Nuffield Health Milton Keynes Fitness and Wellbeing Centre

Updated 13 June 2019

The Nuffield Health Milton Keynes Fitness and Wellbeing Centre (the location) is operated by Nuffield Health (the provider) at Marlborough Gate, Milton Keynes, MK9 3XS. The provider is registered with the Care Quality Commission to carry out various regulated activities at numerous locations across the country. The regulated activities relating to this location are Diagnostic and screening procedures and Treatment of disease, disorder and injury.

Milton Keynes Health and Wellbeing Centre provides health and wellbeing, screening and physiotherapy services to people aged 18 years and over from a purpose-built facility which includes a full fitness suite, swimming pool and other sports facilities. At the time of our inspection, the Centre had a total adult membership of 2,900 and was open from 6am to10pm from Monday to Friday and from 8am to 8pm on Saturdays and Sundays. Health assessments were available from within the dedicated clinic from 8am to 4pm Monday to Friday.

Health assessments are categorised and promoted as:

• A lifestyle health assessment with a Physiologist, for patients wanting to reduce health risks.
• A female assessment with a Doctor, for all aspects of female health.
• A 360-health assessment with a Physiologist and a Doctor which includes a review of diabetes and heart health risks.
• A 360+ health assessment with a Physiologist and a Doctor which focussed on cardiovascular health.

Personalised Assessments for Tailored Health (PATH) are also available, these are tailored to suit the patient’s individual needs. At the time of our inspection, these assessments were available to patients employed by a service that had signed up to this package as part of their employee health and wellbeing scheme.

Health assessments cover key health concerns such as weight, diabetes, heart health, cancer risk and emotional wellbeing, and may involve a number of screening and testing procedures. There is a small laboratory onsite to process some blood tests. More complex tests are sent to the provider’s facility in Warwick for assessment. Following the assessment and screening process, patients have a consultation with a doctor and/or physiologist to discuss the findings and to consider and plan for any required treatment. Patients receive a comprehensive report detailing the findings of the assessment. The report includes advice and guidance on how the patient can improve their health together with information to support healthier lifestyles. Any patients requiring further investigations, or any additional support are referred to other services.

At the time of our inspection, the clinical team consisted of two health assessment doctors

working at the location on a part-time basis and two physiologists. Physiologists are full professional members of the Royal Society for Public Health (RSPH) and are trained to carry out health assessments, give advice and motivate patients to make lifestyle changes affecting areas such as exercise, nutrition, sleep and stress management. There were two physiotherapists based within the clinic. The location has a general manager, a clinic manager and a small team of administrators. Further corporate managerial and administrative support is operated from the provider’s other offices. We were advised by the management team that the service had successfully recruited a cognitive behavioural therapist so that services for CBT for support with emotional and wellbeing could resume within the location. Physiotherapy and cognitive behavioural therapy (CBT) services provided at Nuffield Health Milton Keynes Fitness and Wellbeing Centre also do not fall within the regulated activities for which the location is registered with CQC. We therefore did not review them during our inspection.

We inspected Nuffield Health Milton Keynes Fitness and Wellbeing Centre on 21 May 2019. The inspection team included a lead inspector and GP Specialist Adviser. Before inspecting, we reviewed a range of information we hold about the service, any notifications received, and the information given by the provider at our request prior to the inspection.

During our visit we:

• Spoke with a range of staff including the regional clinical lead doctor, one of the doctors, a physiologist, the general manager and the clinic manager.
• Looked at the systems in place for the running of the service.
• Explored how clinical decisions were made.
• Looked at rooms and equipment used in the delivery of the service and made observations of the environment and infection control measures.
• Viewed a sample of key policies and procedures.
• Looked at a random selection of anonymised patient reports.
• Reviewed CQC comment cards which included feedback from patients about their experiences of the service.

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 June 2019

We carried out an announced comprehensive inspection on 21 May 2019 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

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 this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Nuffield Health Milton Keynes Fitness and Wellbeing Centre (the location) provides a range of health assessments to patients aged over 18 years. Assessments include a range of testing and screening processes undertaken by a doctor and/or physiologist as appropriate. Following the assessment and screening process, patients undergo a consultation with a doctor to discuss the findings of the results and any recommended lifestyle changes or treatment planning. Patients can also access physiotherapy at the centre.

The location is registered with the Care Quality Commission (CQC) under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. For example, at Nuffield Health Milton Keynes Fitness and Wellbeing Centre, services are provided to patients under arrangements made by their employer with whom the service user holds a policy (other than a standard health insurance policy). These types of arrangements are exempt by law from CQC regulation. Therefore, at Nuffield Health Milton Keynes Fitness and Wellbeing Centre we were only able to inspect the services, which are not arranged for patients by their employers with whom the patient holds a policy (other than a standard health insurance policy). Physiotherapy and cognitive behavioural therapy (CBT) services provided at Nuffield Health Milton Keynes Fitness and Wellbeing Centre also do not fall within the regulated activities for which the location is registered with CQC.

The General Manager 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 received nine completed CQC comment cards. All the completed cards indicated that patients were treated with kindness and respect. Staff were described as friendly, caring, helpful and professional. In addition, comment cards described the environment as pleasant, clean and tidy.

Our key findings were:

• The provider had clear systems to keep people safe and safeguarded from abuse. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. A national duty doctor responded to identified safeguarding concerns, including patients at risk of suicide and those suffering domestic abuse.
• Staff assessed patients’ needs and delivered care in line with relevant and current evidence-based guidance and standards.
• There were adequate arrangements in place for laboratory tests as well as for transporting samples for any offsite testing. During our inspection, we noted that the service operated internal and external quality control systems to support this service.
• Patients were treated with dignity and respect and they were involved in decisions about their care and treatment. Treatment was delivered in line with best practice guidance and appropriate medical records were maintained.
• Patients were provided with information about their health and with advice and guidance to support them to live healthier lives.
• The service actively sought feedback from patients and displayed the results and actions taken in response to feedback received.
• The clinic ran regular ‘meet our experts’ sessions which provided information and supportive advice on different conditions facilitated by a multi-disciplinary team of advisors, including doctors, physiologists and nurses.
• Systems were in place to protect patients’ personal information.
• Information about services and how to complain was available and easy to understand.
• An induction programme was in place for all staff and all staff received role specific training prior to treating patients.
• There was a comprehensive training programme and staff were well-supported with training and professional development opportunities. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The provider had a clear vision to provide a safe and high-quality service and there was a clear leadership and staff structure. This vision was adopted locally within the service through an effective leadership team. Staff understood their roles and responsibilities.
• There were clinical governance systems and processes in place to ensure the quality of service provision. Staff had access to all standard operating procedures and policies which were regularly reviewed and updated.
• There was evidence of continuous quality improvement across various areas such as hey performance indicators (KPI) monitoring, adherence to regulatory and best practice standards and quality audits.

The areas where the provider should make improvements are:

• Consider supporting doctors who interpret diagnostic spirometry to achieve the standard of practice set out by the Association for Respiratory Technology and Physiology (ARTP) and enable them to enrol on the National Register, as best practice.

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