St Michaels's Clinic

Updated 5 September 2022

The provider, St Michael’s Clinic Limited, is an independent Healthcare Company registered with the Care Quality Commission (CQC) to provide the regulated activities diagnostic and screening procedures, surgical procedures and treatment of disease, disorder, or injury from St Michaels Street, Shrewsbury SY1 2HE. The clinic provides a very limited service from their satellite premise in Much Wenlock, Shropshire and was not visited as part of this inspection and is managed by the same Registered Manager. The clinic also utilises rooms within a GP practice in Telford two days a week to support and sustain the Community Dermatology Service.

The clinic offers a private and NHS dermatology service to adults and children and is commissioned by Shropshire, Telford and Wrekin ICS, Powys Teaching Health Board and Betsi Cadwallader University Health Board. Currently 79% of treatment is NHS and the remainder private. The service was set up in 2003 and moved into its current premises in 2011 under the previous registered provider. Following the sale and transfer of ownership to The Dermatology Partnership (THP) the service was registered with CQC as St Michael’s Clinic Limited on 6 January 2021. Dr Stephen Murdoch is the nominated individual and the clinical director.

The clinic is located on the outskirts of Shrewsbury. Clinical rooms, including one theatre, are located on the ground and first floors, with a main waiting area, reception and staff offices. There are accessible toilet facilities and free on-site parking.

The service employs four dermatology consultants, six speciality doctors, five GPs with a special interest, 16 nurses, four of whom are Clinical Nurse Specialists and five health care assistants. Four of the doctors work solely at the clinic and others work on a sessional basis. The clinical team are supported by a team of 22 administrative staff, a practice co-ordinator and a business manager. Some roles have been reorganised under the new provider.

The clinic is open between 9am and 8pm on a Monday to Wednesday and between 9am and 5pm Thursday and Friday and is closed weekends and bank holidays. A very limited service is offered from a satellite site in Much Wenlock, Shropshire on a Friday and an occasional Tuesday from 9am and 5pm. The provider also utilises rooms within a Telford GP practice on a Tuesday and Thursday to support and sustain the community dermatology service. More information about the services provided are available on the provider website: www.stmichaelsclinic.co.uk

How we inspected this service

We carried out this comprehensive 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 following the change of provider.

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

This included:

• Requesting a provider information return and additional evidence from the provider prior to and post our site visit.
• A presentation.
• Conducting staff interviews remotely using video conferencing.
• A site visit to undertake a tour of the premises, review clinical records, carry out observations and review key documents which support the governance and delivery 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 5 September 2022

We carried out an announced comprehensive inspection at St Michael’s Clinic on 4 August 2022 following the change of ownership and registered provider.

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

The location was inspected under the previous registered provider on 16 December 2019 and rated good overall and across all five key questions.

St Michael’s Skin Clinic is based in Shrewsbury, Shropshire and provides an outpatient dermatology service to private patients and NHS patients. The clinic specialises in skin treatments including medical, surgical and laser in addition to a range of non-surgical cosmetic interventions, for example botulinum toxin injections and dermal fillers which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

The service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Mr Paul Haycox 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.

CQC comment cards were not distributed to the provider prior to the inspection in order to minimise the risks associated with the COVID -19 pandemic. However, the clinic had systems in place to gain patient feedback.

Our key findings were:

• Patients were able to access care and treatment within an appropriate timescale for their needs. They received clear information about their proposed treatment which enabled them to make an informed decision.
• Patients received effective care and treatment that met their needs.
• There was a system in place to manage infection prevention and control (IPC). Audits were undertaken and action plans developed however, these did not include all identified actions for improvement.
• The service ensured that care and treatment was delivered according to evidence-based guidelines and current best practice.
• The service had systems in place to review the effectiveness and appropriateness of the care it provided.
• Systems, processes and records had been established to seek consent and to offer coordinated and person-centred care.
• Clinical staff were registered with the appropriate governing body and there was a system in place to ensure they were up to date with revalidation.
• Staff maintained the necessary skills and competence to support patients’ needs, however a greater oversight of essential training staff had undertaken was required.
• People using the service were treated with compassion, kindness, dignity and respect.
• The provider and staff team demonstrated a positive culture and a commitment to the delivery of person-centred care and treatment and continuous learning and improvement.
• The provider was aware of, and complied with, the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Review recruitment processes to ensure all checks are carried out in line with policy and regulation.
• Review infection prevention and control audits and cleaning schedules to ensure they are effective.
• Maintain an accurate record of staff training and ensure all staff have completed essential training within the required timescales.
• Further develop quality improvement activity to include repeat clinical audits.
• Consider developing an information sharing agreement with local GP practices.
• Develop a documented business plan to achieve priorities.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services