Background to this inspection
Updated
20 August 2019
Nomad Travel Clinic in Bristol is located at 38 Park Street, Bristol BS1 5JG within the Nomad travel shop. The private travel clinic is a location for the provider TMB Trading Limited who have owned the Nomad travel stores and clinics since June 2016. TMB Trading Limited provide nine travel clinics across England and Wales. Details are on their website: www.nomadtravel.co.uk.
The clinic offers travel health consultations, travel and non-travel vaccines, blood tests for antibody screening and travel medicines such as anti-malarial medicines to children and adults. The clinic holds a licence to administer yellow fever vaccines; and in addition the service works with Public Health England to deliver post-exposure Rabies vaccination. They also provide travel related retail items.
The clinic employs seven travel nurses and sees approximately 900 clients per month. The Bristol clinic is open Monday to Saturday between 9.30am and 6pm; except Tuesday when they are open between 8am and 8pm; and Thursday when they open between 11.30am and 8pm. The clinic also opens on most bank holidays between 11am and 5pm. Clients can access consultation rooms on the ground floor and there are further consultation rooms on the lower ground floor. In addition, Nomad provide a telephone consultation service with specialist travel nurse and have a central customer service team to manage appointment bookings. We did not inspect the central advice service as part of this inspection.
The provider is registered to provide the following regulated activities:
• Diagnostics and screening procedures
• Treatment disease and disorder
• Transport services, triage and medical advice provided remotely
We inspected the clinic on 26 June 2019. Before visiting, we reviewed a range of information we hold about the service. We also asked the service to complete a provider information request. During our visit we:
• Spoke with the lead nurse who was also the registered manager.
• Spoke to the nominated individual who is also the clinical operations manager. (A nominated individual is a person who is registered with the Care Quality Commission to supervise the management of the regulated activities and for ensuring the quality of the services provided).
• Spoke to two travel nurses and the Nomad store manager.
• Looked at information the clinic used to deliver care and treatment plans.
• Reviewed comment cards where clients and members of the public shared their views and experiences of the clinic.
To get to the heart of peoples’ 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
20 August 2019
We carried out an announced comprehensive inspection at Nomad Travel Clinic - Bristol 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.
Nomad Travel Clinic - Bristol is a private clinic providing travel health advice, travel and non-travel vaccines, blood tests for antibody screening and travel medicines such as anti-malarial medicines to children and adults. The clinic holds a licence to administer yellow fever vaccines; and in addition the service provides post-exposure Rabies treatment on behalf of Public Health England.
This location is registered with CQC under the Health and Social Care Act 2008 in respect of some, (the provision of advice or treatment by, or under the supervision of, a medical practitioner, including the prescribing of medicines for the purposes of travel health) but not all, of the services it provides. There are some general exemptions from regulation by CQC which relate to particular types of service and these are set out in of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At Nomad Travel Clinic - Bristol services are provided to clients under arrangements made by their employer with whom the servicer user holds a policy (other than a standard health insurance policy). These types of arrangements are exempt by law from CQC regulation. Therefore, at Nomad Travel Clinic - Bristol we were only able to inspect the services which are not arranged for clients by their employers.
During the inspection we reviewed 53 completed CQC comment cards which described the service as efficient, carried out in a safe and hygienic environment. Clients said staff listened to them and were considerate, friendly, helpful, knowledgeable, caring and respectful.
Our key findings were:
• The clinic had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the provider learned from them and improved their processes.
• The provider routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines and up to date travel health information.
• Each client received an individualised travel health brief containing a risk assessment, health information including additional health risks related to their destinations; and a written immunisation plan.
• Staff involved and treated clients with compassion, kindness, dignity and respect. Care Quality Commission comment cards completed by clients prior to our inspection were all positive about the standard of care received.
• There was a leadership structure in place with clear responsibilities, roles and systems of accountability to support good governance and management. Staff felt supported by the leadership team and worked well together as a team across local branches when necessary.
• The provider was aware of the requirements of the duty of candour.
• Clinic staff were encouraged to plan and develop the service to meet local needs such as responding to local disease outbreaks and visiting schools to provide travel health talks.
We saw the following outstanding practice:
• The clinic provides the rabies post-exposure service for the local area, through a delegated arrangement, on behalf of Public Health England (PHE) for the benefit of patients. Nomad Travel Clinic is one of only two travel clinics in England who have this arrangement that benefits patients through ease of access to assessment and treatment when time is of the essence. Staff are trained to use the PHE Risk Assessment; hold stocks of rabies vaccines on site; and provide treatment directly to clients following an exposure incident without the need for prior contact with PHE or potential delays in accessing vaccines.