City

Updated 3 September 2021

City Travel Clinic operates at 65 London Wall, London EC2M 5TU. The provider is registered with the Care Quality Commission to provide the regulated activities diagnostic and screening procedures, transport services, triage and medical advice provided remotely and treatment of disease, disorder or injury. The service provides medical services for adults and children. The service website can be accessed through the following link: www.nomadtravel.co.uk

The provider offers travel health services including pre travel screening, vaccinations, medicines and advice on travel related issues to both adults and children travelling for business or leisure. The service also providers post travel support and referred clients to a third party for psychological; particularly to those who have travelled to areas of conflict. The service is a designated yellow fever vaccination centre and provides screening services for medical clearance and post-travel consultations. Most services are available to fee-paying clients although some services offered are specific to clients who work for non-governmental organisations who hold an account with the organisation. Services are available to people on a pre-booked appointment basis Monday to Friday between 9:30am and 5pm. Prior to the pandemic the provider informed us that they saw between 200 to 500 clients a month. This had reduced significantly as a result of the pandemic; including a period of closure between March and June 2020. The service told us that they now saw approximately 30 people per week at this location for travel health.

The City location operates in the lower-ground floor of a converted premises and is accessible for service users who have mobility problems and wheelchair users.

The clinic has a reception and waiting area and three consulting rooms.

The inspection was led by a CQC inspector and supported by a GP specialist advisor.

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 3 September 2021

This service is rated as Requires improvement overall. (Previous inspection March 2019 – unrated.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at City both as part of our inspection programme to rate all providers of independent health services and because the provider was found to be in breach of regulation at our previous inspection undertaken on 12 March 2019.

At our previous inspection in March 2019 we identified the following concerns:

• The provider had not undertaken a comprehensive infection prevention and control audit.
• The provider had not risk assessed on how they would manage patients with severe infections, for example sepsis.
• The provider did not have a defibrillator and emergency medicines to deal with a range of medical emergencies.
• The provider did not have a clear system in place to manage referrals.
• The medicines management policy was not clear about the scope of medicines that could be prescribed by the doctors.
• The provider did not have a clear system in place for authorisation of patient specific directions for administering unlicensed vaccines.
• The provider did not ensure that doctors were up to date with evidence-based guidance.
• The provider had not risk assessed the treatments they offered.
• The provider did not undertake any clinical audits.
• The provider did not ensure staff complete training relevant to their role.

As a result of these concerns we issued requirement notices in respect of breaches of regulation 12 (safe care and treatment) and regulation 17 (good governance).

The service provides comprehensive travel health services in addition to other services which are out of scope of CQC regulation. For instance, the service offers covid 19 testing including fitness to fly, test to release and two- and eight-day testing for arrivals to the UK. The service also has an on-site pharmacy which is also not covered by CQC regulation.

Frances Rea is the CQC 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.

Our key findings were:

• The provider had taken action to assess and mitigate risks associated with infection control. One member of staff we spoke with did not know the lead for infection control audit.
• The service had guidance available to staff for responding to infections including sepsis and some staff had completed sepsis training.
• The provider did not have all recommended emergency medicines. The service had undertaken a generalised risk assessment regarding the need for emergency medicines generally but there had not been consideration of the need for individual medicines. Records we reviewed showed that the provider was providing treatment in line with relevant guidelines though we found that their screening assessment template did not prompt clinicians to fully record their assessment.
• The provider had a system in place to monitor referrals to other services although they told us they had not undertaken any referrals in the past 12 months.
• There was a still a lack of clarity in the provider’s medicines management policy regarding the medicines that could be prescribed. However, a revised policy was submitted after our inspection.
• The service now had access to translation services but no hearing loop for those who had impaired hearing.
• The provider had not prescribed any medicine off license since March 2021.
• Clinical staff had undertaken appropriate clinical updates.
• The provider had completed a quality improvement activity but had not undertaken a clinical audit and had stopped collecting feedback from patients via comment cards and client surveys; though we were told that the service reviewed feedback provided on the internet and that verbal feedback provided by patients was positive

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Have all staff complete training on information governance and sepsis.
• Make all staff aware of the lead for infection control.
• Undertake two cycle clinical audits.
• Consider using a hearing loop to support those patients with hearing difficulties.
• Review safety risks in the service’s storage room.

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