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Inspection Summary


Overall summary & rating

Updated 21 July 2021

We have not rated BMH Medical because the location changed during the inspection. The service was found compliant with the Health and Social Care Act 2008 and associated Regulations.

We carried out an announced comprehensive inspection at BMH Medical between 1 and 23 June 2021 to review the service following the providers registration with CQC on 8 November 2019.

BMH Medical, is registered to provide the regulated activity treatment of disease, disorder or injury. The service provided treatment for both men and women who had hormonal imbalance. The service consisted of a registered manager and two doctors who worked as independent contractors.

A registered manager is a person 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 runs.

Clients were introduced to BMH Medical by an online platform Balance My Hormones, which was a separate service owned by the provider, which at the time of the inspection was not within CQC scope of registration as determined by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the registration regulations 2009.

Due to the current pandemic all appointments had occurred online, and the provider had not used the location at 180 Finchley Road, which consisted of consultation rooms rented as required by the hour. On the day of the site visit, the provider found that the property which housed the consultation rooms had been taken over by a new landlord, and the site was not operating as expected. Following the inspection, the provider submitted an application to remove 180 Finchley Road as their location, and submitted an application to add a new location to carry out the service as an online provider, with occasional face to face consultations when requested by clients, in short-term rented premises.

Our key findings were:

  • BMH Medical had systems and process in place to safeguard people from abuse.
  • BMH Medical had the necessary information available to provide safe care and treatment.
  • BMH Medical had systems in place to help ensure the safe management of medicines.
  • Although, due to a change of ownership of the location, we were unable to fully review the location premises, the registered manager demonstrated they had considered the systems that were required to ensure the premises were safe.
  • We reviewed client records and found clients’ immediate and ongoing needs were fully assessed, the doctors had followed guidance and clinicians had enough information to make or confirm a diagnosis.
  • BMH Medical had responded to complaints in a satisfactory manner.
  • Clients had prompt access to appointments.
  • The service sought and acted upon client feedback to make improvements.
  • The registered manager for BMH Medical had a clear vision and set of values, which prioritised patient safety.

The areas where the provider should make improvements are:

  • Implement and agree a defined formulary of medicines/conditions, for the doctors to prescribe from to achieve a consistent approach.
  • Broaden the range of clinical audits that will demonstrate quality improvements.
  • Consider a system to quality assess the clinical treatment provided by the independent doctors.

Dr Rosie Benneyworth BM BS BMedSci MRCGP


Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas

Safe

Updated 21 July 2021

Safety systems and processes

  • BMH medical had a safeguarding policy in place, which was updated during the inspection. The policy outlined who to go to for further guidance.
  • BMH medical staff team consisted of the registered manager and two doctors, all had completed level three safeguarding training for children and the doctors had completed level two safeguarding for adults. The service did not provide treatment to clients under the age of 18 years.
  • BMH Medical staff had checks at the time of recruitment and on an ongoing basis where appropriate. Disclosure and Barring Service (DBS) checks were undertaken. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). BMH Medical had a recruitment policy last reviewed September 2019.
  • Due to the pandemic all appointments had occurred online, and the provider had not used the premises, which they rented by the hour. On the day of the site visit, the provider found that the property had been taken over by a new landlord, and the site was not operating as they expected. We were therefore unable to look in detail at the infection control and premises procedures in detail. However, the registered manager had produced an inspection control policy last reviewed 12 February 2021 and the registered manager had instigated a fire and legionella risk assessment in 9 December 2020, which they had provided to the landlord to carry out the recommended actions.
  • During the inspection the provider explained that they would no longer be located at 180 Finchley Road.

Risks to clients

  • The registered manager contracted two doctors to meet client demand.
  • The provider did not use agency staff at BMH Medical.
  • The provider submitted evidence to demonstrate that one doctor had completed their basic support training in 2020, the second doctor had completed advanced life support training in 2017. However, the registered manager explained both doctors worked for the NHS and received annual training updates. The Resuscitation Council UK recommends that all clinical staff complete annual updates.
  • BMH Medical had medical indemnity insurance in place until 24 October 2021.
  • The property owner was responsible for the emergency medicines and equipment. However, on the day of the inspection we were unable to check the emergency medicines and defibrillator due to the change in owner.

Information to deliver safe care and treatment

  • BMH Medical used a computer software system for recording and storing information about clients. The registered manager explained controls were in place to ensure staff only had access to their own clients.
  • For clients seen online the registered manager explained the online platform had an online ID verification protocol for staff to follow.
  • The online platform had a secure based client portal shared blood test results with both the client and the doctors at BMH Medical.
  • BMH Medical had a system in place to retain medical records in line with Department of Health and Social Care (DHSC) guidance in the event that they cease trading.
  • BMH Medical had a protocol to share medical information with the clients GP. They requested consent from the client to share this information with their GP, however, the protocol stated that the doctor would contact the clientsGP if they believed it was in the client’s best interests.

