Provide Wellbeing Ltd

Updated 13 November 2019

Since the previous inspection, Tollgate Clinic has joined ‘Provide’, a large community interest company, however, it has retained both its name and smaller personal care experience. With support from the larger organisation the service has been able to implement a number of improvements for example: Improvements were seen in the use a primary care community based software record system (SystmOne), this provided staff support, training, greater reporting and auditing facilities, and assurance to deliver security for patient records. Support from ‘Provide’ has ensured better access to human resources for staff. It has also supported and standardised the service providers governance framework.

Tollgate Clinic Limited provides NHS GP referred surgery for carpal tunnel syndrome, and non-scalpel vasectomies. They also provide private patient paid surgery for minor skin lumps and bumps, joint injections, carpal tunnel syndrome, and non-scalpel vasectomies.

The service provider holds pre-surgical assessments, at venues within Essex, for example;

St. James Surgery, Clacton, and assessment including surgery at, The Primary Care Centre, North Road, Westcliff-on-Sea, and the Tollgate Clinic, Tollgate Health Centre, Colchester. We inspected the Tollgate Clinic only, on 29 August 2019.

• There is a car park in the grounds of the Tollgate Health Centre where the Tollgate Clinic provides their service.
• The clinic is accessed through the main entrance of the health centre that is shared with two local GP practices.
• The building, reception, waiting area and clinical rooms are fully accessible to all.
• The service opening hours are 9am to 5pm Monday to Friday.
• They provide post-operative telephone support from Monday to Sunday until 10pm each evening.
• The service was registered to treat adults and children from the age of four, however they do not see anyone younger than twelve.

Before visiting, we reviewed information we hold about the service.

During our visit we:

• Looked at the systems in place to manage and administer the service.
• Assessed how clinical decisions were made.
• Viewed key policies and protocols which related to regulated activities.
• Spoke with staff involved in providing the regulated activities.
• Checked the environment and infection control measures.
• Observed staff interactions with patients.
• Reviewed CQC comment cards which included feedback from patients about their experience of the service.
• Gathered information from stakeholders e.g. NHS choices and local Clinical Commissioning groups.

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 November 2019

This service is rated as Outstanding overall. (Previous inspection September 2018 was an initial un-rated inspection.)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Tollgate Clinic 29 August 2019 as part of our inspection programme, to follow up and rate the service. Tollgate Clinic Limited provides NHS referred surgery for carpal tunnel syndrome, and non-scalpel vasectomies. They also provide private patient paid surgery for minor skin lumps and bumps, joint injections, carpal tunnel syndrome, and non-scalpel vasectomies.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the services it provides.

A senior manager at the service is the registered manager. A registered manager is a person who is registered with the Care Quality Commission 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.

We obtained feedback from 19 people through completed comment cards. These had been provided by the Care Quality Commission prior to the inspection at the service. Feedback was very positive in regard to the care, treatment, cleanliness, clinicians, administrative staff, and receptionists. We were unable to speak to patients on the day of inspection because it was a non-clinic day.

Our key findings were:

• The service provider conducted regular well-documented safety and environmental risk assessments.
• There was a designated lead and systems to safeguard children and vulnerable adults from abuse.
• The service was well equipped to treat patients and the facilities met standards and patient needs. Emergency equipment and medicines were available, well monitored to guarantee they were safe for use, and signposted to ensure ease of access should an emergency occur.
• Appropriate standards of cleanliness and hygiene were seen.
• Patients’ care needs were assessed and delivered according to individual patient needs.
• Treatment and care was delivered in line with current evidence based guidance.
• Staff had the skills, capacity, knowledge and experience to deliver effective care and treatment.
• Information about how to complain was available and easy to understand.
• The service staff worked proactively with the GP practices that referred patients into their service, to improve patient experience.
• Patients told us they were treated with genuine compassion, dignity and respect. Patient feedback was clear, they were active partners and fully involved in decisions about their care and treatment.
• Patient feedback that we received on comment cards was extremely and consistently positive. Many of them told us the care and treatment provided by the staff exceeded their expectations and that they went the extra mile to ensure patients received excellent care.
• There was a clear leadership structure and staff felt supported by clinicians and management.
• The service proactively sought feedback from staff and patients, which it acted on.
• The service used audits to monitor and study every aspect of their service. This ranged from administration, safety incidents, and best practice clinical decisions.
• The service was aware and complied with the requirements of the duty of candour.
• Staff told us they felt respected, supported that their work was valued, and proud to work for the service.
• Leaders were knowledgeable about concerns and priorities relating to the quality and the future of the service. They understood the challenges and knew how to address them. There was a whole team approach to providing high levels of care.

We saw the following outstanding practice:

We saw evidence of a culture that tailored their services to meet the needs of people on an individual basis. They ensured flexibility, and patient centred involved choices in their care and treatment. To enable the service to do this they had developed an audit driven philosophy to monitor and investigate every aspect of the service they delivered. This ranged from service administration, through to patient satisfaction, compliments, comments, and best practice clinical guidance. Audits were run weekly and monthly and discussed with management and clinicians to monitor trends or themes. Actions, improvements and changes were seen as a continual work ethos to improve and develop the service. Staff we spoke with understood this vision and could describe how they were proud to be involved.

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