Halcyon Doctors Limited

Updated 5 May 2022

The service is provided by Halcyon Doctors Limited.

Halcyon Doctors Limited is registered at the following address. This is the location where our inspection was carried out:

The Old Town Hall

4 Queens Road

Wimbledon

SW19 8YB

The service website: www.halcyondoctors.com

Halcyon Doctors Limited is registered to provide the following regulated activity:

• Treatment of disease, disorder or injury

Halcyon Doctors Limited provides clinical psychiatric assessment, treatment and diagnosis for older adults who are experiencing mental illness, cognitive impairments and other long-term conditions in the community. The majority of patients the service sees are people with signs and symptoms of cognitive impairments such as Alzheimer’s disease. The provider will see people for one off assessments and treatment as well as longer-term care when required.

The provider has two separate service lines – a clinical psychiatric assessment service and a medico-legal assessment service. The medico-legal service is not within CQC’s scope of registration; therefore, we did not inspect this part of the service.

We last inspected the provider in 2017 when the service was called Red and Yellow Memory Services Limited. In 2019, the provider changed its name to Halcyon Doctors Limited. The service employs a small operations team that consists of an operations manager, operations team leader, an operations coordinator, a junior operations coordinator, a managing director and a medical director. The medical director leads the service. At the time of our inspection, the provider had appointed a new medical director. The new medical director was being supported by their predecessor.

Most clinicians are recruited into Halcyon Doctors Limited on a contractual basis. The service recruited several consultant psychiatrists, consultant nurses that specialise in dementia care and a physiotherapist. Contracted staff were expected to be supervised and appraised externally to Halcyon Doctors Limited and provide evidence of this to Halcyon Doctors Limited.

The clinic office hours are open between 8.30am and 6pm, Monday to Friday. However, appointments can be scheduled outside of core working hours as well as at the weekends. Clinicians mainly assessed patients at their own home or via video calling. The provider had a contractual agreement in place with a separate healthcare provider to use their consultation rooms when required.

How we inspected this service

During the inspection visit to the service, the inspection team:

• spoke with three family members or carers of patients who have used the service
• reviewed the provider’s feedback log for 2020 and 2021, as well as three formal feedback letters
• spoke with the registered manager, managing director, medical director and their predecessor, two members of staff from the operations team, three consultant psychiatrists and a nurse consultant.
• reviewed four treatment records
• checked how prescription pads were stored and managed
• reviewed three staff employment records
• reviewed information and documents relating to the operation and management of the service

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 5 May 2022

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out a short notice announced comprehensive inspection at Halcyon Doctors Limited on 11 March 2022 as part of our inspection programme.

Halcyon Doctors Limited provides a consultant led outpatient service to assess, treat and diagnose adults aged 18 and above who are experiencing mental illness, cognitive impairments and other long-term conditions.

The operations manager 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.

Halcyon Doctors Limited provides medico-legal services which are not within the scope of registration, therefore we did not inspect or report on this.

We reviewed the provider’s feedback log that contained several comments from 2019 to 2021. We also reviewed three separate feedback letters and spoke with three family members or carers. Comments and feedback were mostly positive and described the service as being professional, efficient and compassionate. Family members told us that clinicians were supportive and provided them with enough information to make an informed choice.

Our key findings were:

• The service provided safe care and treatment. The provider had appropriate systems and processes in place to keep people safe and safeguard them from abuse.
• Clinicians carried out comprehensive assessments and developed treatment plans in partnership with patients. They recommended or prescribed a range of treatments that were informed by best practice guidelines and met the needs of the patients.
• The service employed staff that had the right skills, knowledge and experience to carry out their roles effectively. Contracted clinical staff were required to show proof that they had undertaken an annual appraisal externally to Halcyon Doctors Limited.
• Staff treated patients with compassion and respect and helped them to be involved in decisions about their care and treatment. Families and carers told us that their clinician supported them to understand a diagnosis and treatment options available to them.
• Patients could easily access the service. Staff ensured that care and treatment from the service was delivered within an appropriate timescale for their needs. The service responded promptly to feedback and was keen to make improvements when required.
• The service had effective governance systems in place that monitored the quality and safety of the service and highlighted when an improvement was required. For example, prior to our inspection the service had already identified gaps in care through the quarterly clinical record audits. Plans were put in place to address the issues.

However,

• Permanent staff were not appraised on a regular basis. We identified four out of six members of staff who had not received an annual appraisal. At the time of our inspection, the provider was organising the appraisals for April and May 2022. The provider recognised that this was an area for improvement. The lack of annual appraisals meant that staff performance was not formally evaluated and therefore did not provide individual staff members with an opportunity to reflect and develop.
• The provider needed to strengthen the governance systems in place to ensure that service leads were aware of which doctors have been issued with blank prescription pads so that their usage can be monitored. The lack of monitoring increased the risk of prescriptions being mishandled or abused. The provider told us that whilst the service waits to transfer from paper prescriptions to an electronic system, the service will request doctors to log their prescribing and share the record with service leads.

The areas where the provider should make improvements are:

• The provider should ensure that service leads have oversight of which doctors have been issued with prescription pads so that their usage can be monitored.
• The provider should ensure that staff receive an annual appraisal.

Jemima Burnage

Interim Deputy Chief Inspector Hospitals (Mental Health)

Updated 26 July 2017