Low Barn

Updated 24 August 2023

Low Barn is a Menopause and Well Woman Clinic provided by Bristol Menopause Limited and is located at the following address:

Sheepway

Portbury

Bristol

BS20 TTF

We visited the service at Low Barn during this inspection to review records and documentation, speak with staff and inspect the premises.

The service registered with CQC in 2022 to provide the following regulated activities: diagnostics and screening, family planning and treatment of disease, disorder or injury.

Services are provided to people over the age of 18 and include consultations about and treatment for the menopause, contraception advice and treatment and well woman checks. A phlebotomy (taking blood) service is also provided.

The service employs four nurse practitioners, two of whom are British Menopause Society Accredited Specialists and all are non-medical prescribers. Nonmedical prescribing is the term used to describe any prescribing completed by a healthcare professional other than a doctor or dentist. Administrative support is provided by a receptionist and practice manager.

Further information regarding the service can be found through the website www.bristolmenopause.com

The service provides appointments between the hours of 08:30 and 18:00 on Mondays to Fridays. Out of hours appointments can be arranged when necessary.

The service is provided for women over the age of 18 who mainly self-refer to the clinic. Referrals can be made by the patients GP.

How we inspected this service

Before our inspection we reviewed information we held about the clinic. We also requested and reviewed information from the provider before the inspection and information available on the providers’ website. The provider sent information following the inspection which showed additional systems, processes and policies had been implemented.

We carried out a site visit to the clinic, reviewed records and interviewed the provider.

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 24 August 2023

This service is rated as Good overall with the well-led domain rated as requires improvement. This is the first inspection since the service registered with the Care Quality Commission (CQC).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Low Barn as part of our planned inspection programme.

Bristol Menopause Clinic was set up by the registered provider – Hazel Haydon – who is a registered nurse and a British Menopause Society Registered Menopause Specialist and trainer. We will refer to this person as the registered manager throughout the report. (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). The registered manager also holds the role of nominated individual.

The service is registered with CQC to provide the following regulated activities: diagnostics and screening, family planning and treatment of disease, disorder or injury.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provided. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services, and these are set out in Schedule 1 and Schedule 2 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. Low Barn (Bristol Menopause Clinic) provides support and lifestyle advice to women regarding menopause which is not within the CQC scope of registration. Therefore, we did not inspect or report on these services. For example, guidance on the positive effects of diet, exercise and lifestyle on the peri-menopause and menopause and health promotion topics such as smoking, alcohol and sleep.

Our key findings were:

• The provider had good systems to safeguard adults and children, manage safety alerts and learn from any significant events. However, staff had not been trained to the level recommended within national guidance. The provider made arrangements, on the day of the inspection, for additional training to be undertaken.
• The premises were visually clean, hygienic and tidy. However, there were no infection control audits available on the day of inspection. This was rectified by the provider and submitted to us following the inspection.
• The provider had implemented safe systems to prescribe medicines for patients.
• Patients received effective care and treatment which met their needs. The provider followed national best practice guidelines and ensured care and treatment was based on up-to-date evidence. However, the provider had not formally reviewed or audited the care and treatment provided which could drive improvement.
• The provider had the skills, knowledge and experience to carry out their role. They were a registered nurse and had undertaken specialist training in women’s health. Staff working within the service were supported to access specialist training.
• The provider involved and treated people with compassion, kindness, dignity and respect.
• The facilities were appropriate for the services delivered.
• There were no consistent clear and effective processes for managing risks, issues and performance. However, the provider had taken immediate action following the inspection to rectify this.
• Patient feedback was encouraged and reviewed on receipt. However, the feedback had not been formally audited to identify themes and trends.

We saw the following outstanding practice:

• The provider carried out outreach work to communicate and inform women in the workplace and within minority groups about the perimenopause and menopause.

The area where the provider must make improvements as they are in breach of regulation is:

• Establish and formalise effective systems and processes to ensure good governance in accordance with the fundamental standards of care. The provider had not carried out appropriate environmental risk assessments, which took into account the profile of people using the service and those who may be accompanying them.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Provide appropriate information so that patients are knowledgeable about how to make a complaint.
• Review the training programme regularly to ensure it remains in line with national guidance.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

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