The London Migraine Clinic

Updated 28 June 2022

The London Migraine Clinic is a private clinic offering treatment for migraines, bruxism and hyperhidrosis to adults and children aged over 12 years. All services are private and subject to payment of fees, with no NHS services provided.

The service is registered with CQC for the regulated activity of ‘Treatment of disease, disorder or injury’.

The services are offered on an appointment-only basis. The service is currently open for consultations from 11am and 5pm on Tuesdays, Wednesdays and Thursdays. Appointments can be booked by telephone or through the service’s website.

The service is situated at 2-4 Bulls Head Passage, London, on the lower ground floor of a commercial building, beneath an optician. The service’s premises consist of two consulting rooms, one storage room, and a toilet shared with the optician. Where disabled patients cannot access the lower ground floor via the stairs, there is an arrangement whereby they can be seen in a consulting room on the ground floor, although there is also a step up from street level to the building entrance.

In terms of staff members, the provider was the only doctor and clinician who worked at the service. The doctor was supported by some non-clinical staff members, who were not directly employed by The London Migraine Clinic, but who worked for the optician in the same building and were contracted to provide support for the service; this support included answering telephone calls and emails from patients, booking appointments, meeting and greeting patients, cleaning the consultation rooms and filing patient records.

Part of the London Migraine Clinic's service involves the provider referring patients on to a piercer for daith (ear cartilage) piercing as a migraine treatment. The piercer is not directly employed by the service but works independently at a piercing studio. This activity is not within CQC scope of registration and therefore we did not inspect these services.

The service sees approximately 30 patients per month.

How we inspected this service:

We reviewed information about the service in advance of our inspection visit. This included:

• Data and other information we held about the service.
• Material received directly from the service ahead of the inspection.

During the inspection visit we:

• Spoke with the provider.

Reviewed policies, procedures, and documents.

Updated 28 June 2022

This service is rated 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 The London Migraine Clinic on 8 February 2022 as part of our inspection programme. This was the first CQC inspection of this location.

The London Migraine Clinic is a private clinic offering treatment for migraines, bruxism and hyperhidrosis to adults and children aged over 12 years. All services are private and subject to payment of fees, with no NHS services provided.

The provider is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some general exemptions from regulation by CQC, relating to particular types of service and these are set out in Schedule 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, The London Migraine Clinic refers patients on to a piercer for daith (ear cartilage) piercing as a migraine treatment, which is not within CQC scope of registration. Therefore, we did not inspect these services.

The provider consists of one doctor, who is also the CQC registered manager. 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:

• There were gaps in safeguarding knowledge and training.
• There was an absence of appropriate staff recruitment checks to ensure safety.
• There was no system to manage safety alerts.
• No infection control audit had been completed.
• Blank prescriptions were not stored securely.
• There were gaps and risks in relation to arrangements for emergency medicines and equipment.
• Staff had not completed, and were not required to complete, training and this had not been risk assessed.
• There were no systems to monitor the effectiveness of care and treatment provided, as the provider had not completed any clinical audits or quality improvement activity.
• Treatment outside of National Institute for Health and Care Excellence (NICE) guidelines was not documented as having been communicated to patients.
• There was no system to ensure that staff had the skills, knowledge and experience to carry out their roles.
• Leaders could not demonstrate that they recognised and understood the challenges to quality and sustainability.
• Some of the service’s policies were not service-specific, were missing, did not contain required information, or were not being followed by staff.
• There were no systems, or ineffective systems, in place to manage and mitigate risks, issues and performance.
• Patients were supported to manage their own health and live healthier lives.
• The service treated patients with kindness, respect and compassion.
• Patient feedback was positive about the service and the provider.
• Patients were able to access care and treatment from the service within an acceptable timescale for their needs.
• Staff described the service as open and supportive. Non-clinical staff we spoke with said they felt able to raise any concerns with the provider.

The areas where the provider must make improvements are:

• 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.

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

The areas where the provider should make improvements are:

• Review the storage arrangements for records of patients referred to the piercer to ensure they are secure.
• Review arrangements for signing and dating sharps bins when assembling and for secure siting of sharps bins.
• Review the arrangements for alerting patients that there is limited disabled access to the premises.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care