Information about the service, including contact details, treatments provided and costs, were available on the provider's website. These would be discussed with people when they booked their appointment. We looked at recent written comments made by people using the service in which they spoke positively about the way they had been treated by the service.

Medical histories were taken during consultations, as well as details around current medications and allergies. Follow-up appointments and telephone calls took place with individual patients as necessary. Details of treatments provided were sent to people's regular doctors. An insurance company that referred clients to the service described it as "very good" and said that written reports on care and treatment provided were very thorough and detailed. The doctor at the service who saw patients had been trained in how to handle medical emergencies.

Staff at the service had been trained in child protection and safeguarding vulnerable adults. They knew how to spot signs of possible abuse and how to report any concerns, including to paediatric specialists and social services.

The doctor at the service who saw patients had an annual appraisal and undertook relevant training throughout the year.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. There was a system in place to review any incidents or accidents.

We carried out an announced comprehensive inspection on 22 May 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and Regulations associated with the Health and Social Care Act 2008.

10 Harley Street is an independent health service based in London and Hertfordshire.

Our key findings were:

• The service had appropriate systems to safeguard children and vulnerable adults from abuse, although at the time of inspection the GP had not completed up to date adult safeguarding training.

• The GP had had an enhanced Disclosure and Barring Service (DBS) check and was registered with the General Medical Council (GMC).
• At the time of inspection no emergency medicines were carried by the GP to home visits and no risk assessment had been completed to support this decision. No risk assessment had been completed in respect of the emergency equipment available at the 10 Harley Street premises.
• There was no process detailing how patients were informed that there were no chaperones available for home visits. No risk assessment had been completed regarding staff who could act as chaperones at 10 Harley Street having appropriate chaperone training and DBS checks.
• Clinical equipment used by the GP such as the portable blood pressure machine and adult pulse oximeter had not been calibrated.

• The GP received medicines and other safety alerts by email from the Independent Doctors Federation, and demonstrated an awareness of recent safety alerts, although there was no system in place to document these.
• Individual care records were written and managed in a way that kept patients safe, and referral letters were thorough and contained all of the necessary information.
• Blank prescriptions were kept securely and arrangements for dispensing medicines at the service kept patients safe.
• Vaccines were occasionally stored overnight in a domestic fridge.
• There were policies in place for critical incidents and complaints, and the service was aware of the requirements of the Duty of Candour.
• Patient records we reviewed demonstrated appropriate assessment, care and treatment.
• The GP provided a detailed written report to each patient after their consultation for them to forward on to their NHS GP.
• The GP administered vaccines and child immunisations and had not completed any training or updates in this area to ensure they were maintaining competency and keeping up to date with best practice.

• The service had not reviewed the effectiveness and appropriateness of the clinical care provided to patients through any quality improvement activity, such as clinical audits.

• The GP had not completed any recent Mental Capacity Act training, but they understood the requirements of legislation and guidance when considering consent and decision making. However, verbal consent from patients was not recorded.
• The service gave patients timely support and information, patient ‘thank you’ cards were positive, and the service recognised the importance of patients’ privacy and dignity.
• The service organised and delivered services to meet patients’ needs and the appointment system was easy to use.
• The GP was responsible for the organisational direction and development of the service and the day to day running of it.
• The service did not have an adequate process to verify patients’ identities, including checking that adults attending with children had parental responsibility and documenting this.

We saw one area of notable practice:

• The GP telephoned all patients two or three days after their appointment to check how they were feeling and if they required any further assistance.

We identified regulations that were not being met and the provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Consider the process for patient identification, including checking and documenting parental responsibility for adults bringing children to appointments.
• Review the necessity for a written protocol for prescribing high risk medicines.
• Review training requirements in relation to the Mental Capacity Act and administering vaccines and immunisations.
• Consider the necessity for interpretation services for patients whose first language is not English.