We carried out an announced comprehensive inspection on 10 January 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.

Medelit Back Office is an independent provider of medical services. The service provides home visiting services in general practice, and also visits by geriatricians, psychiatrists and maxillofacial surgeons. The service is provided as a visiting service across London, but the office for the service is based at 74 Victoria Drive, London, SW19 6HL.

The service employs only the clinical lead who is also 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.

The premises is an office only, no clinical services are provided from the base address.

The service is registered with the Care Quality Commission (CQC) to provide the regulated activity of treatment of disease, disorder or injury.

Our key findings were:

• The service had systems to manage risk so that safety incidents were less likely to happen. The service had not needed to report safeguarding concerns or investigate significant events, but systems were in place should they need to.
• Doctors undertaking home visits did not take medicines with them, including those that would be required to manage unexpected presentations or emergency situations.
• The service did not provide infection control or clinical equipment to doctors utilising the service, and required clinicians to bring their own.
• The service had only seen a relatively small number of patients. on this basis audits had not been carried out at the time of the inspection, but they were planned. However, care and treatment were delivered according to evidence based guidelines.
• Staff had been trained in areas relevant to their role.
• Information about services was available and easy to understand. The complaints system was clear and was clearly advertised.
• Patients were able to access care when they needed it.
• The service had governance procedures in place supported by policies and protocols, and staff were aware of how to access and utilise them.

We identified a regulation that was not being met and the provider must:

• Ensure care and treatment is provided in a safe way to patients. This should include ensuring systems are in place to assure medicines availability, infection control and equipment to manage both routine and emergency care are in place.

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

• Commence formal quality review and develop team communication once the service has embedded.
• Consider implementing guidance for prescribing, particularly for antibiotics.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice