10 Harley Street

Updated 18 April 2024

Botonics Limited is located at 10 Harley Street, W1G 9PF, in the London Borough of Westminster. The registered manager operates the service full time from the headquarters and administration offices of Pump House, Plumtree Cross Lane, Itchingfield, Horsham, Sussex, RH13 0NN which is no longer registered with CQC. The provider applied to remove this address as their registered location with CQC in March 2020, as it was not a clinical location to carry out any regulated activities.

Services provided include dermatology, body treatments and plastic surgery. Isotretinoin treatment (a high-risk medicine used to treat severe acne) is provided by two General Medical Council (GMC) registered doctors who provide a combined total of 6.5 hours at the service. Also employed are a registered mental health nurse and another GP. The provider recently recruited a dermatologist on the General Medical Council (GMC) specialist register i.e. consultant dermatologist.

At the time of inspection and since the Covid-19 pandemic, all services related to Isotretinoin prescribing (used to treat severe acne) continued to be provided fully online; for example, GPs carried out online consultations remotely; usually from their home. The management staff for the organisation were based in the offices of Horsham and two administration staff were based overseas in the Philippines.

The provider has a service level agreement with 10 Harley Street to hire a consultation room for their aesthetics service; Room 11 twice a week on Wednesday between 1:30pm and 5.30pm and Friday between 1:30pm and 5.30pm. The location rooms were used for aesthetic services which were out of CQC scope of regulation and not assessed as part of the inspection.

The service is open between 9.00am and 5.00pm on Monday to Friday. The provider also provides telephone and email support seven days a week and hours vary between 10.00am and 7.00pm at the weekends and between 5.00am and 11.00pm on some weekdays. The provider’s website can be accessed at www.botonics.co.uk.

Botonics Limited also has a service level agreement with a separate partner company that is based in Harley Street for the use of surgical theatre facilities. The separate location was not a condition of the provider’s registration and the service level agreement allows Surgical Procedures to be carried out by it.

The provider also operates another brand known as Treatdirect, non-limited company which operates the same governance systems as Botonics Limited and provides the same prescribing clinicians as Botonics Limited. This company was not visited as part of this inspection.

How we inspected this service

Before the inspection, we reviewed a range of information regarding the service, including their action plan submitted following the previous inspection. The inspection was carried out remotely via Teams and we interviewed staff and reviewed documents.

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 18 April 2024

This service is rated as Requires improvement overall. (Previous inspection in July 2022 – Inadequate).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at 10 Harley Street to follow up breaches of regulations from the July 2022 inspection. When we inspected the service in July 2022, we asked the provider to make improvements following breaches of regulations and we issued a Warning Notice under Section 29 of the Health and Social Care Act 2008 for Regulation 17, good governance. Requirement Notices were also issued for Regulation 12, safe care and treatment and Regulation 18, staffing. We checked these areas as part of this comprehensive inspection and found most of the breaches identified had been resolved and significant improvement had been made in providing safe care to patients; however, we continued to find gaps in the effective care of patients and in relation to governance.

There is a registered manager in place. A registered manager is a person who is registered with the Care Quality Commission (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.

Botonics Limited, 10 Harley Street is an independent provider and is registered with the CQC to provide diagnostic and screening procedures, surgical procedures and treatment of disease, disorder or injury in relation to cosmetic treatments where there are some exemptions from regulation by CQC. These relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider also provides a separate aesthetics service delivered by a clinician working in the service. This included full facial rejuvenation and anti-ageing treatments. These types of arrangements are not within CQC scope of registration; therefore, we did not inspect or report on these services.

There were no comment cards distributed to patients as part of this inspection and no patient interviews were carried out during the inspection. Patient feedback was found on Trustpilot online and google reviews.

Our key findings were:

• The provider had taken steps to ensure Isotretinoin prescribing doctors at the service were now part of a consultant led team.
• The provider checked and verified the identity patients using their services in accordance with GMC guidelines.
• There was now a named safeguarding lead and a safeguarding policy in the service.
• Indemnity arrangements were in place for the service.
• There was now a process in place to log, discuss, share and action safety alerts.
• The provider obtained consent prior to providing care and treatment.
• Online patient feedback showed significantly high numbers of positive patient satisfaction with the service.
• Staff felt respected and valued.
• The provider did not always assess needs and deliver care and treatment in line with current legislation, standards and guidance.
• There were gaps in governance arrangements.
• Processes for managing risks, issues and performance were not always clear or effective

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure staff receive training relevant to their role.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue with quality improvement activity.
• Review and act on the recent national recommendations in relation to notifying the GP when a patient commences treatment with Isotretinoin.
• Review national guidance in relation to first consultations being carried out face to face wherever possible.
• Take action to provide a google translate option on the provider website.
• Share business contingency plan with all staff.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Healthcare