Updated 5 September 2019
Vantage Diagnostics (the provider) offers an online dermatology consultancy triaging service to general practitioners using digital photography and dermatoscopy. A dermatoscope is a medical instrument with a light and magnifying lens, that can be attached to a digital camera or phone. The service allows GPs to set up referrals to submit photographs of patients’ rashes and lesions remotely for review by consultant dermatologists, who provide the GPs with a report including diagnosis, triage and treatment advice. Clinical responsibility for patients’ healthcare remains with their GPs, which includes making any routine referrals to secondary care. The reports are issued to GPs within three working days of the photographs being submitted. The service is provided under a contract with one NHS CCG – West Suffolk – with 24 participating general practices and approximately 200,000 patients. The service is not provided directly to patients and does not involve prescribing any medicines. There are no age-restrictions, with GPs being able to refer children under the age of 18-years to the service. But in practice most patients referred are adults.
The provider was registered by the Care Quality Commission under the Health and Social Care Act 2008 in January 2013, in relation to the regulated activity Transport services, triage and medical advice provided remotely. The provider has other elements to its business which are outside the scope of CQC registration. These include the provision of decision support and workflow management software to healthcare providers. It also provides the dermatology triage IT system and technical support to another CCG, but it is not responsible for clinical reviews in that instance.
The teledermatology service to West Suffolk CCG has been provided since October 2014. Approximately 1,000 referrals had been reviewed in the last 12 months. The contract was recently extended for a further year.
The provider operates at Barkat House, 116-118 Finchley Road, London NW3 5HT, where its management, technical, administrative and support staff are based. Clinical staff are based elsewhere and access the service’s online system remotely using suitable security protocols.
How we inspected this service
This inspection was carried out by a CQC inspector and a GP specialist adviser.
Before the inspection we gathered and reviewed information from the provider and feedback from the CCG. During the inspection we spoke with the provider’s Chief Executive, the Clinical Liaison and Transformation Director, who is also the registered manager, and members of the administration team. 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. We also spoke with the main clinician, a consultant dermatologist, who is a doctor registered with the General Medical Council (GMC) with a licence to practice.
We reviewed the provider’s operating procedures and governance policies and looked at a number of triage review 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.