This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in and of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Natural Doctor provides a range of services, for example, breast thermography, breast health consultations, natural hair restoration, natural sexual health products, natural fertility treatment and PULS (Protein Unstable Lesion Signature) cardiovascular risk assessment, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.
The doctor (also the medical director) is the registered manager. 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.
Fourteen people provided feedback about the service, which was positive about the care and treatment offered by the service. They were satisfied with the standard of care received and thought the doctor was approachable, committed and caring. They said the staff were helpful and treated them with dignity and respect.
Our key findings were:
- The service had specialised in individualised bioidentical hormone replacement therapy and functional medicine for adults. Patients were treated with unlicensed compounded medicines.
- Risks to patients were assessed and well managed in some areas, with the exception of those relating to fire drills, emergency medicines, emergency equipment and the management of legionella.
- The clinical equipment was not calibrated and maintained according to manufacturers’ instructions to ensure it was safe to use and was in good working order.
- The service was unable to provide documentary evidence to demonstrate that all staff had completed training relevant to their role.
- There was limited evidence of overall quality improvement activity. However, individual patients were monitored to review the effectiveness and appropriateness of the care provided.
- Consultations were comprehensive and undertaken in a professional manner.
- Consent procedures were in place and these were in line with legal requirements.
- Appointments were available on a pre-bookable basis. The service provided consultations face to face, via telephone and video calls. All initial consultations were face to face.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Information about services and how to complain was available.
- The provider was aware of and complied with the requirements of the Duty of Candour.
- There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
The areas where the provider must make improvements as they are in breach of regulations are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training and professional development necessary to enable them to carry out the duties.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available and with the full informed consent of the patient including making them aware of any possible long term effects.
- Make access and information available for patients who do not speak English.
- Improve access for patients with hearing difficulties.
- Share information that a toilet on the premises is not accessible for patients with mobility issues.
- Follow their own policy on including in all responses to complaints the complainant’s right to escalate the complaint if dissatisfied with the response.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care