CQC report - The State of Care in Independent Primary Care Clinics

17 Apr 2019

Last month the CQC published its report following their inspection of over 450 independent doctor services and 59 slimming clinics.

It highlights some worrying features found on inspection particularly, in relation to safety of the services provided. In quite a long list of concerns, questions were also raised about the adequacy of record keeping and sharing of information with other agencies.

The inspections occurred  between January 2017 and October 2018 with some clinics being re-inspected and showing some improvement.

The Sector
A wide range of services are delivered in this sector from private GP services, to travel clinics, slimming clinics and circumcision clinics. The CQC recognises that often patient’s contact with these clinics is episodic, occurring without a referral from a GP and without the clinic having access to the patients records held elsewhere, meaning that information in relation to prescriptions, history etc, is taken essentially on trust from the patients themselves. Added to that, policies in relation to sharing information regarding clinic treatments with the NHS GP were often found to be unclear which further raises the question of risk to patient safety.

Main concerns
Concerns were highlighted particularly in relation to safety in  prescribing of opioids and antibiotics where the absence of clear procedures presents a risk that patients might duplicate prescriptions of opiate drugs (particularly when identities of patients were not always checked) and lead to the inappropriate prescribing of antibiotic medicines.

Unlicensed medicines were found to be prescribed in slimming clinics inappropriately, for too long and without appropriate information being provided to the patient. The standard of record keeping was inadequate in some services.

The report highlights records being held on paper, inhibiting information sharing and identification of groups of patients e.g. where they may need to be contacted regarding medicines alerts. In some locations records were handwritten, and written in another language and/or illegible. Records were also found to be incomplete, failing to document patient histories, details of examinations and investigations, and consent.

Poor practice was also identified in relation to provision and maintenance of equipment and insecure systems around storage of medicines, patient records and prescription pads.

Leadership, supervision and support for staff was also identified as requiring improvement as was overall governance of service provision.

Serious issues to be addressed
Whilst on re-inspection the CQC found some improvements, there is little of comfort in this report for potential users of independent clinics such as this. Whilst the sector scored highly on the way it cares for patients in terms of kindness, respect and compassion, that is seriously undermined by the other report findings.

Within this report are some serious issues which must be addressed swiftly, particularly in relation to safety concerns. One hopes that the clinics concerned respond quickly and effectively before more patients are put at risk.Clinicians working in the sector should also be mindful of their professional responsibilities and obligations. Some of the failings encountered could  result in a referral to the GMC, with serious consequences for the practitioner concerned. If patients come to harm both the clinic and the clinicians may face claims for damages. The implications for those indemnifying practitioners and clinics in this sector are clear.

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Disclaimer: This document does not present a complete or comprehensive statement of the law, nor does it constitute legal advice. It is intended only to highlight issues that may be of interest to customers of BLM. Specialist legal advice should always be sought in any particular case.

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