We rated Psychiatry-UK as requires improvement because:

• There was insufficient oversight and understanding of safeguarding procedures. Safeguarding policies and procedures lacked information to enable staff to make referrals to the local authority without delay. Staff did not all know how to make safeguarding referrals. Staff had not completed an appropriate level of training in safeguarding.

• Staff did not verify the identity of the person they were consulting with before starting the appointment and this meant there was a risk staff could prescribe medicines, record and share information about the wrong patient.

• Staff did not routinely record patients’ consent to treatment or whether or not they had needed to assess the patient’s capacity to consent to their treatment. The provider did not ensure all staff were trained in the Mental Capacity Act.

• Psychiatrists did not always record patients’ current or historical risks in patients records or in letters to GPs. Staff did not always develop and document crisis plans with patients.

• There were limited opportunities for staff to discuss their work, service development and learning from incidents and complaints.

• There were limited ways to monitor psychiatrists’ work, answer questions and provide support as the provider did not offer formal induction, supervision or team meetings to staff. Some staff did not have appraisals that were specific to their work with Psychiatry-UK. There was a lack of oversight and monitoring of the quality of consultations and the provider had not developed systems and processes to enable them to performance manage staff.
• Although the provider took steps to store care records securely, information such as letters to GPs needed to be stored locally in order for psychiatrists to edit them and this presented a risk to the security of patient information.

However

• The provider was well staffed and there were no waiting times. Patients could choose which psychiatrist they consulted with and appointments were available at a range of times. Patients said the service was easy to access.
• Patients gave good feedback and said staff were kind and respectful. Patients said they were involved in decision making about their care. Patients could include their families in their care if they wanted to and carers said they felt supported and involved.

• Psychiatrists completed a comprehensive assessment during the first appointment with each patient. They used nationally recognised scales to help them make accurate diagnoses. Assessments were personalised, holistic and recovery-oriented.

• Staff made shared care arrangements with GPs to ensure physical health monitoring was in place.
• The provider was keen to develop the service and they took part in the development of new approaches. There were opportunities for specialist psychiatrists to develop the service they offered.