Psychiatry-UK

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

The provider had appropriate safety policies which were regularly reviewed and communicated to staff. The service had a designated safeguarding lead. Staff reported safeguarding using the provider’s reporting system in line with the safeguarding policy. Safeguarding was discussed at the quality and safety committee meetings.

Individual safeguarding incidents were discussed at Patient Safety Incident Response Framework (PSIRF) panel meetings. Audits around risk and safety were routinely completed and the auditing process had been streamlined. The service had a new system to record and report safety incidents, risk, and complaints which was user friendly and easy to navigate. The service had an effective system to follow up and act on known safeguarding risks when patients disengaged.

Staff had a clear understanding of risks. The service monitored the people on the waiting list and staff ensured that appropriate action was taken when their risk changed. The service had effective risk management systems in place and used innovative artificial intelligence (AI) systems to recognise when adults were at risk of harm or abuse.

Staff followed risk management processes to safeguard patients. These processes included reviewing risk ratings, reducing waiting times and sometimes referring patients to more appropriate services when indicated. The service used a traffic light risk system called a BRAG rating. Patient risk was assessed and given a colour rating of black, red, amber or green. A green rating indicated no current risk, red was the highest risk level and black indicated when a patient was not suitable for the service provision.

The service had an eligibility criteria policy in place. This ensured they only took patients they could manage safely.

The service had enough staff, who knew the patients well. Staff received basic training to keep patients safe from avoidable harm. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed.

The service had a number of policies in place that aligned with their service model including homeworking policies.

This service scored 66 (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 used patient feedback about care and treatment to make improvements. Examples included up to date waiting time information added to the service website and patient portal.

The service encouraged a culture of openness and honesty throughout the organisation.

There was a system for recording and acting on significant events. Staff understood their duty to raise concerns and report incidents and near misses. Leaders and managers supported them when they did so. We saw evidence that incidents were investigated thoroughly, and patients and their families were involved in these investigations.

Patients could self-refer or use the NHS right to choose option to receive their care and treatment from the service. Patients told us they chose the service as the waiting times were shorter than the NHS. However, patients had waited over 12 months in some instances for ADHD assessments, this was due to an increased demand nationally for adult ADHD assessments. The provider sent routine wellbeing texts and messages through the patient portal to monitor risk while patients waited for assessment and treatment.

Patients told us that once they received a diagnosis from the service, they had to wait to receive medications. This was due to waiting lists for medications being a separate pathway within the service, in addition to global manufacturing shortages of some ADHD specific medicines.

While waiting times were around 12-18 months for adult ADHD assessments and 12 months for ASD assessments, due to new AI functionality and processes, the service had demonstrated a significant reduction in waiting times to 12 months and 3 months respectively. Ongoing work in this area also indicated further reductions in wait times were projected in 2025.

Following an assessment by the service, people who met their admission criteria were moved to the waiting list for treatment. Patients were able to keep in touch with the service via the patient portal during this time. Staff sent regular wellbeing check-in text messages to patients while they waited for treatment.

Pathways leads were responsible for patient referrals, assessments, titration and discharge. There were a cohort of associate doctors supervised by the provider's psychiatrists. If they were new to a pathway, such as ADHD, they were taken through a series of training sessions.

Patients were risk assessed at the point they were referred into the service and this informed where they would be placed on the waiting list, which was regularly reviewed. In comparison to national averages, and similar providers, Psychiatry UK waiting times were comparative and significantly shorter than NHS waiting times for both adult ASD and ADHD pathways.

The provider employed a designated safeguarding lead. Safeguarding incidents were managed appropriately, and all staff knew how to make a safeguarding referral. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

The service had implemented a new system which allowed all safeguarding information to be logged, stored and audited.

The provider used an AI system to assess patient risk. When risk of harm was identified, the provider's safeguarding lead reviewed the alerts raised and requested welfare checks on those patients.

Patients commented on the delays between receiving their diagnosis and waiting to receive medication. A small number of patients said there were errors in their diagnostic reports which were difficult to challenge. Patients told us this had a detrimental impact on their jobs and relationships and their trust in the service.

Patients on the waiting list could access the provider's portal and so could update their own risk information, which was then screened by AI and the nurse liaison team. The service also sent regular wellbeing texts inviting patients to report any changes to their presentation and wellbeing.

Some patients told us that they engaged in this process and found it was easy to share information with their clinicians while others were unsure if their responses were read by staff when they used the patient portal because they did not always get a response.

The nurse liaison team signposted patients on the wait list to their local crisis teams. This information was also available on the provider's website. The clinical team liaised with local services and sometimes GP’s, depending on the patient's geography.

Staff monitored patients on the waiting list to detect and respond to increases in level of risk. They did this by completing rolling risk monitoring forms for each patient at the point of their referral, prior to their assessment and screened the results at every stage.

The provider invited patients to forums where they could share their views.

The service did not offer any face-to-face appointments. Patient interactions with the service were within a virtual environment.

Patients met with their clinicians online via video calls which were recorded. Patients were given information about privacy, confidentiality and consent at the beginning of their assessments. However, some patients told us they were not asked for consent to record their assessments. Staff told us the view on different devices when joining online assessments may have caused this confusion.

The service had a small office which was used as a correspondence address. We saw that prescription pads were stored in a locked filing cabinet within the office and regular audits were completed.

The office had fire safety signage and notices. Staff knew safety procedures in the event of a fire and there was a designated fire marshal.

Clinicians were required to follow the organisation's home working policy. Requirements for confidentiality included blurring their backgrounds, ensuring a confidential environment and having a secure postal address. Managers audited how staff followed this policy to ensure confidentiality was maintained. Patients were also required to ensure they were in a confidential environment when accessing the organisation's portal.

Staff had completed and kept up to date with their mandatory training. The mandatory training programme was comprehensive and met the needs of patients and staff. Managers monitored mandatory training and alerted staff when they needed to update their training.

The provider had an internal system to check the competencies and registration for contracted staff.

The service had an ongoing recruitment drive and had streamlined the recruitment process for applicants. This meant that staff were onboarded efficiently, turnover was low (November and December 2024 at 2% and January 2025 at 3%) and the service could grow with patient demand.

The organisation was in the process of expanding staffing capacity. Managers told us the demand for the service was high which meant they were always recruiting new staff.

Most of the clinicians were contracted staff. The provider informed us they were focused on investing in the clinical leadership team due to the increase in referrals to the service.

The senior leadership team attended Board, executive meetings and audit meetings. The provider had shared office space in London where the executive team met once a month in person.

Managers identified staff learning needs through the appraisal process. Staff had a self-review then a management review. Staff not receiving NHS supervision via a responsible officer received it through an external programme. Nonclinical staff were supervised in house.

The service employed Psychiatrists registered with the General Medical Council and were up to date with revalidation.

We did not look at Infection prevention and control during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

The provider employed a medicines management lead and staff followed a medicines management policy. Managers conducted audits on medicines management. There was a tracking system in place to monitor prescriptions being sent and received by the relevant patient.

The service engaged proactively with patients GPs to share information. There was a shared care agreement between the provider and the patient’s GP for patients who were responding positively to a particular treatment. However, we saw instances where the patients did not receive their prescriptions medicines in time due to a break down in shared care. However, the service had a good learning culture and where things had gone wrong, they had taken steps to change their processes to ensure that these would not repeat and there would be continuity of care for patients whilst shared care agreements were in place.

The service had systems and processes in place to ensure that patients were safely prescribed medicines remotely. The roles and responsibilities of clinicians and prescribers in supporting patients with their medicines was clearly defined and in line with national guidance and recommendations. Prescribers had regular contact with their peers to discuss complex cases and were offered opportunities for learning and development.

Medicines were prescribed in line with national guidance and there was robust monitoring in place to ensure that any variation in prescribing was reviewed and justified. Patients were empowered to be actively involved in decisions about their care and treatment and there were effective lines of communication between staff and patients for them to discuss their treatment whilst receiving services from the service.

There were effective governance processes in place to ensure that prescriptions and medicines were tracked and managed appropriately. The service made good use of technology to remotely monitor the physical health of people before and during treatment. Where any concerns were raised regarding the physical health of a patient, this was escalated appropriately to the relevant healthcare professional to ensure they received the treatment and support they needed.

The service communicated medicine stock issues to people directly and via the website. However, there was no routine follow up with people to explain when treatment would resume if they were placed on a list for patients whose treatment was paused whilst awaiting medicines to return into stock. The service did ensure they regularly made contact to assess the risk to patients who were held on various waiting lists and respond appropriately where needed.