LloydsPharmacy Online Doctor Also known as Expert Health Limited

Updated 5 February 2020

Background

Dr Thoms/Lloyds Pharmacy Online Doctor provides online (digital) GP service which includes consultation with a GP. The service was set up by Expert Health Limited in 2002 and was one of the world’s first online health providers.

The service can be accessed through their website, onlinedoctor.lloydspharmacy.com where patients can can free assessments and/or request consultations or medications that require consultation questionnaires to be completed. The service is available only for patients in the UK. If orders are placed between 9am and 6pm on a weekday, the clinical team will aim to assess it and respond to the patient within one hour. Orders placed after 6pm will be processed the next morning, whilst orders placed at weekends or bank holidays between 9am and 6pm will take longer to assess but should be processed within a few hours. Medicine orders cannot be placed over the phone, but a phone line is available to answer queries Monday to Friday 8am to 6pm, Saturday 9am to 6pm. The provider prescribed to 274,517 patients between September 2018 and August 2019.

This is not an emergency service. Patients do not have to pay to register with the service. Subscribers to the service pay for their medicines when making their on-line application. Once approved by the prescriber, medicines prescribed via the Lloyds Pharmacy Online Doctor website can be collected from one of the 1,800 affiliated pharmacies or they can be dispensed, packed and posted by a tracked and secure courier service.

The service is led by a managing director and medical director who are supported by; 8 GPs, both male and female, 5 of whom are salaried and 3 contracted, a clinical education lead, a clinical manager, director of medical research, clinical lead for transformation and innovation, director of medical technology, clinical lead for sexual health and quality, three independant prescribing pharmacists, a compliance and quality manager, Clinical Governance & Regulatory Compliance Officer as well as patients advisory team and an administrative team. GPs carried out the online consultations remotely usually from the providers offices but sometimes at their home.

Dr Thoms/Lloyds Pharmacy Online Doctor is registered with Care Quality Commission (CQC) and has a registered manager 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.

How we inspected this service

Before the inspection we gathered and reviewed information from the provider. During this inspection we spoke to the Registered Manager and members of the management, support and administration team.

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.

Updated 5 February 2020

Letter from the Chief Inspector of General Practice

We rated this service 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? – Outstanding

We previously inspectedDrThom/LloydsPharmacy Online Doctorin May 2017. The full comprehensive reports for these inspections can be found by selecting the ‘all services’ link for on our website atDrThom/LloydsPharmacy Online Doctor.

We carried out an announced comprehensive inspection at DrThom/LloydsPharmacy Online Doctor on 17 September 2019 as part of our inspection programme and to provide a quality rating.

DrThom/LloydsPharmacy Online Doctor are an online (digital) GP service that offers a range of general medical services that include postal testing, remote treatment and remote advice. The service can be accessed through their website, onlinedoctor.lloydspharmacy.com. This is a fee-based service and is available only for patients in the UK. We inspected the online service known as Dr Thom/LloydsPharmacy Online Doctor, we did not inspect the provider’s affiliated pharmacies which are based throughout England.

At this inspection we found:

• The senior management team demonstrated they were a driving force dedicated to delivering the mission of the service. All staff we spoke to felt valued by the leaders and said there was a high level of staff support, engagement and development.
• Patients safety was their priority. The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Patients could access care and treatment from the service within an appropriate timescale for their needs.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. They effectively used the skills and abilities of their staff team to provide innovative and accessible care, treatment and support to their patients.
• The service had comprehensive business development strategy and quality improvement plan that effectively monitored the service provided to assure safety and patient satisfaction.
• There was a commitment and appetite to work with external partners including the NHS and the third sector to share learning and make the service as accessible as possible.

We saw the following areas of outstanding practice:

• There was a Get-Grow-Keep’ strategy where they developed staff skills, competence and knowledge and encouraged staff development opportunities linked to the strategy. They had sponsored one of their GPs to receive training to develop an algorithm to ensure advice and information is given in digestible bite sized chunks throughout the interactive consultation as well as the information being saved in the patient record for later reference.
• The provider demonstrated commitment to system-wide collaboration and leadership. The provider was part of the Sexual Health London (SHL) joint commissioning model, which included an NHS Trust and an integrated diagnostic company who provided remote/self-sampling sexual health services. This has allowed them to improve the process of follow-up and referring patients back to NHS clinics. This is the first collaborative commissioning model of its kind across London and in UK as a whole.
• The provider held quarterly external education activities for GPs free of charge. The most recent education session covered Digital health – the changing face of medicine, Heart Rhythm Disorders and Women’s Health Update. These are usually attended by 30 - 40 GPs.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care