55 Harley Street

We carried out an announced comprehensive inspection on 9 November 2017 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 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.

Background

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.

Skin55 Limited is a consultant led provider of specialist dermatology services from a location at 55 Harley Street, London, W1G 8QR. The location consists of five floors as well as a lower ground floor. The reception, waiting room and administrative office are on the ground floor as is the accessible toilet. The lower ground floor is the main area for therapies which includes a laser room, two theatres for minor surgery and a nurse treatment room including equipment for phototherapy. There are ten consultation rooms throughout the premises as well as regular toilet facilities. The location has a lift installed providing access to all floors.

The provider employs a practice manager, three nurses and two reception staff. The nursing staff consist of a band 7 equivalent nurse and two band6 equivalent nurses. There are approximately ten consultant dermatologists who rent rooms from the provider and work under practising privileges (the granting of practising privileges is a well-established process within independent healthcare whereby a medical practitioner is granted permission to work in an independent hospital or clinic, in independent private practice, or within the provision of community services). All the consultants hold NHS substantive positions. The consultants source their own patients and provide treatment and care with the support of the provider’s nursing team. One nurse specialises in skin cancer, the second nurse leads on dermatology and the third nurse leads on theatre and surgery.

Services provided include skin cancer care, medical and surgical dermatology (under local anaesthetic), laser treatment, phototherapy, mole mapping and wound care. There is a walk-in nurse clinic Wednesday and Thursday 9.30am to 11.30am providing wound care and suture removal. However, at the time of our inspection there had been no demand for this service. The clinic opens 9am to 6pm Monday to Friday and 9am to 12pm alternate Saturdays. The consultants provide consultations and minor surgical procedures for approximately 60 patients a week.

The provider is registered with the Care Quality Commission (CQC) for the regulated activities of Treatment of Disease Disorder or Injury, Surgical Procedures and Diagnostic & Screening Procedures.

The lead consultant is the registered manager. A registered manager is a person who is registered with the CQC 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.

We received eight completed CQC comment cards which were all very positive about the service provided. We were unable to speak with any patients directly at the inspection.

Our key findings were:

• Systems and processes were in place to keep people safe.
• Staff were aware of current evidence based guidance and they had the skills, knowledge and experience to carry out their roles. Although reception staff had not received formal safeguarding training.
• There was some evidence that the clinic audited clinical outcomes for example postoperative complications were monitored on an on-going basis.
• Staff we spoke with were aware of their responsibility to respect people’s diversity and human rights.
• Patients were able to access care and treatment from the clinic within an appropriate timescale for their needs.
• There was a complaints procedure in place however information on how to complain was not readily available.
• Governance arrangements were in place. There were clear responsibilities, roles and systems of accountability to support good governance and management.

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

• Review safeguarding training for reception staff.
• Review the information available to patients on fees, chaperoning and the complaints procedure.
• Review the facilities for those patients who are hard of hearing.