Archived: Online Clinic (UK) Limited - Taybridge Road

Updated 22 May 2018

Background

Online Clinic (UK) Limited was registered with the Care Quality Commission on 1 October 2010. The service offers online consultations to patients, through online forms and a messaging system conducted within the patients online record, for a condition selected by the patient themselves. A doctor will then review the request, may ask for further information and then, if appropriate, provide a private prescription to be dispensed by a third party pharmacy. The services are delivered by the provider via two websites; www.theonlineclinic.co.uk and www.privatedoctordirect.com.

At the time of our inspection there were eight GPs working for the service, all of these GPs were UK based GMC registered doctors. An additional clinical lead was also in place and working with the registered manager.

A registered manager was in place. 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.

During our inspection, we spoke with the registered manager, clinical lead and office based staff. We looked at policies and protocols, medical questionnaires, other documentation and patient records.

How we inspected this service

This inspection was carried out on the12 March 2018 by a CQC inspector, and a GP specialist adviser.

Before the inspection, we gathered and reviewed information from the provider. During our inspection, we spoke with the registered manager, clinical lead and office based staff. We looked at policies and protocols, medical questionnaires, other documentation and patient records.

To get to the heart of patients’ experiences of care and treatment, we 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.

Why we inspected this service

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.

Updated 22 May 2018

Letter from the Chief Inspector of General Practice

Our first inspection of Online Clinic (UK) Limited took place on 21 March 2017 and identified the service was not providing safe, effective or well-led services in accordance with the relevant regulations. We carried out a follow up inspection on 6 June 2017 and found the provider had made substantial improvements.

The full comprehensive report on the 21 March 2017 inspection and the report for the focused inspection of 6 June 2017 can be found by selecting the ‘all reports’ link for Online Clinic (UK) Limited on our website at www.cqc.org.uk.

We carried out this announced comprehensive inspection at Online Clinic (UK) Limited on 12 March 2018 to ensure the necessary improvements had been embedded.

Online Clinic (UK) Limited was registered with the Care Quality Commission on 1 October 2010. The service offers online consultations to patients, through online forms and a messaging system conducted within the patients online record, for a condition selected by the patient themselves. A doctor will then review the request, may ask for further information and then, if appropriate, provide a private prescription to be dispensed by a third party pharmacy, which we do not regulate. The services are delivered by the provider via two websites; www.theonlineclinic.co.uk and www.privatedoctordirect.com.

Findings from our inspection on 12 March 2018 in relation to the key questions were as follows:

Are services safe? – we found the service was providing a safe service in accordance with the relevant regulations. Specifically:

• The provider had ensured all staff had an understanding of safeguarding relevant to their role and arrangements were in place to safeguard people, including arrangements to check patient identity.
• Prescribing was externally monitored by a locum pharmacist and audited regularly to ensure it was in line with national guidance, and people were told about the risks associated with any medicines used outside of their licence.
• The provider had set a low threshold in recording and investigating significant events to ensure all possible improvements would be identified and these were implemented with a structured, team approach and outcomes monitored.

Are services effective? - we found the service was providing an effective service in accordance with the relevant regulations. Specifically:

• The provider recognised that GP contact was the cornerstone of safety when patients choose to opt out of the NHS system for care and had taken several steps to improve the number of patients who consented to information sharing with their registered GP.
• An audit showed an increase from 1% to 28% of patients completing their registered GP section on the form over the same period the previous year.
• Additional resources, including allocating a lead member of staff, had been invested in auditing the quality of the service. There was a schedule of regular audits planned throughout the year and the service was working with an external pharmacist to ensure the outcomes were impartial and followed best practice guidelines.
• There was comprehensive oversight of staff training and quarterly GP meetings had external speakers scheduled to allow for topical updates to the online environment.

Are services caring? – we found the service was providing a caring service in accordance with the relevant regulations. Specifically:

• Although consultations occurred remotely through a messaging system, the GPs were encouraged to interact with the patients to ensure their involvement and understanding of the treatment options.
• Follow up of patients after a prescription was issued, on different timeframes depending on patients presenting condition, was given to allow for ongoing support from the provider.
• Patient feedback reflected they found the service treated them with dignity and respect.
• There was a GP profile for each GP so patients had access to information about GPs working at the service.

Are services responsive? - we found the service was providing a responsive service in accordance with the relevant regulations. Specifically:

• Information about how to access the service was clear and the service was available seven days a week.
• The provider did not discriminate against any client group and would provide assistance to access the service if safe to do so.
• Guidance for patients to complain about the service was clear, and the provider supported patients through the process. Complaints were handled appropriately with an open and honest approach.

Are services well-led? - we found the service was providing a well-led service in accordance with the relevant regulations. Specifically:

• There was a clear leadership and governance structure. The registered manager and clinical lead worked closely with the IT lead and practice manager to ensure staff were supported, and patients received appropriate care.
• There was a range of information which was used to monitor and improve the quality and performance of the service.
• Systems were in place to ensure that all patient information was stored safely and kept confidential.

We saw an area of notable practice:

• GPs we spoke to praised the development of a prescribing matrix which listed the limited formulary the provider used, the maximum allowed doses, against the presenting conditions to allow easy reference and a consistent and safe approach to all patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice