Archived: Psychiatry-UK LLP

Updated 22 November 2023

Psychiatry-UK LLP is the name of the service, provider, and registered location. The service provides consultant-led mental health care and treatment for adults living with attention deficit hyperactivity disorder (ADHD) and other conditions such as autism spectrum disorder and mood disorders. A team of prescribing nurses provide titration treatment. ADHD care is provided to NHS patients through commissioned contracts, some of which operate on a ‘right to choose’ basis and the service provides a range of mental health services to private patients. Right to choose is a national initiative that enables patients to opt for a specific service or provider once they are referred to a specialty by a GP or other NHS professional.

The service also provides dementia assessments to older people through an NHS commissioning arrangement for one trust. Treatment for ADHD forms most care provided, and services are delivered nationally, including in Cumbria, Northumberland, Essex, Berkshire, and the Isle of Wight.

The service provides remote assessment and titration services for children and young people (CYP) living with attention deficit hyperactivity disorder (ADHD) through NHS child and adolescent mental health services (CAMHS) contracts, 1 of which was for diagnostics. Commissioned services formed part of wider clinical pathways. For example, under 1 contract the service diagnoses conditions and titrates medicines then refers the patient back to the NHS trust. The service also provides mental health diagnostic and treatment services privately for self-paying or insured patients.

The service provides CYP care to patients aged from 7 years old to 18 years old. While there is no formal transitional care pathway in place where patients still require care when they become 18 years old, the service liaises with NHS commissioners to arrange continuity of care.

The service registered with us in December 2020 at its current address to provide the following regulated activity:

• Treatment of disease, disorder or injury

There is a registered manager in post.

The service does not operate from clinical premises and all care is delivered using digital tele-conference software. Clinicians meet patients virtually from home offices and patients join appointments online from their choice of location.

We last inspected the service in March 2020 and rated it good overall.

The provider’s main service was community-based mental health services for adults of working age. Where our findings on CYP – for example, management arrangements – also apply to the main service, we do not repeat the information but cross-refer.

Following the inspection, we took immediate action to ensure regulated activities could be delivered safely. This resulted in the provider suspending acceptance of new referrals through the NHS ‘right to choose’ system and the implementation of a waiting list management plan.

Updated 22 November 2023

Our rating of this service went down. We rated it as requires improvement because:

• While staff assessed and managed risk once patients were on their caseload, the system was inconsistent and lacked standardised risk assessment tools.
• Staff mostly followed good practice with respect to safeguarding but there were inconsistencies and areas for improvement that senior leaders and governance systems had not identified.
• The provider did not have sufficient oversight of the risks relating to clinicians providing remote care, including the availability of on-demand emergency support and assurance of confidential working environments.
• Medicines management systems did not include sufficient prescription tracking capabilities to provide assurance of security and there was no audit system in place to manage risk.
• Governance systems, including for incident reporting and management, had not kept pace with the growth of the service. This meant there were gaps in assurance of risk management and the capacity of the senior leadership team to safely manage the service.
• There was a lack of evidence the provider acted on feedback from staff in the annual survey to improve working practices and address concerns.

However:

• The service provided safe care once patients were assessed and in a treatment plan.
• Staff worked well with multidisciplinary organisations to coordinate care for patients living with comorbidities and complex needs.
• Staff described good working relationships and on-demand support in a positive, collaborative culture.

Updated 22 November 2023

We have not previously inspected the children and young people service. We have not rated the service and instead provide a narrative report.

Our key findings were:

• The service provided safe care. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed.
• Staff developed holistic care informed by a comprehensive assessment and in collaboration with families. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients.
• Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff understood the principles underpinning capacity, competence, and consent as they apply to children and young people and managed and recorded decisions relating to these well.

However:

• Risk assessment processes were inconsistent, both during patient treatment and as part of governance processes.
• While safeguarding standards overall were good, there were inconsistencies in documentation and communication relating to ongoing safety and care.

Updated 22 November 2023

Our rating of this service went down. We rated it as requires improvement because:

• The number of patients referred to the service significantly exceeded capacity. Waiting list governance and management systems were insufficient to ensure staff could provide appropriate care to patients at risk of deterioration.
• Systems to manage patient risk when they could not be contacted were limited and did not provide assurance of safety and good practice.
• There were significant gaps in accountability for the welfare of patients who were waiting for assessment after a referral. There was no structured understanding between the providers involved in each patient’s care regarding this period of waiting, which led to patients ‘lost to follow up’ and lengthy delays in the provider’s reporting of patients who died whilst on a waiting list.

However:

• The provider had recognised the risks associated with the increase in demand and had implemented a wide-ranging series of plans and strategies to address them, including a wholesale restructure of the organisation and senior leadership team.
• Standards of training and professional development reflected the needs of staff and patients.