Updated 22 February 2017
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 a pilot for services provided by independent doctors and was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. We would like to thank all managers, clinicians and staff at Centennial Medical Care for their help and co-operation in this inspection, and for responding quickly to our informal feedback.
Centennial Medical Care (CMC) opened in February 2014 as an independent provider of GP and specialist consultant services. The registered manager is the practice manager. There is a board of three directors, two of whom are directly involved in the running of the business.
CMC is based in Elstree in Hertfordshire. There are 238 registered patients in total of whom 136 are adults and 133 are children and young people. CMC had 306 patient visits a month on average in 2015. Of these 183 were for consultant appointments, 35 were for GPs, 28 were for physiotherapy, 25 for minor procedures and the rest for diagnostics. Consultants working at CMC carry out a range of minor treatments and consultations. The most predominant specialities are gynaecology, sports injuries, dermatology, physiotherapy and paediatric specialities such as gastroenterology, rheumatology and allergies.
There is a practice manager, one full-time and two part-time receptionists, an accounts administrator and a part-time healthcare assistant. The GPs are on call, and attend if a patient makes an appointment. CMC has arrangements with 45 consultants to cover 21 specialities and attend clinics based on patient demand. These consultants work under practising privileges (the process to grant a medical practitioner permission based on their competency, to work within a private healthcare provider).
The patients who are patients under the care of a GP are considered to be CMC patients and their medical history and notes are kept on site. The patients who are considered consultant’s patients, could be seen at more than one location. The service does not keep consultant patient’s medical records on site and there was no service level agreement to obtain them quickly. Any diagnostic test results were scanned onto the patient management system for reference if needed.
CMC generates its income from renting consulting rooms to consultants, receiving facilities fees from medical insurance companies for procedures, ultrasound and blood tests, and direct payment for diagnostics. They have a revenue share agreement with GPs.
CMC’s premises, over two floors, comprise seven consulting rooms (one with ultrasound machine), a minor operations room, two reception areas, a retail pharmacy and an administration office.
Opening hours are 8 am to 7 pm Monday to Friday and 9 am to 2 pm on Saturday.
CMC launched a walk-in minor injuries unit (MIU) on 18th January 2016, staffed by a paramedic, who saw eight patients before 4th February. CMC closed the MIU on a voluntary basis on the 6th February, and has since stated that it does not intend to re-open it.
The inspection on 2nd February 2016 was led by a CQC inspector who visited with four specialist advisors.. This was the first inspection of CMC.
As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection. We received two comment cards, both with positive comments about care. We also interviewed six patients at CMC on the day of the inspection. Patients told us they were pleased with the level of care and communication.
We informed Healthwatch and the local clinical commissioning group that we were inspecting the service; however we did not receive any information from them.
During the inspection we:
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Collected CQC comment cards to be completed by patients prior to our inspection. Three patients responded and their feedback was positive.
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Spoke with a range of staff including, a GP, management and reception staff, a healthcare assistant, three consultants and a paramedic.
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We reviewed information and record systems including treatment records and patients’ written consent.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:
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Is it safe?
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Is it effective?
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Is it caring?
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Is it responsive to people’s needs?
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Is it well-led?
These questions therefore formed the framework for the areas we looked at during the inspection.
Our key findings were:
- Clinical governance was underdeveloped - quality assurance systems and Information about the quality of care and treatment was limited. There was no adult safeguarding lead.
- As CMC did not have ready access to medical records, there was no audit trail to show that patients’ care and treatment was delivered in line with current evidence based guidance or that risks to patients were recorded.
- There were no in-house agreed clinical protocols or agreed care pathways, including formalised arrangements with other care providers.
- Waiting times and appointment cancellations were not monitored.
- Arrangements to deal with medical emergencies were not formalised.
- The service did not proactively seek feedback from patients and record it in order to make improvements
- Services were not fully adapted for the needs of different people – for example, there was no hearing induction loop.
- CMC did not prepare fully for the opening of its minor injuries unit (MIU) – it lacked clinical risk assessments, clinical protocols, formalised arrangements with other healthcare providers and staffing assessments. Although preparation of patient group directions was in line with National Institute for Health and Care Excellence (NICE) guidance, the lead GP and Medical Advisory Committee had not authorised them in time for the opening of the MIU.
- There was little knowledge of the Mental Capacity Act 2005.
However, we also found that:
- Patients were treated with kindness and respect and they were involved in their care and decisions about their treatment.
- Facilities were attractive and adapted to children’s needs
- Effective and clear safeguarding arrangements were in place for children
- CMC had an effective system in place for reporting and learning from significant events, and there had been no reported harms to patients.
- CMC had a range of policies and procedures to govern non-clinical activity, but some were missing or overdue a review.
Full details at the end of this report of the regulations that were not met. Since our inspection, Centennial has responded with action plans to meet the regulations, and many of the actions we requested are already in place.