8 June 2022
The MC Clinic Ltd provides medical treatment for patients focused around the use of cannabis-based products for medicinal use (CBPMs) by medical staff working within government guidelines. The service is located at 10 Harley Street, London, W1G 9PF. The building entrance lobby is accessed via steps from the pavement. Wheelchair access is via a ramp at the front of the building. The service has access to two consultation rooms and a waiting area for patients. However, at the time our inspection most consultations were taking place online due to Covid–19.
The opening hours are 9am to 6pm with patients’ appointments between 9.30am and 5pm. Patients can also book appointments for evenings and weekends. The medical team comprises of nine consultants who specialise in Psychiatry, Pain and Neurology. There is also a managing director, head of operations, clinic nurse advisor and nine patient services coordinators.
The service treats a range of conditions including pain, psychiatric conditions, neurological conditions, gastroenterological, cancer and palliative care.
How we inspected this service
We reviewed information sent to us by the provider remotely prior to attending the site to reduce the time spent on site in line with our Covid- 19 inspecting guidance. We spoke with the managing director, clinical director, registered manager, one of the consultants, head of operations and administrative staff. We looked at records related to patient assessments and the provision of care and treatment. We also reviewed documentation related to the management of the service. We reviewed patient feedback provided to a third party.
To get to the heart of patients’ experiences of care and treatment, we asked the following three questions:
- Is it safe?
- Is it effective?
- Is it well-led?
These questions therefore formed the framework for the areas we looked at during the inspection.
8 June 2022
We carried out an announced comprehensive inspection at The Medical Cannabis Clinic on 1 & 9 March 2022 ( Previous inspection May 2021 rated Good). Following this inspection it is rated as Requires Improvement overall.
We looked at three key questions and they are rated as:
Are services safe? – Requires improvement
Are services effective? – Requires improvement
Are services well-led? – Inadequate
We carried out this announced focused inspection of The Medical Cannabis Clinic under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions and to follow up on breaches of regulation we identified in a compliance review in May 2021 and to follow up on information of concern that we had received. At the inspection carried out in May 2021 we found they were not operating effective systems and processes to ensure good governance in accordance with the fundamental standards of care, in particular:
- Some policies did not provide clear guidance to clinical staff such as the medicines management and the prescribing policy in relation to how consent is obtained and what information is given to patients about unlicensed drug use.
- There was no formal recruitment and selection process for clinical staff and no skills assessment process for managerial staff.
- The provider did not have a formal system for carrying out clinical audits and quality improvement.
- Patients were not provided with clear information about external factors that may delay receipt of their medication
At this focused inspection on 1 & 9 March 2022 we looked at the domains of Safe, Effective and Well-led. We found that although some improvements had been made, we found further concerns and served Warning Notices on the provider in relation to breaches of Regulations 12 (Safe Care & Treatment) and Regulation 17 (Good Governance)
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations
The Medical Cannabis Clinic provides medical treatment for patients focused around the use of Cannabis Based Products for Medicinal Use (CBPMs) by experienced medical staff working within the government guidelines.
At the time of our inspection the provider was in the process of recruiting a registered manager and the head of operations was undertaking these duties. 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.
We did not speak directly with patients during the inspection.
Our key findings were:
- The provider had systems in place to protect people from avoidable harm and abuse.
- All staff we spoke with felt valued by the leaders and said there was a high level of staff support and engagement.
- Individual care records did not always indicate what the patient was being treated for.
- There were no details of discussion in Multi Disciplinary Team (MDT) meetings to demonstrate robustness of decision making.
- The provider did not have effective processes in place to assess the competencies of all staff they employed in order to plan appropriate training and development.
- The policies relating to medicines and prescribing of cannabis based medicinal products did not cover important operational aspects of the service and were not always followed.
- We found there was a lack of transparency with patients as regards pharmacy choice.
- Clinical outcomes audits did not contain sufficient details about patient outcomes to provide an adequate evaluation of the treatments prescribed.
- Patients could access care and treatment from the service within an appropriate timescale for their needs.
- There was a commitment and appetite to work with external partners to share learning and make the service as accessible as possible.
- A nurse led aftercare support service had been launched to provide additional support to patients managing chronic pain. This has had some positive feedback from patients.
The areas where the provider must make improvements as they are in breach of regulations 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.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care