Qualified Circumcision Clinic

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 Qualified Circumcision Clinic as part of our inspection programme. The service had never been inspected or rated at this location previously.

The service provides circumcision to children and adults for therapeutic and non-therapeutic reasons. The service is offered on a private, fee paying basis only, and is accessible to people who choose to use it.

The provider is the sole clinician for this service and carries out all of the circumcision procedures undertaken at clinic location.

How we inspected this service

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

During our inspection we:

• Looked at the systems in place relating to safety and governance of the service.

• Viewed key policies and procedures.

• Reviewed clinical records.

• Interviewed the provider both by telephone and face to face.

• Spoke with staff and received written questionnaires from them.

• Spoke with families of people who used the service.

To get to the heart of patients’ experiences of care and treatment, we asked the following questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive?
• Is it well-led?

These questions formed the framework for the areas we looked at during the inspection.

Note: Within the report where there is reference to a parent or parents this also includes those who act as a legal guardian or legal guardians of an infant or child.

Our key findings were:

• Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
• The service had procedures in place regarding consent, and when required the formal identification of those with parental responsibility.
• The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
• There were systems, processes and practices in place to safeguard patients from abuse. We saw staff had received safeguarding training appropriate to their roles.
• The service had developed materials for parents/service users which explained the procedure and outlined clearly the recovery process.
• The service operated an advice line which allowed service users to contact them with any concerns post-procedure.
• Patient records were detailed and noted important information such as anaesthesia, including the type used, batch numbers and quantities administered. However, batch numbers of circumcision devices used were not recorded by the provider.
• Whilst the service had not received any complaints at the time of our inspection, we saw evidence that processes were in place to ensure these would be investigated and be subject to necessary oversight.
• Some quality improvement activity was undertaken by the service including clinical audit. It was noted that some audit activity was limited in scope, depth and detail in respects of methodology and improvements identified and made.
• There was a clear leadership structure. The service had established a governance board which examined key decisions connected to the operation of the clinic.
• The service sought feedback from a proportion of service users via an annual satisfaction survey. Feedback for the clinic showed high satisfaction rates, which mirrored information we received from service users on the day of inspection.
• Staff performance monitoring was undertaken, and we saw that appraisals had been undertaken. We also saw that staff communication was effective and that meetings and debriefings were being held.

The areas where the provider should make improvements are:

• Improve the depth, scope and detail within clinical audits used to assess outcomes for patients and compliance with service standards.
• Begin recording the batch numbers of circumcision devices used.

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