Atlantic Clinic Ltd

Letter from the Chief Inspector of General Practice

We carried out an announced inspection at Atlantic Clinic Ltd on 27 June 2016.

Our previous inspection in January 2016 had found the service was not providing safe, effective and well led care in accordance with the relevant regulations. It was providing caring and responsive care in accordance with the relevant regulations. As a result of the inspection there were requirement notices and a warning notice. The timescale given to meet the warning notice was 30 May 2016.

The warning notice was served related to regulation 17 Good governance.

Areas which did not meet the regulations in January 2016 were:

• There were not effective systems or processes to assess monitor and improve the quality and safety of the services provided in the carrying on of the regulated activities.
• There was not a maintenance of records in relation to persons employed in the carrying on of the regulated activity and the management of the regulated activity.
• There was a lack of sufficient clinical auditing within the service to ensure the regular monitoring of the quality of care and treatment provided and the implementation of changes to improve patient treatment outcomes.
• There was a lack of overarching governance arrangements within the service to support the delivery of good quality care and a lack of evidence of continual learning and improvement.
• There are no formal systems or processes in place to monitor the use of best practice guidance information to deliver care and treatment which meets patients’ needs.
• Lack of formal systems and processes to review the on-going learning needs of staff.

The requirements notices were in relation to the need to make improvements. The provider was asked to:

• Ensure regular maintenance and servicing of all steam sterilisers within the service.
• Establish clear processes and procedures which ensure the effective cleaning, decontamination and tracking of all reusable instruments used within the service.
• Ensure systems are in place to monitor and manage risks associated with national patient safety alerts within the service.
• Ensure all necessary and relevant checks are undertaken for all staff prior to employment.
• Ensure all staff receives regular supervision and appraisal which reflects their full scope of work, including those doctors providing services to patients on a sessional basis.
• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure clinical audits are used to promote continuous improvement and improve patient outcomes, including auditing of dental x-rays.
• Ensure staff undertake training to enable them to undertake their role, including training in basic life support and chaperoning and where required, dental nurse training.

At our inspection on 27 June 2016 we found the service had complied with the warning notice and was now compliant with the regulations as set out both in the warning notice and the requirement notices. The service was now providing safe, effective and well led care.

Our Key findings were:

• There were regular maintenance and servicing of all steam sterilisers within the service.
• There were clear processes and procedures for effective cleaning, decontamination and tracking of all reusable instruments used within the service.
• There were systems are in place to monitor and manage risks associated with national patient safety alerts within the service.
• There were necessary and relevant checks are undertaken for all staff prior to employment.
• Staff received regular supervision and appraisal.
• Staff had undertaken training to enable them to undertake their role.
• There was an effective system in place for reporting and recording significant events.
• Lessons were shared to make sure action was taken to improve safety in the service.
• The service had clearly defined and embedded systems, processes and clinics in place to keep patients safe and safeguarded from abuse.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Clinical audits demonstrated quality improvement.
• There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 7 January 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Background

Atlantic Clinic provides services predominantly to meet the needs of the local Polish population within the Southampton area. A range of services are provided which include obstetrics and gynaecology, orthopaedics, paediatrics, GP services, psychiatry, dermatology and dentistry. Dental services are provided from the first floor only. The practice employs six staff which includes receptionists, a trainee dental nurse, a phlebotomist and two managers. Doctors who provide services to patients are not employed by the practice but are contracted to deliver services on a sessional basis. The service is open from 09.00 to 20.30 from Monday to Sunday.

The premises include several consulting rooms, treatment rooms and offices located over two floors of the building. The first floor is accessed via a flight of stairs only. There is no lift access to the first floor.

There is a responsible individual who represents the provider Atlantic Clinic Limited and there is a lead doctor within the service who is the registered manager. 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.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection and we spoke to some patients on the day of our inspection. Nine patients provided feedback about the service. All of the comments were positive about the care they had received. Patients told us that staff acted in a professional manner and they felt they received good standards of care. Atlantic Clinic had not been subject to previous inspection by the Care Quality Commission.

Our key findings were:

• Services were provided from modern, well equipped and well maintained premises.
• Sterilisation equipment had not been adequately serviced and maintained to ensure the safety of patients. There was a lack of formal processes and procedures to ensure the effective decontamination of all reusable instruments used within the service.
• The service offered flexible opening hours over seven days each week and appointments to meet the needs of their patients.
• Dental services were provided on three days each week. Arrangements to provide emergency support to dental patients outside of those hours were not clearly defined.
• Patients received a comprehensive assessment of their health needs which included their medical history.
• Patients told us they were listened to, treated with respect and were involved in discussions about their treatment options.
• A range of information leaflets were available to patients, written in Polish and English, to enable them to make informed decisions about treatment options available to them.
• Staff had not received training in some key areas such as basic life support and chaperoning.
• There was a lack of systems in place to implement national patient safety alerts within the service.
• Appropriate recruitment checks on staff had not always been undertaken prior to their employment.
• The service did not have systems in place to monitor the ongoing training, continuous professional development and annual appraisal review of doctors working on a sessional basis. There was no system of supervision to provide support to sessional staff.
• There was a lack of formal governance arrangements and monitoring of patient outcomes. The service had not undertaken any clinical audits. They did not hold meetings to review clinical practice.
• There was a lack of review of and use of best practice guidance to implement changes to improve patients’ treatment outcomes. Prescribing practices were sometimes outside of local formulary and NICE guidelines.
• The service regularly sought the views of patients. Feedback from patients was consistently positive about the care they received.

