The Dovecote Office

This service is rated as Good overall.

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

We carried out an announced comprehensive inspection at the location The Dovecote Office as part of our inspection programme.

The service treats patients suffering with chronic pain and those who have associated physical and psychological symptoms, such as poor sleep, opioid dependency, depression and anxiety. Procedures include medial branch nerve blocks, nerve root blocks, epidurals, peripheral nerve blocks, trigger point injections and radiofrequency ablations.

This service 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 exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Dovecote Office provides a range of non-surgical interventions, for example, acupuncture and physiotherapy which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

The Medical Director/Consultant 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.

Our key findings were:

• Systems to keep patients safe were well-managed, however, recruitment procedures had not been fully implemented but work to improve this area has been implemented.
• Patients received an effective and evidence-based service and were supported to live healthier lives. Processes to obtain patient consent were thorough and well-managed.
• Staff received training and support relevant to their role; however, induction records had not always been completed.
• Patients were treated with kindness and respect and were involved in decisions about their treatment.
• The service was responsive to people’s needs and patients were able to access the service in a timely manner.
• The service was well-managed and learning and improvement was the focus of all staff. The provider shared learning widely with external bodies in order to improve patient care. The service took immediate action where any shortfalls were highlighted in the inspection and work had already commenced to improve recruitment processes.

We saw the following outstanding practice:

• The clinicians did not prescribe medicines but recommended suitable treatment plans to the patients’ GP. They felt this group of patients needed a sole prescriber (the patients’ GP) to oversee the medicines and provide clarity for patients. The service took a triangulated approach in some cases and worked with community pharmacists to ensure all patients were safe and receiving the right care.
• Staff were encouraged to report any incident no matter how small. This approach had enabled the service to identify and improve an area relating to patient records and correspondence, which may otherwise not have been identified.
• Staff were proactive in developing innovative ways to support people with chronic pain. They had developed pain management programmes which enabled patients to learn more about their condition and develop self-management strategies. The team were implementing a café-style therapy service for informal drop-ins including group meetings/activities to advise, educate and signpost to services. The provider had liaised with patients about terminology for explaining one of the treatments so the procedure did not have negative connotations. The team agreed with a consensus of language based on patient views to encourage more positive attitudes to treatment. During the covid 19 pandemic the service had implemented virtual pain education appointments. They had continued to offer this service to some individuals who requested it based on their needs.
• The staff team had also supported patients over and above their role. For example, they had worked with a local swimming pool for protected swimming time for patients during quiet periods and they had supported one patient to access suitable resources to enable them to learn to read and write.

The areas where the provider should make improvements are:

• Continue to review and monitor implementation of recruitment procedures and review assessment of risk related to staff imunisation status and health needs.
• Review the legionella risk assessment at the host site and implement systems to manage Legionella as required.
• Consistently complete induction records.

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