Qualified Circumcision Clinic

Updated 25 February 2022

Mr Altaf Mangera operates as an independent circumcision provider. The provider operates as the Qualified Circumcision Clinic and delivers services from two locations in Sheffield and one in Coventry. One of the Sheffield based services operates from accommodation within Dovercourt Surgery, 3 Skye Edge Avenue, Sheffield, South Yorkshire, S2 5FX. The service provides circumcision to children and adults for therapeutic and non-therapeutic reasons under local anaesthetic and carries out post procedural reviews and revisions of patients who have undergone circumcision at the clinic. The majority of circumcisions carried out by the clinic were on children under one year of age. The service is registered with the Care Quality Commission for the provision of Surgical procedures and the Treatment of disease, disorder or injury.

Dovercourt Surgery where this service is hosted is a modern GP practice which is easily accessible for those bringing children or young people to the clinic, or for those with mobility issues. For example, it has level floor surfaces, automatic doors and parking is available. The Qualified Circumcision Clinic utilises the minor surgery room within the practice for the delivery of services, as well as ancillary areas such as two recovery rooms, a waiting area and toilets.

The service is operated by a single named provider, and procedures are undertaken by the provider (male) who is a qualified and registered urologist. Other staff working at the clinic includes a clinical support worker (male) and a receptionist (female).

The Sheffield based service operates clinics depending on demand and the availability of accommodation within the host GP practice.

The service has a web site www.qcclinic.co.uk

Updated 25 February 2022

This service is rated as Good overall. The service was last inspected on 8 February 2020 when it was rated Good overall, with a rating of Requires Improvement for the key question of Safe, and Good for all other key questions.

The key question inspected was rated as:

Are services safe? – Good

We carried out an focused desktop inspection at Qualified Circumcision Clinic to follow up on breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014. As a result of our inspection undertaken in February 2020, we issued the provider with a requirement notice under Regulation 17: Good governance due to areas of non-compliance we found. At this inspection, we looked across the key question of Safe in order to assess the improvement, and to review compliance with the requirement notice.

The service provided a circumcision service for children and adults for therapeutic and non-therapeutic reasons. The service is offered on a private, fee paying basis only, and is accessible to people who choose to use it.

The provider is the sole clinician for this service and carries out all of the circumcision procedures at the clinic.

At the previous inspection in February 2020 we found that in relation to the breach of Regulation 17: Good governance:

• On the day of procedure, no checks were undertaken to formally verify and record the identity of parents, or those with legal parental authority, who had brought in a child to receive a circumcision.
• Quality improvement and clinical audit activity was limited and lacked depth.
• Information held in personnel and staff recruitment files was not sufficient to fully evidence staff suitability for their roles, and to identify any possible issues or concerns. Issues identified included a lack of references, and limited evidence of training attainment.

In addition, as part of this inspection we told the provider that they should make improvement to:

• Undertake to update the consent policy to include references to mental capacity.

We checked all of these areas as part of this focused desktop inspection and found that the majority of these issues had been resolved. The only area which still required further improvement related to clinical audits, which although improved since the last inspection still lacked depth, scope and detail.

How we inspected this service

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This was a focused desktop inspection which looked at the key question;

• Is it safe?
• Clinicians and non-clinical staff were up to date with necessary training. This included basic life support.
• The level of information held in staff personnel and recruitment files had increased and clearly showed information such as staff training attainment.

The inspection was undertaken via telephone interviews with the provider and physical review of documents on 23 January 2022.

Note: Within the report where there is reference to a parent or parents this also includes those who act as a legal guardian or legal guardians of an infant or child.

Our key findings were:

• Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
• The service had procedures in place regarding consent, and when required the formal identification of those with parental responsibility.
• The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
• There were systems, processes and practices in place to safeguard patients from abuse. We saw staff had received safeguarding training appropriate to their roles. In addition, consent procedures had been updated and included reference to individual mental capacity.
• The service had increased the quality improvement work that had been undertaken by the service. However, it was noted that this activity was limited in scope, depth and detail in respects of methodology and improvements identified and made.

The area which the provider should make improvement is:

• Improve the depth, scope and detail within clinical audits used to assess outcomes for patients and compliance with service standards.

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