Balance My Hormones

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that patients were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains Good.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a positive culture of safety, based on openness and honesty. There were processes that all staff were aware of for them to report significant incidents, near misses and safety events. There was a system to record and investigate when things went wrong; staff apologised, where appropriate and gave patients support. Learning from incidents and complaints was used to identify and embed good practices where issues had been found. For example, the provider had arranged suicide awareness training to help staff identify patients potentially at risk.

Staff made improvements and action plans in response to our assessment feedback. For example, immediately after our assessment, leaders and managers established a plan to assess and monitor parts of the patient's care pathway assigned to non-clinical staff. The staff we spoke with and those who completed a questionnaire said they felt comfortable raising concerns. The leaders were aware of their responsibility to carry out duty of candour.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. However, some internal systems to ensure safe care had weaknesses. Appropriate protocols were in place for identifying and verifying the patient identity and this was checked by the clinician at each consultation. Patients were initially asked to complete a medical intake form that was subsequently overseen by a doctor. Most patient-reported information, including symptoms, concerns, medication compliance, and test results, was received and recorded by non-clinical staff. This information was relayed to the doctor through written messages, and the doctor responded similarly via the non-clinical staff, who then communicated the doctor's response to the patient. There was no leadership oversight by a qualified clinician to monitor or assess the quality or safety of this process, which relied on non-clinical staff to interpret, assess, and relay clinical information between the patient and the doctor, and this process entailed risks. Although we found no evidence of patient harm in the 10 patient records reviewed, we identified a case where a patient's abnormal blood test result required direct management by a doctor. This involved revisiting the patient's consent to contact their GP and ensure that doctors had enough information to treat the patient safely. However, the consulting clinician had not done so and had not maintained the patient record properly.

Processes to manage emerging medical issues and for managing blood test results ordered and received during a clinical consultation, were effective.

The service had systems to safeguard children and vulnerable adults from abuse.

There were no safeguarding cases the provider had needed to act on, but it had arrangements in place to work with other agencies to support patients and protect them from neglect and abuse.

Disclosure and Barring Service (DBS) checks were undertaken for staff in accordance with their roles. (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).

Staff received up-to-date safeguarding training appropriate to their role and had access to appropriate safeguarding policies. Staff were aware of the safeguarding lead that was a doctor, and they knew how to identify and report a safeguarding concern.

The service worked with patients to understand and manage risks by thinking holistically.

Patients were required to complete an online questionnaire and have relevant blood test and a medical consultation before starting treatment.

We reviewed 10 patient care records. We saw evidence of GP contact details, consent to share information with their GP, emergency contact details, and completed consent to treatment forms. These records indicated that patients' physical and mental history and blood testing were appropriately undertaken, considered, and documented.

If a patient had blood tests from an NHS or other external provider, these were accepted provided the results were reasonably contemporaneous and included identity confirmation. Staff stated that all abnormal blood tests were referred to the clinical lead doctor or another doctor in their absence, who decided whether to contact the patient or send an email to their GP.

This process was followed by a plan of treatment options, discussion of side effects, and an agreed treatment plan, with follow-up where appropriate. We saw examples where a patient’s supply of medicines prescribed was restricted or declined until the necessary blood tests or consultation were attended.

The service considered safe care alongside patient’s needs that enabled patients to do the things that mattered to them. The service invited patients to complete the ADAM (Androgen Deficiency in the Aging Male) and AMS (Aging Males' Symptoms) questionnaires to assess patient reported symptoms related to low testosterone levels in men, and to evaluate and monitor the impact of testosterone replacement therapy on patients' quality of life.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met patient’s individual needs.

The provider carried out staff checks at the time of recruitment and on an ongoing basis where appropriate.

We found training was up to date and learning needs and development of staff were managed appropriately. Safe recruitment practices were followed.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We found that the service ensured medicines and treatments were safe and met patients' needs, capacities, and preferences, following appropriate guidance on remote prescribing. Patients were involved in planning, including when changes were made.

The provider maintained a partnership with a nominated pharmacy that dispensed medications, and comprehensive blood tests and follow-ups were implemented to ensure patient safety regarding medicines compliance. There was clear and effective management of prescriptions. Only doctors generated and signed prescriptions electronically. Medicines were dispensed by the provider's in-house pharmacy and sent by tracked post to the patient.

Patients were given written advice on essential considerations, such as injection technique and side effects. Initially, they were provided with a sharps bin to dispose of excess medicine (for example, leftover in an ampoule) at the dispensing pharmacy. However, this was impractical as the pharmacy posts medicines nationwide. During our assessment, the provider improved its disposal protocol, advising patients to return unused or expired medicines to their nearest pharmacist or seek assistance from the provider's pharmacy if needed, which is good practice.

The provider’s medicines formulary and policy did not formalise arrangements to ensure appropriate prescribing and monitoring of patients, which indicated patients could be at risk. We considered that in the 10 patient records we reviewed, all indicated that prescribing was appropriate; 9 out of 10 had appropriate blood test monitoring, and the provider followed up with the remaining patient.

We saw examples where a patient’s supply of medicines prescribed was restricted or declined until the necessary blood tests or consultation were attended. Immediately after our assessment, the provider reviewed its policies to include arrangements for appropriate prescribing and monitoring of patients.

The provider had a protocol for prescribing treatments for a small number of patients with conditions including Type 2 diabetes and obesity. This protocol was based on national clinical guidance, for instance, inclusion/exclusion criteria, monitoring parameters, and patient counselling.

There was an effective system to receive and disseminate safety alerts and medicines recalls, which were discussed in meetings and logged. We saw evidence of alerts being followed up and appropriate actions taken.