Safe and appropriate use of medicines

  • BMH Medical had systems and arrangements for the management of medicines. These systems minimised potential risks. The service had a safe system in place for the management of prescriptions and monitored their use.
  • BMH Medical does not prescribe Schedule 2, 3 and 4 controlled drugs (medicines that have the highest level of control due to their risk of misuse and dependence).
  • BMH Medical staff prescribed medicines to patients and gave advice on medicines in line with legal requirements and the provider’s policy. Processes were in place for checking medicines and staff kept accurate records of medicines. Where there was a different approach taken from national guidance there was a clear rationale for this that helped protect patient safety.
  • The registered manager explained that BMH Medical would only provide testosterone treatment for men and hormone balancing for men and women, any other conditions were referred to the client’s GP or an independent clinician.
  • Although doctors were aware of which medication to prescribe, BMH Medical did not have a defined formulary of medicines/conditions to be assured of consistency.
  • At BMH Medical some of the medicines prescribed were unlicensed. Treating clients with unlicensed medicines is potentially a higher risk than treating clients with licensed medicines, because unlicensed medicines may not have been assessed for safety, quality and efficacy. These medicines are not recommended by the National Institute for Health and Care Excellence (NICE) or other appropriate professional bodies. Where patients were treated with unlicensed medicines, this was outlined to the clients and informed consent was obtained.

Track record on safety and incidents

  • BMH Medical had a safety alert protocol which was last reviewed in April 2021 and a system to review and take action regarding Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts.

Lessons learned and improvements made

  • BMH Medical had a significant events toolkit which was last reviewed in April 2021. The service had not had a significant event since registering with CQC.
  • There were adequate systems for reviewing and investigating when things went wrong and learning from incidents.
  • The service had a policy to instruct staff regarding the management of the Duty of Candour.

Effective

Updated 21 July 2021

Effective needs assessment, care and treatment

  • Clients were introduced to BMH Medical using a separate service which the provider had established. Balance My Hormones was an introductory online administration platform, which at the time of inspection did not fall under the scope of CQC registration. As part of the introduction the platform provided BMH medical with client information and their blood tests results.
  • The registered manager explained that BMH Medical would only provide testosterone treatment for men and hormone balancing for men and women. Any other conditions were referred to the client’s GP or an independent clinician.
  • At BMH Medical clients attended an appointment with the doctor, who would review and agree the treatment plans and prescribe the medication. At the time of the inspection the appointments were mainly online.
  • Following the first appointment, follow up was carried out at six weeks, six months and then annually. Any clients who did not attend their follow up appointments were followed up.
  • The two BMH Medical doctors had completed additional areas of specialist study including AMMG Clinical Applications for Age Management Medicine. They also followed the guidance of the International Society for the Study of the Aging Male (ISSAM) and British Society for Sexual Medicine guidance.
  • We reviewed ten client records and found their immediate and ongoing needs were fully assessed, the doctors had followed guidance and clinicians had enough information to make or confirm a diagnosis.

Monitoring care and treatment

  • The registered manager explained that BMH Medical registered with the CQC on 16 December 2020 and therefore they had insufficient time to complete formal clinical audits, due to the pandemic.
  • BMH Medical had carried out one audit in April 2021. The audit reviewed the client follow up blood test at six weeks after the first consultation with a doctor. This found 90% of blood tests were completed six to eight weeks after commencing treatment.

Effective staffing

  • BMH Medical consisted of the registered manager and two contracted doctors. The provider submitted a training matrix which demonstrated they had completed all the mandatory training, such as basic life support and safeguarding.
  • The registered manager explained that the doctors had completed specialist training in Clinical Applications for Age Management Medicine.
  • The provider had an induction programme for newly appointed staff.
  • The two doctors were registered with the General Medical Council (GMC) and were up to date with revalidation.
  • At the time of the inspection the registered manager would informally review the independents doctors’ records to ensure the quality of the consultation

Coordinating client care and information sharing

  • The service had a protocol to share medical information with the clients’ personal GP They requested consent from the client to share information with their GP. However, the protocol stated that the doctor would contact the GP if they believed it was in the client’s best interests.
  • Before providing treatment, doctors at the service ensured they had adequate knowledge of the client’s health, any relevant test results and their medicines history.
  • The registered manager submitted information to demonstrate how abnormal blood tests were followed up by BMH Medical.
  • BMH Medical registered manager explained that client information was shared appropriately (this included when clients moved to other professional services), and the information needed to plan and deliver care and treatment was available to relevant staff in a timely and accessible way.

