Archived: Northern Circumcision Clinic - Sheffield

Updated 13 March 2018

Northern Circumcision Limited is an independent circumcision service provider which is registered in Billingham, County Durham and operates from locations in Leeds and Sheffield. The Sheffield based service operates from accommodation within Sloan Medical Centre, 2 Little London Road, Sheffield, South Yorkshire, S8 0YH. The service provides circumcision to those under 18 years old for cultural and religious reasons under local anaesthetic, and carries out post procedural reviews of patients who have undergone circumcision at the clinic. Between 95-98% of circumcisions carried out by the clinic were on children under one year of age.

Sloan Medical Centre where the service is hosted is a modern GP practice which is easily accessible for those bringing children or young people to the clinic, for example it has level floor surfaces, automatic doors and parking is available. The Northern Circumcision Clinic utilises the minor surgery room within the practice for the delivery of services, as well as ancillary areas such as waiting areas and toilets.

The service is led by two directors (one male/one female) and is delivered by four clinicians (all male – one of whom is also a director). These clinicians are all trained and experienced in this area of minor surgery, being either qualified paediatric surgeons or GPs. Other staff working to support the clinic includes a booking clerk, and an assistant who supports the operation of the service in a non-clinical delivery role. Two reception staff are provided by the host GP practice as part of a service level agreement.

The Sheffield based service provides one to two sessions per clinic, and clinics are held at approximately three/four weekly intervals depending on patient demand.

The inspection was led by a CQC inspector who had access to advice from a specialist advisor. The CQC inspector was also supported by a second CQC inspector on the day of inspection.

Before visiting, we reviewed a range of information we hold about the practice and asked other organisations to share what they knew. Stakeholders we contacted did not raise any information of concern with us.

During our visit we spoke with staff, reviewed comment cards where patients and members of the public shared their views, observed how patients were treated in the reception area and reviewed key documents which supported the delivery of the service.

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 13 March 2018

We carried out an announced comprehensive inspection on 27 January 2018 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 providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was 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 providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service provided circumcisions to those under 18 years of age for cultural and religious reasons under local anaesthetic, and carried out post procedural reviews of patients who had undergone circumcision at the clinic.

The clinic made use of parental feedback as a measure to improve services. They had produced their own survey form and results were analysed on a regular basis. Results obtained from a recent clinic held in December 2017 showed 100% of parents reported their experience of using the service as excellent.

We also received 11 Care Quality Commission comment cards. These were very positive regarding the care delivered by the clinic and mentioned the friendly and caring attitude of staff. Responses stated that the service was professional, and that staff took the time to explain the process to them.

Our key findings were:

• The service was offered on a private, fee paying basis only and was accessible to people who chose to use it.
• Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
• The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members. We also saw that the clinic had put in place additional measures following an inspection of another clinic operated by the provider, this Leeds based clinic had been inspected in October 2017.
• There were systems, processes and practices in place to safeguard patients from abuse, and we saw how these had been used in the past to raise concerns with safeguarding bodies.
• Information for service users was comprehensive and accessible.
• Patient outcomes were evaluated, analysed and reviewed as part of quality improvement processes.
• We saw evidence that when a complaint was received it was investigated thoroughly and mechanisms were in place to make subsequent improvements to the service based on complaints.
• There was a clear leadership structure, with governance frameworks which supported the delivery of quality care.
• The service encouraged and valued feedback from service users. Comments and feedback for the clinic showed high satisfaction rates.
• Communication between staff was effective with meetings and post sessional debriefings being held.

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

• Review assurance processes with the host GP practice to ensure all relevant health and safety and infection prevention and control measures are in place.
• Review assurance processes to ensure that all policies, procedures and operating protocols were dated.
• Continue to review and implement the clinic's revised procedure to directly inform the GP of the patient, via electronic communication methods, that the procedure has been carried out.