We carried out an announced comprehensive inspection on 7 February 2019 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 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 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.

London Bioidentical Hormones is an independent clinic in central London, which provides a range of bespoke healthcare service to adults and specialises in individualised bioidentical hormone replacement therapy and functional medicine for women.

The principal GP 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.

Six 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 principal GP 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 women. Patients were treated with unlicensed compounded medicines and systems were in place to ensure this was carried out safely.
• There was evidence of quality improvement activity including clinical audit.
• Consultations were comprehensive and undertaken in a professional manner.
• Consent procedures were in place and these were in line with legal requirements.
• There was an infection prevention and control policy and procedures were in place to reduce the risk and spread of infection.
• The service was unable to demonstrate they had adequate health and safety arrangements in place to ensure fire safety and management of legionella in the premises.
• The service had not carried out a risk assessment or developed a service specific fire evacuation plan to identify how staff could support patients with mobility problems to vacate the premises.
• All emergency medicines were not available in the service and there was no formal documented risk assessment as to why they were not required.
• 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.
• The service had proactively gathered feedback from the patients.
• Information about services and how to complain was available.
• The provider was aware of and complied with the requirements of the Duty of Candour.

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

• Ensure care and treatment is provided in a safe way to patients.

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:

• Carry out more frequent checks to assure medical oxygen and a defibrillator are fit to use and maintain written records of these checks.
• Consider how to improve access to patients with hearing difficulties.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care