Archived: Circle Clinical Services Limited

Updated 21 November 2018

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.

Circle Clinical Services Limited have contracts with Bedfordshire and Greenwich CCGs to deliver a fully integrated system of care for patients with musculoskeletal issues. This includes bone, muscle, and tissue conditions; and associated pain; physiotherapy, podiatry, community triage, orthopaedic surgery, rheumatology and chronic pain under the NHS Prime Service Provider.

Patients are referred by their GPs to the service which then reviews them and directs them for treatment through appropriate care pathways. The service acts as a single triage point and a single patient hub, subcontracting with all the other providers, and offering patients choice over which provider they go to. Patients are directed to one of 21 secondary care locations of their choice or to one of 19 community therapy locations. The service also delivers care at one if its 12 community hub locations where appropriate. During this inspection we were only able to visit the main hub located in the Enhanced Services Centre, Kimbolton Road, Bedford. The service is located on the first and second floor of a purpose-built premises with lifts available for those patients that used a wheel chair.

The service serves a population of 440,000 in Bedfordshire CCG and 276,000 in Greenwich CCG. The clinical team consisted of a multidisciplinary team of physiotherapists, extended scope physiotherapists, GPs with special interests, sport and exercise medicine consultants, pain consultants, orthopaedic consultants, rheumatology consultants, spinal consultants, pain nurses, clinical psychologist and healthcare assistants. Some of the consultants worked on ‘practicing privileges’ where permission is granted through legislation to work in an independent hospital clinic. The clinical team is supported by a team of administration staff including patient choice advisors, quality and contracts management, GP liaison as well as the governance and service transformation team.

The service is registered to provide the regulated activities of diagnostic and screening procedures, surgical procedures and treatment of disease, disorder or injury.

The service is registered to provide the regulated activities of diagnostic and screening procedures, surgical procedures and treatment of disease, disorder or injury.

The director of operations 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

When we visited the service on the 20 September 2018 the inspection team consisted of a lead CQC inspector, a GP Specialist advisor and a nurse specialist advisor to CQC.

Before visiting, we reviewed information we gathered from the provider through the provider information return and other information we hold about the service. During the inspection we spoke with clinical staff including:

• Lead GP with special interest and chairman
• Head of Clinical Services
• Musculoskeletal Physicians
• Physiotherapists
• Governance and quality lead and operations lead as well as other administration staff

As part of our inspection we also asked for CQC comment cards to be completed by patients prior to our inspection. We received 27 completed comment cards where people who used the service shared their views and 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 21 November 2018

We carried out an announced comprehensive inspection on 20 September 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Our key findings were:

• There were systems in place to keep patients safe and safeguarded from abuse.
• Risks well managed at the main Hub site we visited. The service recognised more assurances were required to ensure safety at other sites where care was also being delivered.
• Incidents were acted on and used to support learning.
• We visited only one of the 12 patient hubs which was located in a purpose-built health centre and appeared visibly clean and well maintained.
• There were systems in place to support infection, prevention and control and for managing the safety of equipment.
• The service did not dispence medicines but arrangements to manage emergencies and emergency medicines were in place.
• Appropriate processes were in place for the recruitment of staff. Staff were supported with their learning and development needs and had access to training and regular appraisals
• There was evidence of audits undertaken to ensure the quality of service.
• Patient information was shared as appropriate with relevant health and care professionals involved in the patients care and treatment and patients were informed.
• Feedback from people about the service they received was positive. People who had used the service felt involved in decisions and said that they were treated with dignity and respect.
• There was a complaints process in place and available on the provider website.
• There were established governance arrangements and strong leadership to support the running of the service. Meetings were held at various levels to review service quality.
• There was a strong focus on continuous learning, improvement and innovation at all levels of the organisation.
• The service had a fixed term five-year contract with the CCGs and had been able to demonstrate increased activity whilst demonstrating savings for the CCGs. This was achieved through various means such as service re-design (innovative patient pathways) involving a multidisciplinary team, increased community provision and innovative technology.

There were areas where the provider could make improvements and should:

• Review processes to gain assurance that all hub sites can deliver safe care.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice