Letter from the Chief Inspector of General Practice
We rated this service as Good overall. (Previous inspection July 2018 – compliant with all regulations (not rated)).
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? – Good
We carried out an announced comprehensive inspection at Hexpress Health Support Office on 9 May 2019 as part of our inspection programme.
Hexpress Health Support Office (Hexpress) provides an online prescribing service to patients aged 18 years and over. Patients wishing to use the service access it via one of their websites, where they are able to select the medicine they wish to obtain from a list of available medicines; patients are then required to provide information to verify their identity and complete an online questionnaire relating to their medical history. The information supplied by the patient is then reviewed by one of Hexpress’ doctors, and where appropriate, a prescription is issued, and the medicine is dispensed to the patient by Hexpress’ own pharmacy, where it is delivered by post, courier, or via a collection point.
At this inspection we found:
- 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 had policies in place for activities such as recruitment and staff training; however, whilst we were satisfied that these activities were undertaken in line with the requirements of regulations, the service did not always follow their own policies.
- The provider had processes in place to ensure patient confidentiality. Doctors worked from their personal laptops, but the provider’s system could only be accessed via an encrypted, password protected portal.
- The service routinely reviewed the effectiveness and appropriateness of the care it provided via reviews of samples of patient records; however, it did not carry-out clinical audits for areas such as antibiotic prescribing to demonstrate a commitment to learning and improving the quality of service it provides. The service had risk-assessed each of the medicines available to be prescribed and had limited the medicines available according to the level of risk.
- The information requested from patients prior to a prescription being issued allowed the service to appropriately verify the patients’ identity and enabled prescribing doctors to consider the patients’ medical history when making prescribing decisions. Patients were asked to input information about their presenting condition and information about any relevant monitoring tests, but there was no facility for supporting information (such as photographs in the case of skin conditions, or copies of test result letters in the case of conditions such as diabetes) to be uploaded to the system to support clinical decision making and review progress.
- Staff involved and treated people with compassion, kindness, dignity and respect.
- Patients could access care and treatment from the service within an appropriate timescale for their needs.
- The provider had given some thought to how patient records would be stored for the legally required retention period in the event that they ceased to trade; however, they had not made specific provision for this.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider should make improvements are:
- Review the appropriateness of their service model with reference to the General Pharmaceutical Council’s guidance on distance supply of prescription only medicines.
- Review whether it would be beneficial to add the facility for patients to upload documents and photographs as part of the prescribing process.
- Review the need to carry-out clinical audit for areas such as antibiotic prescribing to ensure that national guidance is being followed.
- Ensure that the working practices of the service reflect internal policy.
- Put in place provision for patient records to be stored in line with legal requirements should the service cease to trade.
- Review whether there are any benefits to issuing staff with specific laptops for undertaking reviews of patient information.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care