Archived: BPAS - Tamworth

BPAS Tamworth is part of the provider group British Pregnancy Advisory Service (BPAS).

The service is registered as a single speciality termination of pregnancy service. BPAS Tamworth provides consultations, Early Medical Abortions (EMA) up to nine weeks gestation and medical abortions between nine and ten weeks. The service has no minimum age restriction for termination of pregnancy. Other services offered by BPAS Tamworth include pregnancy testing, abortion aftercare, sexually transmitted infection (STI) testing and treatment, contraception advice and supply and miscarriage management.

The treatment unit manager, also the registered manager, managed both BPAS Tamworth and BPAS Cannock.

We carried out an announced inspection of this service on 31 May 2016 and attended on an unannounced basis on 6 June 2016. We inspected this service as part of our independent healthcare inspection programme This formed part of the first wave of inspection of services that provide a termination of pregnancy. This inspection was carried out using the Care Quality Commission’s new methodology.

Are services safe at this service

• We saw that clear systems were in place for reporting incidents. Although no serious incidents had been reported during 2015, we saw that staff were aware of how to report these. Reported incidents were discussed through regional management meetings; learning and action points were disseminated to staff through briefing paperwork and team meetings. Staff demonstrated an understanding of ‘duty of candour’. The duty of candour is a regulatory duty that relates to openness and transparency and requires providers of health and social care services to notify patients (or other relevant persons) of certain ‘notifiable safety incidents’ and provide reasonable support to that person.
• Staffing levels were appropriate in terms of managing care and treatment. Staff employed at BPAS Tamworth were appropriately qualified, experienced and trained to undertake their role.
• We saw good levels of infection prevention and control. The clinic was visibly clean and tidy, and personal protective equipment was available and was used by staff use.
• Medicines were generally well managed. Improvement in relation to the transportation of medicines between clinics has been undertaken since the inspection.
• Risk assessments to protect patients from abuse and coercion were used, and procedures were in place to allow patients to express any concerns in a confidential manner. Staff received appropriate safeguarding training which included information about female genital mutilation and sexual exploitation of children.
• During our announced inspection, we saw that the resuscitation trolley was located within a locked room; this meant staff could not access this in an emergency. However, we saw that this concern had been rectified during our unannounced visit.

Are services effective at this service

• Staff had access to relevant guidelines, policies and procedures. Care was generally provided in line with Department of Health Required Standard Operating Procedures (RSOPs) and national best practice guidance. The service had completed a programme of clinical audits depending on risk assessments.
• The exception was the use of simultaneous administration of abortifacient drugs for early medical abortion (EMA), which is currently outside of current Royal College of Obstetrician and Gynaecologist (RCOG) guidance. We saw that a structured governance system was in place and had been followed to introduce this treatment option.
• BPAS Tamworth employed competent staff and there were appropriate checks in place to ensure that staff competence and requirement to practice was reviewed. Ongoing training needs were identified through yearly appraisals; staff were appropriately supervised.
• We saw that staff gained consent for procedures and treatment choice consistently throughout appointments and recorded this within patient records. There were appropriate arrangements in place to ensure that consent was appropriately gained for patients under 16 years and for patients who may have limited understanding. However, we saw that information regarding the slightly raised risk of complications arising from simultaneous administration of abortifacient medication was not verbally discussed when patients’ chose this treatment, although this information was included within ‘My BPAS guide’.
• BPAS monitored outcomes, particularly about the effectiveness of early medical abortion (EMA). However, in order to gather data to inform this analysis, staff were reliant upon patients contacting them two weeks following treatment with the outcome of a pregnancy test. Staff offered a text reminder service to remind patients to take this test and to contact the clinic with the results.

Are services caring at this service

• We saw that patients were treated in a caring and compassionate manner during appointments.
• We saw that staff treated patients with dignity and respect from reception to discharge.
• Staff communicated effectively with patients, ensuring they were actively involved within their own care and treatment. During appointments, staff took extra time where needed to allow questions to be asked and answered, and to thoroughly explain different options. We saw staff actively listened to patients to understand individual needs.
• We saw staff provided appropriate emotional support during appointments. Staff gave information and details of BPAS counselling services which could be accessed both pre and post treatment if required.
• We saw that patients were actively encouraged to complete BPAS feedback forms ‘Your Opinion Counts’. During the inspection, it was observed that almost all patients completed this form prior to leaving the clinic. Information provided by BPAS as a whole company reported that between January and April 2015, 99% of 10,162 respondents would recommend the service. This is better than the NHS average of 65%.

Are services responsive at this service

• Staff were aware of patients who may have additional needs; we observed and were told about positive examples, such as interpreters being used for non-English speaking patients, and alternative counselling options for a patient with a developmental disorder. The service had good links to services that provided support to women who had experienced domestic violence.
• Patients were able to book appointments through the BPAS telephone booking service which was open 24 hours a day throughout the year. This also enabled patients to choose the most suitable location and timing of appointment to meet their needs.
• Services were planned to meet the needs of the local community. Although BPAS Tamworth is a part time clinic offering one type of treatment, staff were easily able to refer patients to alternative clinics for timely treatment if required.
• The service had received no informal or formal complaints throughout 2015, and up to the point of our inspection. Compliments were received through completion of patient feedback forms. Management meeting members, which included treatment unit managers identified action points to address any concerns across all clinics in order to raise patient satisfaction.

Are services well led at this hospital/service

• BPAS had a clear vision and set of values. We saw staff working to the vision and values, promoting a safe and non-judgemental environment to care for patients using the service.
• We saw clear lines of accountability up to executive management for specific areas of work. For example, a specific committee was set up to review areas such as incidents, complaints and clinical practice. We saw that where BPAS were legally required to complete certain paperwork, this was monitored and audited to ensure compliance.
• We saw, and audit records confirmed, that patient records were well maintained, legible and contained all appropriately signed paperwork required by The Abortion Act 1967.
• A local risk register has been developed since our inspection to ensure that risks specific to BPAS Tamworth were identified.
• The registered manager at BPAS Tamworth presented as supportive and effective.

The provider needs to make improvement in the following area.

The provider must:

• Ensure that all patients are verbally informed during consultation appointments about the elevated risk of complications and continuing pregnancy associated with the simultaneous administration of abortifacient drugs for early medical abortion (EMA).

Professor Sir Mike Richards

Chief Inspector of Hospitals