There were areas where the provider must make improvements and:

• Ensure regular maintenance and servicing of all steam sterilisers within the service.
• Establish clear processes and procedures which ensure the effective cleaning, decontamination and tracking of all reusable instruments used within the service.
• Ensure systems are in place to monitor and manage risks associated with national patient safety alerts within the service.
• Ensure all necessary and relevant checks are undertaken for all staff prior to employment.
• Ensure all staff receive regular supervision and appraisal which reflects their full scope of work, including those doctors providing services to patients on a sessional basis.
• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure clinical audits are used to promote continuous improvement and improve patient outcomes, including auditing of dental x-rays.
• Ensure staff undertake training to enable them to undertake their role, including training in basic life support and chaperoning and where required, dental nurse training.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the service’s supply of emergency medicines, to include medicines which support the fitting of intrauterine devices and epileptic seizures.
• Ensure use of best practice guidance and NICE guidance in treatment and prescribing practices in order to ensure optimum treatment outcomes for patients.
• Provide clear information to patients on chaperoning services available.
• Provide clear information to patients about how to access emergency support outside of the service’s opening hours and when specialist clinicians are unavailable.
• Ensure processes are in place to track and monitor the use of prescription pads.
• Implement a consistent approach to patient record keeping including consistency in the language used and ensuring all hard copy records are scanned into the electronic record in a timely manner.
• Review the service's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping and to include periodontal monitoring and soft tissue examination.
• Review policies and procedures to ensure they reflect current practices within the service.
• Review alarm systems within the service for alerting others in an emergency situation.

We carried out an announced comprehensive inspection on 7 January 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Background

Atlantic Clinic provides services predominantly to meet the needs of the local Polish population within the Southampton area. A range of services are provided which include obstetrics and gynaecology, orthopaedics, paediatrics, GP services, psychiatry, dermatology and dentistry. Dental services are provided from the first floor only. The practice employs six staff which includes receptionists, a trainee dental nurse, a phlebotomist and two managers. Doctors who provide services to patients are not employed by the practice but are contracted to deliver services on a sessional basis. The service is open from 09.00 to 20.30 from Monday to Sunday.

The premises include several consulting rooms, treatment rooms and offices located over two floors of the building. The first floor is accessed via a flight of stairs only. There is no lift access to the first floor.

There is a responsible individual who represents the provider Atlantic Clinic Limited and there is a lead doctor within the service who is the registered manager. 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.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection and we spoke to some patients on the day of our inspection. Nine patients provided feedback about the service. All of the comments were positive about the care they had received. Patients told us that staff acted in a professional manner and they felt they received good standards of care. Atlantic Clinic had not been subject to previous inspection by the Care Quality Commission.

Our key findings were:

• Services were provided from modern, well equipped and well maintained premises.
• Sterilisation equipment had not been adequately serviced and maintained to ensure the safety of patients. There was a lack of formal processes and procedures to ensure the effective decontamination of all reusable instruments used within the service.
• The service offered flexible opening hours over seven days each week and appointments to meet the needs of their patients.
• Dental services were provided on three days each week. Arrangements to provide emergency support to dental patients outside of those hours were not clearly defined.
• Patients received a comprehensive assessment of their health needs which included their medical history.
• Patients told us they were listened to, treated with respect and were involved in discussions about their treatment options.
• A range of information leaflets were available to patients, written in Polish and English, to enable them to make informed decisions about treatment options available to them.
• Staff had not received training in some key areas such as basic life support and chaperoning.
• There was a lack of systems in place to implement national patient safety alerts within the service.
• Appropriate recruitment checks on staff had not always been undertaken prior to their employment.
• The service did not have systems in place to monitor the ongoing training, continuous professional development and annual appraisal review of doctors working on a sessional basis. There was no system of supervision to provide support to sessional staff.
• There was a lack of formal governance arrangements and monitoring of patient outcomes. The service had not undertaken any clinical audits. They did not hold meetings to review clinical practice.
• There was a lack of review of and use of best practice guidance to implement changes to improve patients’ treatment outcomes. Prescribing practices were sometimes outside of local formulary and NICE guidelines.
• The service regularly sought the views of patients. Feedback from patients was consistently positive about the care they received.

There were areas where the provider must make improvements and:

• Ensure regular maintenance and servicing of all steam sterilisers within the service.
• Establish clear processes and procedures which ensure the effective cleaning, decontamination and tracking of all reusable instruments used within the service.
• Ensure systems are in place to monitor and manage risks associated with national patient safety alerts within the service.
• Ensure all necessary and relevant checks are undertaken for all staff prior to employment.
• Ensure all staff receive regular supervision and appraisal which reflects their full scope of work, including those doctors providing services to patients on a sessional basis.
• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure clinical audits are used to promote continuous improvement and improve patient outcomes, including auditing of dental x-rays.
• Ensure staff undertake training to enable them to undertake their role, including training in basic life support and chaperoning and where required, dental nurse training.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the service’s supply of emergency medicines, to include medicines which support the fitting of intrauterine devices and epileptic seizures.
• Ensure use of best practice guidance and NICE guidance in treatment and prescribing practices in order to ensure optimum treatment outcomes for patients.
• Provide clear information to patients on chaperoning services available.
• Provide clear information to patients about how to access emergency support outside of the service’s opening hours and when specialist clinicians are unavailable.
• Ensure processes are in place to track and monitor the use of prescription pads.
• Implement a consistent approach to patient record keeping including consistency in the language used and ensuring all hard copy records are scanned into the electronic record in a timely manner.
• Review the service's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping and to include periodontal monitoring and soft tissue examination.
• Review policies and procedures to ensure they reflect current practices within the service.
• Review alarm systems within the service for alerting others in an emergency situation.