Community Health Centre

At our inspection on 22 July 2021, we rated the service as good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Choose a rating

Are services responsive? – Choose a rating

Are services well-led? – Good

We carried out an announced focused inspection at Community Health Centre on 22 July 2021. This was because the practice had previously been rated as requires improvement in the safe and well-led domains, and therefore rated requires improvement overall, at our last inspection on 28 November 2019. The caring and responsive key questions were rated as good at the previous inspection and as we had no information indicating any concerns relating to these two key questions, their previous ratings of good are carried forward from the previous inspection.

Following our inspection in November 2019, we asked the provider to make improvements regarding compliance with Regulation 17 Good Governance. We checked these areas as part of this focused inspection in July 2021 and found that these had been resolved.

Community Health Clinic is registered with the Care Quality Commission (CQC) as an independent health service providing non-therapeutic circumcisions. It is a service provided within the GP practice at Community Health Centre on Melbourne Road. The GP practice had previously been separately registered with the CQC, but was in the process of updating their practice’s CQC registration at the time of our inspection.

One of the partners at the GP practice is the registered manager for the circumcision service. 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:

• The process for obtaining parental consent and verifying parents and the child’s identity had been strengthened since our previous inspection. Records we reviewed demonstrated this, although we identified one occasion where a child had been circumcised without evidence of an identity check being completed prior to the procedure.
• The system for recording details of the local anaesthetic administered during the procedure in the patient’s record had been addressed since our previous inspection.
• The practice had implemented a process to communicate with the patient’s own GP practice following the circumcision procedure.
• There was evidence of how patient outcomes were evaluated, analysed and reviewed as part of quality improvement processes. The service had introduced a process of ongoing audit to demonstrate that patient records reflected key outcome indicators. However, there was no formalised written audit available.
• The circumcision clinic was incorporated into the wider practice schedule of health and safety checks including infection control. In addition, the circumcision clinic adhered to the practice policies, although there was no specific reference to the service in relevant policies.
• Staff delivering the service were experienced and up to date with mandatory and other relevant training.
• There was no formal assurance process to audit the discussions the healthcare assistant had with parents and patients post procedure. However, we were assured that the oversight from the surgeon and GP partners ensured this was managed safely.
• Patient satisfaction was overwhelmingly positive about their experience of the service and their interaction with the team.
• The service had developed information leaflets to give to parents/patients post procedure and a frequently asked questions section on their website, which explained the procedure and clearly outlined the recovery process.

The areas where the provider should make improvements are:

• Provide ongoing assurance via audit and staff training that all appropriate identity documents are in place prior to the circumcision procedure taking place.
• Implement a review of relevant practice policies to ensure they are inclusive of the circumcision clinic. This should incorporate policies on consent, infection control, and safeguarding.
• Undertake an audit of the healthcare assistant’s out-of-hours discussions with parents to demonstrate assurance that these are accurately recorded and completed within the scope of the role.
• Develop a more formal audit process to demonstrate the annual outcomes achieved by the service. For example, adherence to standards on consent, record-keeping, and post procedure complications.
• Document that the parent and healthcare assistant were in attendance during the circumcision procedure for infants and young children in the patient’s record.

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