The Care Quality Commission
  • Doctor
  • Independent doctor

The London Migraine Clinic

Overall: Requires improvement read more about inspection ratings

2-4 Bulls Head Passage, London, EC3V 1LU

Provided and run by:
Mountainside Limited

All Inspections

30 May 2022

During an inspection looking at part of the service

We previously carried out an announced inspection of The London Migraine Clinic on the 8 February 2022. Where we found the practice was in breach of Regulations 17 Good Governance and 12 Safe Care and Treatment of the Health and Social Care Act 2008. In line with the CQC’s enforcement processes, we issued warning notices which required The London Migraine Clinic to comply with the regulations by the 5 May 2022.

At the commencement of the inspection the provider submitted a log of the actions they had taken in response to the warning notice for the breach of regulation 17 and explained they had not received the warning notice of the breach of regulation 12. However, they had partly complied with the warning notice as some of the concerns were reflected in the regulation 17 warning notice.

The London Migraine Clinic is currently rated as requires improvement overall and requires improvement for providing a safe, effective, and well-led service and good for providing a caring and responsive service.

The full report of the practice’s previous inspection can be found by selecting the ‘all reports’ link for The London Migraine clinic on our website at www.cqc.org.uk.

The London Migraine Clinic is a private clinic offering treatment for migraines, bruxism and hyperhidrosis to adults and children aged over 12 years. All services were private and subject to payment of fees, with no NHS services provided. The provider was registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some general exemptions from regulation by CQC, relating to particular types of service and these are set out in Schedule 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, The London Migraine Clinic refers patients on to a piercer for daith (ear cartilage) piercing as a migraine treatment, which is not within CQC scope of registration. Therefore, we did not inspect this service.

The provider consists of one doctor, who was also the CQC registered manager. A registered manager is a person who is registered with the 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.

We carried out this announced focused warning notice inspection on 30 May 2022 at The London Migraine Clinic to check whether the provider had addressed the issues in the warning notice and now met the legal requirements.

At the inspection on 30 May 2022, we found the provider was taking action to reach compliance, however further work was required to embed this fully and demonstrate sustainability. This report covers our findings in relation to those specific areas, is not rated, and does not change the current ratings held by the practice.

Our key findings were:

  • Staff had completed safeguarding training appropriate to their level.
  • The provider had systems in place to support the safe recruitment of staff.
  • The provider had a risk assessment in place to support the decision of which emergency medicines and equipment they held at the service.
  • The provider had a system in pace to manage safety alerts from the Medicines and Healthcare Products Regulatory Agency (MHRA).
  • The provider had incorporated the request for evidence of parental responsibility in the patient details form which was completed during admission to the service.
  • The provider had started to collect data which enabled them to carry out a clinical and patient feedback audits. At the time of the inspection, they had received feedback from 10 patients about their experience of the service and outcome of the treatments.
  • During the inspection, we saw that the safeguarding policies did not have a date implemented or when they were last reviewed. Therefore, although the provider has made improvements to the policies documented in the warning notice, further work was required to ensure all policies were reviewed and updated.

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

08/02/2022

During a routine inspection

This service is rated as Requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at The London Migraine Clinic on 8 February 2022 as part of our inspection programme. This was the first CQC inspection of this location.

The London Migraine Clinic is a private clinic offering treatment for migraines, bruxism and hyperhidrosis to adults and children aged over 12 years. All services are private and subject to payment of fees, with no NHS services provided.

The provider is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some general exemptions from regulation by CQC, relating to particular types of service and these are set out in Schedule 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, The London Migraine Clinic refers patients on to a piercer for daith (ear cartilage) piercing as a migraine treatment, which is not within CQC scope of registration. Therefore, we did not inspect these services.

The provider consists of one doctor, who is also the CQC registered manager. A registered manager is a person who is registered with the 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.

Our key findings were:

  • There were gaps in safeguarding knowledge and training.
  • There was an absence of appropriate staff recruitment checks to ensure safety.
  • There was no system to manage safety alerts.
  • No infection control audit had been completed.
  • Blank prescriptions were not stored securely.
  • There were gaps and risks in relation to arrangements for emergency medicines and equipment.
  • Staff had not completed, and were not required to complete, training and this had not been risk assessed.
  • There were no systems to monitor the effectiveness of care and treatment provided, as the provider had not completed any clinical audits or quality improvement activity.
  • Treatment outside of National Institute for Health and Care Excellence (NICE) guidelines was not documented as having been communicated to patients.
  • There was no system to ensure that staff had the skills, knowledge and experience to carry out their roles.
  • Leaders could not demonstrate that they recognised and understood the challenges to quality and sustainability.
  • Some of the service’s policies were not service-specific, were missing, did not contain required information, or were not being followed by staff.
  • There were no systems, or ineffective systems, in place to manage and mitigate risks, issues and performance.
  • Patients were supported to manage their own health and live healthier lives.
  • The service treated patients with kindness, respect and compassion.
  • Patient feedback was positive about the service and the provider.
  • Patients were able to access care and treatment from the service within an acceptable timescale for their needs.
  • Staff described the service as open and supportive. Non-clinical staff we spoke with said they felt able to raise any concerns with the provider.

The areas where the provider must make improvements are:

  • 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.

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

The areas where the provider should make improvements are:

  • Review the storage arrangements for records of patients referred to the piercer to ensure they are secure.
  • Review arrangements for signing and dating sharps bins when assembling and for secure siting of sharps bins.
  • Review the arrangements for alerting patients that there is limited disabled access to the premises.

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