Archived: Dr Morton's - The Medical Helpline

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Morton's - The Medical Helpline on 24 February 2017.

Dr Morton’s – The Medical Helpline offers consultations with doctors by email or telephone which may result in the prescribing of medicine. Patients were also able to request prescriptions via the provider’s website which were then processed by a third party pharmacy.

Overall, we found this service provided caring, responsive and well led services in accordance with the relevant regulations; however, we identified some areas relating to the safe care and effective services where the provider must make improvements.

Our key findings were:

• Systems were in place to protect personal information about patients. The company was registered with the Information Commissioner’s Office.
• Identity checks relied on a verification of bank account details and email verification. If a patient contacted the provider by telephone, there was also a system to recognise the telephone number of the patient to help verify identification. The provider was considering the use of facial recognition technology in the future to ensure a patient’s identity was adequately verified.
• Prescribing decisions were monitored informally by the lead clinician to prevent any misuse of the service by patients and to ensure doctors were prescribing appropriately. Overall clinical outcomes had been monitored.
• The provider did prescribe some medicines for unlicensed indications; patients were not made aware of this or the potential impact of this decision. Some medicines were available for direct supply within packs, for example travel packs. There was limited clinical assessment to ensure these medicines were appropriate for individual patients; the provider has taken some action relating to this finding since our inspection.
• We were told the lead GP received updates on clinical guidance and safety alerts; the provider demonstrated examples of discussing and taking action in response to these alerts.
• There were systems in place to mitigate safety risks including analysing and learning from significant events and safeguarding.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• There were appropriate recruitment checks in place for all staff.

• An induction programme was in place for all administrative staff. Clinicians contracted with the service received specific induction training prior to treating patients. Staff, including clinicians, also had access to all policies. The provider had a record of staff training; however there was no evidence kept readily available on the day of our inspection to confirm attendance at training or to demonstrate the level of such training or when the training had been completed. Since our inspection the provider has supplied additional some evidence regarding staff training; however we were not assured that all clinicians had received appropriate training in safeguarding children.

• New and updated policies did not always reflect the current practice within the service.
• Staff were not clear on who was responsible for lead roles such as safeguarding and health and safety.
• The details of a patient’s GP were not captured if they opted out of consenting to the sharing of information. The provider has taken action in response to this finding since our inspection.
• Non-clinical quality improvement had been on-going and focused on the service user experience. Since the inspection, we have received evidence of four clinical call audits; however these did not demonstrate clinical quality improvement. There were plans to introduce an additional program of clinical audit.
• Patients were treated in line with best practice guidance and medical records were adequately maintained.
• Information about services and how to complain was available.
• There was a business strategy in place and this was regularly discussed at board meetings.
• Staff we spoke with were aware of the organisational ethos and philosophy and told us they felt well supported and that they could raise any concerns.
• There was limited feedback from patients; however the feedback available was positive.

The areas where the provider must make improvements are:

• Ensure the patient identification system is risk assessed to ensure it is safe and effective.
• Ensure there is a system in place to monitor staff training and to ensure training is of an appropriate level and updated as required.
• Commence a formal programme of clinical quality improvement.
• Ensure staff are aware of lead roles such as safeguarding and that policies reflect this information.
• Ensure there is overarching governance in place; ensure policies reflect current practice and that staff have read and understood these policies.

The areas where the provider should make improvements are:

• Encourage patient feedback.
• Consider the need for translation services.
• Ensure patients are made aware if they are ordering medicines intended for an unlicensed indication and that they consent to this use.
• Ensure clinicians are working towards completion of the level three safeguarding children training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice