Archived: Yakub Chemist Limited

Updated 30 October 2017

Yakub Chemist is an online service that allows patients to request prescriptions through a website which are then dispensed by the affiliated pharmacy. Patients register with the website www.medicines2u.com and select a condition they would like treatment for. The patient then completes a health questionnaire which is reviewed by a GP; if this request is approved a prescription is then issued and sent to the pharmacy also run by the same company for dispensing.

At the time of our most recent inspection we were told that the promoted products on line were for hormone replacement therapy (HRT), weight loss products and chlamydia medicines. Patients were also able to request medicines for asthma, male hair loss, period delay, acne, cold sores, emergency contraception and products to support smoking cessation. Following a concern we raised at the inspection on 6 September 2017 the provider withdrew the treatments for asthma.

The website can be accessed 24 hours a day but the service processes orders from 9am to 5pm Monday to Friday. The provider had employed a GP at our previous inspection. However, they now employ a clinician with a licence to practice that is not a GP, who works remotely in analysing patient information forms when patients apply online for prescriptions. A team of administration staff that support delivery of the service work at the registered location.

A Registered Manager is 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

Our inspection team was led by a CQC Lead Inspector. On the first day the team included a GP specialist advisor and a member of the CQC medicines team and on the second day the team also included a CQC Inspection Manager.

Why we inspected this service

We undertook a review inspection of Yakub Chemist on 6 and 11 September 2017 to check compliance with the warning notices served following the inspection on 10 April 2017. The inspection focused on three of the five questions we ask about services; is the service safe, effective and well-led. This is because concerns were identified in these three areas during our previous inspection.

Updated 30 October 2017

We carried out an announced comprehensive inspection at Yakub Chemist Limited on 10 April 2017, during which we found that the service was not providing safe, effective or well-led services. However, we found that they were providing caring and responsive services in accordance with the relevant regulations.

Following our April 2017 inspection we issued two warning notices under Section 29 of the Health and Social Care Act 2008 which required the provider to become compliant by 28 August 2017. We issued one on 24 April 2017 in relation to breaches of Regulation 17 Good Governance and one on 28 July 2017 for breaches of Regulation 12 Safe Care and Treatment. The full comprehensive report on the 10 April 2017 inspection can be found by selecting the ‘all reports’ link for Yakub Chemist Limited on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 and 11 September 2017. This was to check whether the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in April 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were:

• The provider was still not providing safe, effective or well-led services.
• The provider had not actioned the majority of concerns identified during the last inspection.
• Care was still not being delivered in line with current evidence based guidance. Policies did not reflect current guidance and medical questionnaires that patients completed did not reflect the policies.
• There was no evidence of effective clinical oversight.
• Identification checks were not taking place routinely, nor were they completed when patient and cardholder details did not match. We saw evidence that identity checks had only been performed on nine patients since June 2017.
• Prescribing was still not monitored to ensure it was safe and in line with remote prescribing guidance.
• The provider was unable to demonstrate that medicine safety alerts issued by the MHRA or NICE guidance were acted upon or distributed to staff.
• The safeguarding policy was not specific to an online environment, did not reflect national current guidance and did not include sufficient information to protect patients.

• We were told that if a patient consented to their information being shared with their GP the provider would share the information appropriately; however, we reviewed evidence and found that information had not been shared with any GPs since April 2017. There were over 400 patient contacts that should have been shared with GPs. The administrator told us that this was a back log to be completed. The clinician was not aware of this and told us that the provider shared information with the patients GP immediately.

• The provider did not have an effective business continuity plan in place to provide a safe and effective service should the sole clinician or the information technology staff member be absent. This meant that if there was an alert or a patient safety incident when this staff member was unavailable, the provider would not be able to identify any patients at risk or take appropriate action.
• Following our previous inspection the provider had forwarded an action plan. This documented all the concerns from the warning notices previously issued and all but one of the actions required had been marked as complete. Evidence on the day of the inspection showed that this was not the case and that the provider did not have the understanding of the actions that they were required to take in relation to the breaches identified.

We identified regulations that were not being met and the provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We have taken urgent action in response to the concerns identified at Online Clinic (UK) Limited; we have suspended the provider’s registration until 13 January 2018.