Eastgate House

Updated 2 January 2023

Eastgate House is the CQC registered location name for Baby Circumcision Clinic. The service is provided by Musamedics Limited. It is an independent male circumcision service established in 2021 which is delivered from accommodation rented within The Eastgate Therapies Centre, 19-27 Humberstone Road, Leicester. LE5 3 GJ. The service utilises a clinical consultation room and other facilities within the premises for the delivery of the circumcision service.

The service is registered with the CQC for the regulated activity of surgical procedures.

The service provides circumcision to new born and infant male children up to the age of 18 months old for non-therapeutic reasons. The service is available to any patient and does not require a clinical referral. Whilst most patients will be from the Leicester area, the service sees patients from other parts of the country.

The service is delivered by one male doctor, who is currently working as a paediatric registrar within secondary care, and a male health care assistant. This doctor is also the clinical lead for the service. There was also a male receptionist who booked patients into the clinic and processed their paperwork.

The clinics are usually held once a fortnight on a Sunday, and on average 15 patients are seen at each clinic. The service is open from 9am to 4pm.

The service has a website at www.circumcisionclinics.uk

How we inspected this service

This inspection consisted of:

• Requesting evidence from the provider to be submitted electronically.
• A site visit which included a review of patients’ notes; a review of the environment including adherence to infection control standards and compliance with health and safety regulations; and observing one of the circumcision clinics taking place.
• Speaking with staff as well as parents and families of children attending the clinic for a procedure.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 2 January 2023

At our inspection on 4 December 2022, we rated this service 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 Eastgate House (also known as Baby Circumcision Clinic) on 4 December 2022. This inspection was undertaken as a newly registered service with the Care Quality Commission (CQC). The service had registered with CQC in July 2021, and whilst we usually inspect new providers within 12 months of registration, this inspection was delayed as the provider had to relocate their service to new premises in July 2022.

Eastgate House is registered with the CQC as an independent health service providing non-therapeutic male circumcisions. It is a service provided within the Eastgate Therapies Centre premises close to Leicester city centre.

There was a named registered manager for the circumcision service. 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:

• Patient satisfaction was overwhelmingly positive about their experience of the service and their interaction with the team. Patients were especially complimentary regarding the follow up care provided to them after the procedure, and with the professionalism and caring approach displayed by the team.
• Patients were able to access care and treatment promptly.
• The service had developed information sheets to give to parents/patients both pre and post procedure. There was a section on their website which explained the procedure and clearly outlined the recovery process.
• Staff delivering the service were experienced and appropriately qualified to provide the service to patients.
• There was evidence of how patient outcomes were evaluated, analysed and reviewed as part of quality improvement processes.
• The service did not always provide care in a way that kept patients safe, for example by ensuring the premises were fully compliant with health and safety compliance.
• Patients did not always receive effective care and treatment that met their needs. For example, the potential complications from the procedure were not being fully discussed with parents and signed off by a doctor.
• Internal governance processes required some strengthening as some areas of risk had not been effectively identified and mitigated.

We found two breaches of regulations. The provider must:

• 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.

The areas where the provider should make improvements are:

• Produce written exclusion criteria for the service
• Obtain evidence of staff training for all employees, even if this is completed within a different service.
• Analyse their own patient feedback forms to consider any service changes that may be required.
• Develop a succession plan to ensure service continuity.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services.