We carried out an announced comprehensive inspection on 13 August 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?
We carried out this 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.
The provider, which is 3VHealthcare Limited, is registered with the Care Quality Commission (CQC) to provide services at Eccles Road, Chapel-en-le-Frith, High Peak, Derbyshire, SK23 9RG. The clinic has been used to provide services to patients since 2009. It is registered with the CQC to provide three regulated activities which are diagnostic and screening services; treatment of disease, disorder and injury; and surgical procedures.
3VHealthcare Limited – Goyt Valley Medical Practice provides consultant-led NHS clinics and an ultrasound scanning facility in the Chapel-en-le-Frith area of the High Peak. The service works closely with the provider's other location, 3VHealthcare Limited – Thornbrook Surgery, situated half-a-mile away, which also provides consultant-led NHS clinics. The office opening hours are Monday to Friday 8am to 5pm, and patients can contact the service by telephone between 8.30am and 16.30pm. Clinical sessions are available throughout the week at different times according to the specialty. Monthly ophthalmology clinics are held on a Saturday at the Goyt Valley site in Chapel-en-le-Frith.
Patients are referred into the service by authorised clinicians, including GPs, nurse practitioners and optometrists. All clinical sessions are provided on the ground floor within a GP practice. Adequate parking is available for patients at each location.
Three GPs are the directors of 3VHealthcare Limited and there is also one non-executive director of the company. There is a management team comprising of an office manager, and three named service managers with responsibilities for each specialty. Four administrative staff support the team including IT support, these staff are based in a health centre situated next door to Thornbrook Surgery. This is solely an administrative base and no regulated activities are provided from this site. 3VHealthcare Limited staff also use a room at Thornbrook Surgery which is rented from the practice. The service also employs a pharmacist on a sessional basis. In addition, there are 15 consultants, two GPs with a Specialist Interest (GPSI), an associate specialist, and a diagnostic radiographer who work for the service on a sessional basis, but are not directly employed. Two specialist nurses (a rheumatology and an ophthalmology nurse) are employed on a zero hours contract to support the consultant clinics.
A GP from one of the three practices which established the service is the registered manager, and this GP is also one of the three directors of 3VHealthcare Limited. 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 service provided prompt and easy access to the clinics it provided for patients residing locally. This was highly valued by patients who otherwise would need to travel to hospitals some distance away, and the area was subject to poor transport links and frequent adverse weather in the winter months.
- We received 31 CQC comment cards from patients about this service. We also spoke with several patients attending the service on the day of our inspection. The patients’ responses were almost entirely positive about their experiences at the service. Comments included that patients felt staff were very friendly and courteous, they felt listened to and their questions were answered in a way which was easy to understand, as well as being treated with dignity and respect. Patients also told us they valued having access to this service locally and that they received an appointment promptly after being referred.
- Directors and managers spoke with passion about the service and their commitment to deliver a service to meet the needs of their patients. There was a clear vision to provide high quality, locally-based, and sensitive care.
- The management team liaised effectively with visiting clinicians to ensure the continuity and coordination of care and service delivery. Service managers provided a named person for both patients and staff as a point of contact. There were clear responsibilities, roles and systems of accountability to support good governance and management.
- The service maintained comprehensive records of activity and outcomes to assess quality of service provision. This included monitoring satisfaction through the Family and Friends Test, and quality was discussed regularly with their commissioning Clinical Commissioning Group (CCG). An annual quality account was produced by the service.
- There was effective management of significant events. The service had a low threshold to record incidents to ensure everything was captured and learning opportunities maximised.
- The clinical staff used evidence based guidance to ensure appropriate and effective treatment and advice was given to patients.
- Staff told us there was an open and inclusive culture of management and felt their views were listened to.
There were some areas where the provider should make improvement:
- Consider the development of a regular clinical audit programme.
- Develop an induction protocol for visiting consultants
- To continue the ongoing work in developing a designated website for 3VHealthcare Limited to enhance patient information.
- To review the availability of information on the complaints procedure for patients.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice