review of our data

23 January 2022

During an inspection looking at part of the service

8 February 2020 to 8 February 2020

During a routine inspection