96 Harley Street

Updated 6 September 2021

96 Harley Street is a service consisting of one consultant psychiatrist, one practice manager and one part-time personal assistant. The consultant for this service was a sole practitioner. This meant they did not have a team of colleagues to provide support and oversight of their work. In order to address the risks this presents, the consultant met with other practitioners working in the same building and had had regular appraisals.

This service provides outpatient mental health assessment and treatment for adults.

Since the COVID-19 pandemic, this service has been delivering appointments via video conferencing platforms. Patients are also seen at 96 Harley Street.

The service is registered with CQC to undertake the following regulated activities:

• Treatment of Disease, Disorder or Injury

How we inspected this service

During the inspection visit to the service, the inspection team:

• checked the safety, maintenance and cleanliness of the premises
• spoke with the practice manager, the consultant psychiatrists and personal assistant
• reviewed six patient care and treatment records
• reviewed GP letters on a further four records to specifically look at the risk summary
• spoke to five service users
• reviewed two staff records
• reviewed information and documents relating to the operation and management of the service

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 6 September 2021

This service is rated as Good overall. (Previous inspection in December 2013 not rated)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced inspection at 96 Harley Street as part of our inspection programme.

This service provides outpatient mental health assessment and treatment for adults.

The consultant psychiatrist at the service 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.

Our key findings were:

• The service provided safe care. Clinical premises where patients were seen were safe and clean. Staff assessed and managed risk well and followed good practice with respect to safeguarding.

• Staff completed a comprehensive mental health assessment of each patient. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients.

• The teams included or had access to the full range of specialists required to meet the needs of the patients. The consultant psychiatrist ensured that staff received supervision and appraisal. Staff worked well together as a team and with relevant services outside the organisation.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. The service actively involved patients in care decisions.

• The service was easy to access. The criteria for referral to the service did not exclude patients who would have benefitted from care.

• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

• At the time of inspection, waiting lists were not managed well to ensure that patients who required urgent care were seen promptly. It was also not clear who was responsible for patients' care and treatment, while they were waiting for an assessment. Immediately following the inspection, a new protocol was put in place. The consultant reviewed all new patient referral letters three times per week, so that they had oversight of the patients on the waiting list. If the patient was low risk they would be put onto the waiting list, but if they were identified as higher risk they may be seen sooner or referred to another service. The provider also now communicated clearly to the referrer that responsibility for the patient remained with the referrer until the assessment had taken place.

• Patients could give feedback on the service, but the process for doing so was not always communicated to patients. The practice manager was in the process of setting up a tablet so that clients could input their feedback following sessions.

• Staff had previously received safeguarding and safety training appropriate to their role, but at the time of the inspection the training was out of date (the training had expired in October 2020). A new training provider was being sought to provide face to face training.

The areas where the provider should make improvements are:

• The provider should ensure that it embeds processes to ensure all new referrals and waiting lists are monitored.

• The provider should ensure that delays to assessment are communicated to the referring professionals.

• The provider should ensure that all staff are up to date with their mandatory training.

• The provider should seek formal feedback from patients more frequently to inform service development.