The Lawrence Clinic

The Lawrence Clinic is operated by TLC Medical Centre limited liability partnership (LLP). It is a multidisciplinary clinic, offering musculoskeletal, complementary and front foot surgery. The clinic was established in October 2003 bringing together specialists in medicine, surgery and complementary medicine under one roof. The clinic was owned and managed by four directors, one of whom was the registered manager. The directors did not undertake any clinical functions.

The Lawrence Clinic provided front foot surgery for adults aged 18 and over. We inspected this service using our comprehensive inspection methodology. We carried out the short notice announced part of the inspection on 19 October 2019. It was necessary to conduct a short notice announced inspection because the service was only open one or two Saturdays per month and only if demand from users of the service required it.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this clinic was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery service level.

Services we rate

We rated this service as Good overall.

We found good practice:

• The service had enough staff to care for patients and keep them safe. Medical staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

• Leaders ran services using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and staff were committed to improving services.

• Mandatory training completion was high and all staff had received an appraisal within the last year.

• The provider had robust arrangements in place for obtaining consent for patients having surgery or other procedures at the service.

However, we found the following areas of concern:

• There were tears on the couch in the theatre, which posed an infection risk. The clinic was in the process of replacing this item.

• At the time of the inspection, the provider did not have a process in place to protect the public from the risk of Legionnaires disease. This was evidenced in the bathroom where the shower hose had been removed, leaving an outlet which was not tested regularly. We raised this as a concern with the registered manager at the time of the inspection. Since the inspection, the provider had contracted with an external company to have the water tested regularly.

• The service did not take minutes of all meetings. It is good practice to minute discussions of meetings so there is an accurate record of what was discussed.

• The service did not have a written strategy in place, however the small team’s vision and ethos and shared values were evident.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North)