Supporting clients to live healthier lives

  • The BMH medical registered manager explained that when clients’ needs could not be met by the service, staff redirected them to the appropriate service for their needs.
  • The registered manager explained BMH Medical took a holistic approach to clients care and treatment.

Consent to care and treatment

  • BMH Medical staff understood the requirements of legislation and guidance when considering consent and decision making.
  • Clients accessed care through the online platform introductory service, which followed a consent procedure last reviewed in April 2021.The information given to clients set out what the introductory company and BMH Medical offered and their fees.

Caring

Updated 21 July 2021

Kindness, respect and compassion

  • BMH medical started in December 2020 and had carried out a client survey, which had 21 responses. This found when clients were asked does BMH Medical make you feel at ease (introduction, explanation of position being friendly and warm towards you, treating you with respect; not cold or abrupt) 100% stated it was good to excellent.
  • When asked whether staff showed care and compassion, 95% of respondents stated it was good to excellent and 5% found it fair.
  • The service sought feedback on the quality of clinical care clients received.
  • The service gave clients timely support and information.

Involvement in decisions about care and treatment

  • BMH medical started in December 2020 and had carried out a client survey, which had 21 responses. This found when asked: -
  • Whether staff listened and paid attention to what you are saying, 100% stated it was good to excellent.
  • Whether staff explained things clearly (answering your questions, giving you adequate information) 90% stated it was good to excellent and 10% stated it was fair.
  • Whether staff helped you take control (exploring with you what you can do to improve your health yourself; encouraging rather than lecturing you) 90% stated it was good to excellent and 10% stated it was fair.

Privacy and Dignity

  • Clients could request a chaperone.
  • We were told the doctors undertook consultations in a private space where confidentiality could be maintained.
  • The registered manager recognised the importance of people’s dignity and respect.

Responsive

Updated 21 July 2021

Responding to and meeting people’s needs

  • The registered manager understood the needs of their clients and improved services in response to those needs.
  • The premises were appropriate for the services delivered.

Timely access to the service

  • Clients were introduced to BMH Medical from the providers other online administration platform, which did not fall under the scope of CQC registration. The platform, sought initial information from the client, arranged blood tests and arranged appointments with the doctors.
  • Clients could make appointments with BMH medical face to face or online.
  • The service commenced in December 2020 and has carried out a client survey, which had 21 responses and the majority of responses were very positive about the service provided.

Listening and learning from concerns and complaints

  • BMH Medical had a complaints policy for staff to follow which was last reviewed in September 2020.
  • BMH Medical had received one complaint since registration, which demonstrated learning. The client had complained about the quality of an online consultation because it was carried out when they were in their car. The learning included administration staff checking to ensure that patients were prepared for their consultation.
  • Clients were provided with information on how to complain at the first appointment.

Well-led

Updated 21 July 2021

Leadership capacity and capability

  • BMH medical management structure consisted of the registered manager only, who was knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.

Vision and strategy

  • The registered manager for BMH Medical had a clear vision and set of values, which prioritised patient safety.

Culture

  • The registered manager was aware of and had systems to ensure compliance with the requirements of the duty of candour.
  • The two doctors who worked at the service had independent annual appraisals in the last year and were considered valued members of the team by the provider.

Governance arrangements

  • Leaders had started to implement policies, procedures and activities to ensure safety and assured themselves that they were operating as intended.
  • The registered manager had administration support to review and implement the structures of governance and planned to increase the level of support to ensure good governance.
  • The registered manager explained that the policies were created for BMH Medical during their CQC registration. However, the providers website and policies did not clearly differentiate between BMH Medical which is registered with CQC, the separate introductory agency and Balance My Hormones (BMH) which is the online platform. During the inspection the provider did take steps to review the website to make the difference clearer.

Managing risks, issues and performance

  • The registered manager had oversight of safety alerts, incidents and complaints.
  • The provider had a business continuity plan which was last reviewed on the 4 October 2019.

Appropriate and accurate information

  • There were arrangements in line with data security standards for the availability, integrity and confidentiality of client identifiable data, records and data management systems.
  • The provider reviewed client feedback to improve the quality of the service.

Engagement with clients, the public, staff and external partners

  • BMH Medical encouraged and heard views and concerns from the public, clients, staff and external partners.
  • We saw positive comments about the service online.

Continuous improvement and innovation

  • There was a focus on improvement.
  • The registered manager and doctors followed guidance from the International Society for the Study of the Aging Male (ISSAM) and British Society for Sexual Medicine guidance.