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CQC takes action to protect patients using PCP Clapham substance misuse service

17 September 2015
  • Media

The Care Quality Commission (CQC) has taken enforcement action to prevent a substance misuse service in south west London from offering treatment for detoxification to patients withdrawing from opiate drugs or alcohol until adequate arrangements are in place to provide safe care.

PCP Clapham Ltd provides a day therapy service for people with substance misuse problems, including rehabilitation and alcohol and opiate detoxification where needed.

CQC inspectors visited the service during May and July 2015, and identified serious concerns regarding the care and treatment of patients withdrawing from opiate drugs or from alcohol.

Inspectors found that management did not provide staff with the appropriate support, training or supervision to enable them to care for patients safely.

The majority of staff had not been trained in how to recognise or manage the potentially dangerous complications of withdrawal from alcohol and drugs, and only had superficial knowledge of the signs and symptoms they needed to look for. Between January 2014 and May 2015 there were three incidents of patients suffering seizures during withdrawal from alcohol.

Using its enforcement powers, CQC has restricted the provider from admitting patients who require assisted withdrawal from alcohol or opiate drugs until appropriate systems and procedures are established.

CQC has also told the provider that it must take action to ensure safe care and treatment is provided to patients, effective governance systems and staff procedures are implemented and fully embedded, and that the skills and experience of people offered employment is checked before they start work.

A full report of the inspection has been published on the CQC website:

Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and CQC lead for mental health, said:

"Our inspection at PCP Clapham identified an unacceptable level of risk to patients. We have taken enforcement action to protect the welfare of patients and the public.

“We found that most staff, other than the recently-appointed nurse, had not been trained in the complications of withdrawal from alcohol or opiates and had only a superficial knowledge of the signs and symptoms they needed to look out for.

“It is clear that the service was not safe enough and did not ensure that its staff had the appropriate support, training, supervision or appraisal to enable them to carry out their duties safely and effectively.

“It is essential that PCP Clapham takes urgent and sustained action to ensure the safety of patients that come under its care. “We will return to check that the necessary improvements have been made before we consider lifting this restriction and allowing PCP Clapham to once again offer treatment for detoxification.”


For further information please contact Yetunde Akintewe, CQC Regional Engagement Manager, on 07471 020 659. For media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the press office is unable to advise members of the public on health or social care matters.)

For general enquiries, please call 03000 61 61 61.

Last updated:
29 May 2017

Notes to editors


In July 2015, CQC began announcing comprehensive inspections of independent standalone substance misuse services. Initially, these services will be inspected without the provision of a rating, although CQC is working closely with the Department of Health to clarify its’ regulatory powers.


Further details are available in the CQC provider handbook on specialist substance misuse services:


About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.