The Hand to Elbow Clinic

Updated 15 November 2019

The Hand to Elbow Clinic is a consultative, diagnostic, and treatment clinic. The clinic operates with three Orthopaedic Consultants specialising in treatment and surgery relating to the fingers, hand, wrist, forearm and elbow. The clinic also runs specialist physiotherapy sessions, providing treatment for hands, elbows and shoulders. All services are provided from a converted residential property at 29a James St West, Bath, BA1 2BT.

The premises consist of a reception area, three consulting rooms, a store room, a treatment room, bathroom and kitchen. Wheelchair access to the building is by way of moveable ramp. There is a low step into each of the consulting rooms and wheelchair access to the bathroom.

The service has one clinical lead and one non-clinical lead. There also three self-employed Consultant Orthopaedic Surgeons and two self-employed Chartered Physiotherapists. The clinical staff are supported by two administrative staff members, one of whom is the practice manager and medico-legal personal assistant whilst the other is the NHS Co-ordinator and private medical secretary.

The service operates from 8am to 6pm on a Monday, Tuesday, Wednesday and Thursday and from 8am to 4pm on Friday. Appointments are available on Monday afternoon, all day Tuesday, Wednesday morning and some Friday afternoons. The clinic does not offer out of hours services.

We carried out this inspection on 30 August 2019 and 5 September 2019 and before visiting, we looked at a range of information that we hold about the provider. We reviewed the last inspection report from November 2012 and from information submitted by the service in response to our provider information request.

During our visit we spoke with the clinical lead and the administrative staff, observed practice and reviewed documents.

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 15 November 2019

This service is rated as Good overall.

A previous inspection was carried out at The Hand to Elbow Clinic on 14 November 2012 when we inspected the provision of private doctor consultation and treatment services. At that time, we did not rate the service but found the provider had met the requirements of the key questions for providing safe, effective, caring, responsive and well led care. 

We carried out this comprehensive inspection at The Hand to Elbow Clinic on 30 August 2019 and 5 September 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This announced inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to check that the provider had maintained the standards we saw at our last inspection.

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? – Good

The service has a registered manager. Like registered providers, they are ‘registered persons’ who 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 service is registered with the Care Quality Commission (CQC) to provide the regulated activities diagnostic and screening procedures, surgical procedures and treatment of disease, disorder or injury.

Our key findings were:

• The service had systems in place to manage significant events.
• The provider had a clear vision to deliver high quality care for patients.
• There were clearly defined systems, processes and practices to minimise risks to patient safety.
• Staff had been trained in areas relevant to their role.
• The service had systems in place for monitoring and auditing the care that had been provided.
• The clinicians assessed patients’ needs and delivered care in line with current evidence-based guidance.
• Information about services provided was available and easy to understand.
• The clinicians had the skills and knowledge to deliver effective care and treatment.
• There was an effective system in place for obtaining patients’ consent.
• The service had systems and processes in place to ensure that patients were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• The service was aware of and complied with the requirements of the Duty of Candour.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care