Exeter Medical

Updated 10 July 2019

We carried out this announced inspection on 14 May 2019.

As part of the preparation for the inspection, we reviewed information provided for us by the service. In addition; we reviewed the information we held on our records regarding this provider.

During the inspection we used a number of methods to support our judgement of the services provided. For example, we toured the building, interviewed the providers and staff, reviewed at the clinical systems and patient records and reviewed documents relating to the service.

Exeter Medical provides a broad range of medical and allied services to the population of the South West of England. The business roots and core business, however, are in reconstructive and aesthetic plastic surgery.

Exeter Medical undertakes both self-funded and privately insured local anaesthetic operations. The service also works for local Clinical Commissioning Groups and other NHS organisations to provide outpatient services including medical consultations and minor operations.

A wide range of outpatient procedures and treatments are offered to meet the needs of patients requiring reconstructive and aesthetic plastic surgery, dermatology, general surgery and laser treatments.

The service operates from:

Admiral House

Grenadier Rd

Exeter Business Park

Exeter

Devon

EX1 3QF

The premises is a modern purpose built building situated on a business park. There is level access with accessible facilities for any patient with mobility issues and those bringing children to the clinic. There are three waiting areas in the building and two reception areas. The provider has responsibility for maintaining the building.

The service was bought by Ramsay Health Care UK Operations UK in December 2018. Ramsay Health is a global healthcare provider which in England focuses on adult outpatient services, diagnostics, screening and elective surgical procedures. Exeter Medical is led by a Hospital Director supported by a Head of Clinical Services, Theatre Manager/ Clinical Lead, an Operations Manager, an NHS co-ordinator and a team of administration and nursing staff. The doctors working at the service also work as NHS consultants and are experienced in their individual areas of practice. For example, dermatology, plastic surgery, vascular surgery and general surgery.

The clinic operates weekly from 9am to 5pm Monday, Thursday and Friday. The service operates 9am to 7pm on a Tuesday and 9am to 8.30pm Wednesday.

Further information about the service can be found at www.exetermedical.co.uk

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 10 July 2019

This service is rated as Good overall. The service had been inspected previously on 17 July 2018 but had not been rated at that time.

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 of Exeter Medical on 14 May 2019 to ask the service provider the following key questions; Are services safe, effective, caring, responsive and well-led?

During the CQC inspection on 17 July 2018 and recommended the provider should make improvements regarding systems for retention of recruitment records and embedding the nationally recognised Health and Safety Executive environmental assessments. We checked these areas as part of this comprehensive inspection and found both of these issues had been resolved.

Exeter Medical is an independent health organisation providing medical services, minor surgery, advice and treatment and aesthetic cosmetic treatments, to privately funded patients and patients referred by local NHS clinical commissioning groups (CCG). The service is offered on a private, fee paying basis and is accessible to people who chose to use it. Some services are provided on behalf of NHS services. For example, vasectomy and carpal tunnel surgery. The service is part of Ramsay Health Care UK Operations group (Ramsay Health).

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of treatment, advice or surgery by a medical practitioner under the regulated activities of Diagnostic and screening procedures, Surgical procedures and Treatment of disease, disorder or injury. The aesthetic cosmetic treatments that are also provided are not covered under CQC regulations. Therefore, we were only able to inspect and report on the provision of minor surgery, advice and treatment

During our inspection we spoke with three patients and received six CQC comment cards. Feedback about the service was entirely positive. Patients told us they had their procedures fully explained beforehand and felt involved in decision making. Staff were described as patient, kind and considerate. Patients had confidence in the clinicians who provided their treatment.

Our key findings were:

• There was an effective system for reporting and recording significant events. The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.

• Staff had received appropriate training according to their role.
• The provider had acted upon CQC recommendations arising from the previous inspection. For example, the system for retention of staff recruitment records had been reviewed and was in line with the regulations.
• The provider had continued to embed nationally recognised Health and Safety Executive environmental assessments at the service.
• Patient feedback about reception staff and clinical staff was positive. The service encouraged and valued feedback from service users via in-house surveys and their website.
• Complaints had been dealt with in line with the regulations.
• Staff told us that their morale was good, that they felt supported by the leadership and involved in decision making at the service.
• Care and treatment was provided in a modern, clean and well organised environment.
• Regular team meetings were held and there was an online training system for staff.
• Procedures were safely managed and there were effective levels of patient support and aftercare advice.

• There were systems, processes and practices in place to safeguard patients from abuse.
• Information for service users was comprehensive and accessible. Staff had the relevant skills, knowledge and experience to deliver the care and treatment offered by the service.
• The service had processes in place to securely share relevant information with others such as the patient’s GP, NHS organisations, safeguarding bodies and private healthcare facilities.

We saw the following outstanding practice:

• The organisation engaged with the local community by providing an annual charity ‘mole check’ event at the service. The event included full mole checks for members of the local community in exchange for a minimum £10 cancer charity donation. The Saturday morning event in June 2018 had seen 130 patients being checked and £2340 being raised. Any abnormal results were processed using the urgent two week wait pathways. This year’s event is planned for 1 June 2019.

The areas where the provider should make improvements are:

• Increase the number and range of clinical audits undertaken to enhance quality improvement systems in place.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care