The Care Quality Commission
  • Hospital
  • Independent hospital

BPAS - Stratford upon Avon

Overall: Good read more about inspection ratings

Rother House Medical Centre, Alcester Road, Stratford-upon-avon, CV37 6PP

Provided and run by:
British Pregnancy Advisory Service

All Inspections

During an assessment of Termination of pregnancy

Our view of the service we carried out the comprehensive assessment on the 1 July 2026 the assessment was undertaken due to the length of time since the previous assessment at the service which had been carried out using previous inspection methodology at this assessment we assessed all quality statements in all key questions under our single assessment framework and we rated this service good overall

The inspection team included a lead inspector a second inspector and a specialist advisor with expertise in midwifery and maternity we spoke with 11 staff 5 patients and checked 10 patient records as part of this inspection.

The service had enough staff to care for patients and keep them safe staff had training in key skills understood how to protect patients from abuse and manage safety well. The service-controlled infection risk well.

Staff assessed accessible information policy risk to patient acted on them and kept good care records stuff manage medicines well

The service had a good learning culture, and people could raise concerns patients were protected and kept safe the facilities and equipment met the needs of people were clean and well maintained and any risks mostly mitigated

People were active partners in the assessment of their needs managers monitored the effectiveness of the service and made sure staff are competent staff work well together for the benefit of patients and support them to make decisions about their care and treatment, and had access to good information the service had policies and care pathways in place that were in line with national guidance.

There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care staff involved patients in planning any changes.

The service completed a range of audits, including manual handling health and safety and duty of candour

Patients had access to good information. Key services were available 5 days a week

Staff treated patients with compassion and kindness respected their privacy and dignity took account of their individual needs and help them understand the treatment they provided emotional support to patients in a professional and non judgmental way.

The service planned and provided care in a way that met the needs of local people, and the communities served it also worked with others in the wider system and local organisations to ensure safe care and treatment

The service provided person centred care and treatment with patients actively involved in decisions about their treatment.

Information was communicated to patients in a way they could understand patients knew how to provide feedback.

Patients received fair and equal care and treatment patients were involved in planning their treatment and understood options around choosing to withdraw or not receive care.

Leaders run services well using reliable information systems and supported staff to develop their skills staff understood their roles and responsibilities the services vision and values and how to apply them in their work staff felt respected supported and valued they were focused on the needs of patients receiving care.

Leaders were visible knowledgeable and supportive helping staff develop in their roles staff felt supported to give feedback and were treated equally free from bullying or harassment.

The service engaged well with patients and the community to plan and manage services, and all staff were committed to improving services continually.

There was a culture of continuous improvement.

During an assessment of the hospital overall

British Pregnancy Advisory Service (BPAS) Stratford-upon-Avon is operated by the British Pregnancy Advisory Service (BPAS) and is a not-for-profit charitable organisation with 70 locations in England. BPAS Stratford-upon-Avon clinic is the main clinic in Stratford-upon-Avon, with other sites available in Coventry and Nuneaton.

The service provides the following: pregnancy testing, unplanned pregnancy counselling consultations, medical abortion, abortion aftercare, miscarriage management, sexually transmitted infection testing and treatment, contraceptive advice and contraception supply. The service provides care and treatment for women and girls aged 13 years and over.

BPAS Stratford-upon-Avon did not provide on-site surgical abortion services. Women who required a surgical abortion were referred to another BPAS location or appropriate provider elsewhere in England to access this procedure.

On the 1st of July 2026 we inspected the service. This was a comprehensive assessment of services provided at this location. The inspection was undertaken due to the length of time since the service was previously inspected.

At this inspection we assessed all the quality statements in all key questions under our single assessment framework. This has resulted in updated ratings. Whilst this is not the first inspection of the service it is the first inspection of the service under the new methodology.

At our last inspection, we rated the service as Requires Improvement. At this assessment, the overall rating has improved to Good. This means people were safe, received effective care and treatment, and experienced services that were caring, responsive and well led. The service had made improvements in the areas previously rated Requires Improvement and now achieved Good ratings across all key questions.

27 April 2022

During a routine inspection

British Pregnancy Advisory Service (BPAS) Stratford Upon Avon is operated by British Pregnancy Advisory Service and was inspected as part of CQC’s comprehensive inspection programme. BPAS Stratford Upon Avon has not been inspected since it was registered in June 2019. BPAS Stratford Upon Avon has two satellite services in Coventry and Nuneaton and is called the ‘Stratford Upon Avon hub’. The BPAS Stratford Upon Avon hub provide termination of pregnancy services for women in Stratford Upon Avon, Coventry and Nuneaton and the surrounding areas.

From 1 April 2021 to 31 March 2022, the Stratford Upon Avon hub completed a total of 1896 early medical abortions (less than nine weeks six days pregnant). Of this total 799 were completed at the Stratford Unit Avon, 688 at Coventry and 409 at Nuneaton.

Prior to the inspection, inspectors reviewed monitoring and ongoing information about the service.

We rated this location it as requires improvement because:

  • Women did not have timely appointments and had to wait longer than national guidance and there could be a delay in women receiving treatment.
  • Requirements of the duty of candour were not fully met.
  • Not all medicines were stored appropriately.
  • Timely statutory notifications were not always made to The Care Quality Commission

However:

  • The service had enough staff to care for women and keep them safe. Staff had training in key skills, understood how to protect women from abuse. The service controlled infection risk well. Staff assessed risks to women, acted on them and kept good care records.
  • Staff provided good care and treatment and there were appropriate arrangements to ensure women had appropriate pain relief. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women, families and carers.
  • The service made it easy for people to give feedback.
  • Leaders ran services using information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of women receiving care. Staff were clear about their roles and accountabilities. The service engaged well with women and the community to plan and manage services and all staff were committed to improving services continually.