Archived: Nationwide Pharmacies Ltd

We carried out an announced focused inspection at Nationwide Pharmacies Ltd, an online GP consultation and prescribing provider located in Buckinghamshire on 25 October 2019.

At our previous inspection in April 2019, the service was rated good overall, however we identified concerns relating to the provision of safe services. We therefore rated the safe key question as Requires Improvement and we issued a requirement notice in relation to the safety systems to manage medicines and verify patient identify. Specifically:

• The provider prescribed medicines to treat asthma and Class 4 and 5 controlled opiate medicines such as codeine and dihydrocodeine. The records we reviewed did not detail a rationale for prescribing these medicines without consent to contact and share information with the patients GP.
• Patient identity checks were not fully effective in particular for patients being prescribed medicines liable to abuse, overuse or misuse or medicines that require ongoing monitoring or management.

The April 2019 inspection was part of the digital and online providers inspection programme to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. The inspection reports for the previous inspections can be found by selecting the ‘all services’ link for Nationwide Pharmacies Ltd on our website at www.cqc.org.uk

At this inspection, on 25 October 2019, we found the service had addressed the issues identified at the last inspection. This led to the service being rated as Good for the provision of safe services whilst the overall rating of Good remains.

At this inspection we found:

• Nationwide Pharmacies Ltd had had made significant improvements to address the concerns identified at the April 2019 inspection. We saw the provider had effectively assessed, monitored and improved the safety of the services provided. These improvements were managed via a series of action plans and resulted in a change to the operating model.
• We saw the provider had revised and strengthened the processes and supporting systems when the GP prescribed medicines for the care, treatment and management of asthma and a range of medicines for pain relief which included opiates.
• The prescribing process now included compulsory access to the patients Summary Care Record and contact with the patient’s GP prior to a prescription being issued.

• Following the April 2019 inspection, we saw the provider had added an additional verification check when completing patient identity checks. On registering with the Nationwide Pharmacies Ltd, and at each consultation patient identity was verified. These existing checks now included an additional safety check for patients who were prescribed medicines liable to abuse, overuse or misuse or medicines that require ongoing monitoring. These patients were now required to provide photo identity such as driving licence or passport.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We rated this provider as Good overall. 

There had been three previous inspections of this provider in February 2017, June 2017 and April 2018. The inspection in April 2018 highlighted the provider was working in accordance with the relevant regulations.

The inspection reports for the previous inspections can be found by selecting the ‘all services’ link for Nationwide Pharmacies LTD on our website at .

The key questions are rated as:

• Are providers safe? – Requires improvement
• Are providers effective? – Good
• Are providers caring? – Good
• Are providers responsive? – Good
• Are providers well-led? – Good

We carried out an announced comprehensive inspection at Nationwide Pharmacies LTD, an online GP consultation and prescribing provider located in Buckinghamshire on 30 April 2019. This inspection was part of the digital and online providers inspection programme to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Patients register for the provider on the provider’s website, select the medicines they require, complete an online consultation form which is reviewed by a GP, and if approved, the affiliated pharmacy (which we do not regulate) sends the medicines to the patient.

At this inspection we found:

• The provider had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the provider learned from them and improved their processes.

• Patient identity checks were not fully effective in particular for patients being prescribed medicines liable to abuse, overuse or misuse or medicines that require ongoing monitoring or management.

• The provider reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.

• The provider prescribed medicines to treat asthma and Class 4 and 5 controlled opiate medicines such as codeine and dihydrocodeine. The records we reviewed did not detail a rationale for prescribing these medicines without consent to contact and share information with the patient’s GP.

• All patient data was encrypted and securely stored.

• Staff involved and treated people with compassion, kindness, dignity and respect. Patient feedback from a variety of different sources highlighted high levels of satisfaction.

• Patients could access care and treatment from the provider within an appropriate timescale for their needs.

• Information about the provider and how to raise concerns and complaints was available.

• There was a strong focus on innovation, continuous learning and improvement at all levels of the organisation.

The area where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

(Please see the specific details on action required at the end of this report).