• Remote clinical advice

Forward Clinical Limited

Overall: Good

300 St. John Street, London, EC1V 4PA 0330 097 0165

Provided and run by:
Forward Clinical Limited

Latest inspection summary

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Background to this inspection

Updated 4 May 2022

The provider was registered by CQC on 20 May 2021 in respect of the regulated activities Treatment of disease, disorder or injury and Maternity and midwifery services.

At the time of registration, the provider operated from offices at 300 St. John Street, London EC1V 4PA. However, it has now moved to a fully remote working model for all staff – clinicians, management and administrative officers and technicians. The location remains the provider’s registered office address and it retains access to meeting facilities there.

The provider operates an online consultation and advice service (the service) known as Pando Access. Using the system, people can engage in a secure text exchange with a clinician to discuss and receive advice relating to women’s healthcare and maternity / midwifery support throughout a pregnancy and up to six weeks postnatally. The service had previously included providing advice on health issues relating to children aged under-16 years, but at the date of this inspection the paediatric element of the service was suspended temporarily, due to commercial reasons. The provider told us this would be reinstated in due course and there were further plans to extend the scope of service to include teledermatology and men’s health.

The service operates between 9:00 am and 5:00 pm Monday to Friday. Access to the service is available to people who reside in and are located in England and Wales at the time of the consultation. The service does not currently involve prescribing drugs or medications, but clinicians may recommend some that are available over the counter without prescription. The service does not make referrals to non-urgent secondary care provision. Nor is it intended to provide emergency care or ongoing advice for long term health conditions. People contacting the provider in those circumstances are referred to emergency providers such as 999 or the local Accident and Emergency (A&E) department, or NHS 111.

People register to use the service via arrangements with third party organisations. To register, they must be over-18 years of age. They can then set up secure instant text message exchanges with duty doctors and midwives to discuss issues relating to women’s health and maternity / midwifery. When necessary to assist diagnosis, service users can attach photographs, videos or other files for clinicians to access and advise on. Although the services do not include arranging tests, results from tests arranged elsewhere can be discussed with clinicians.

The clinicians are registered with the relevant professional bodies. They are employed by the provider as independent practitioners and when not engaged with the service they work for the NHS in England. At the time of the inspection there were two doctors specialising in women’s healthcare and eight midwives contracted to the provider, operating various duty shifts. It is a condition of their contracts that they do not work Pando service shifts whilst on duty with the NHS.

In addition, there were nine paediatric-specialist doctors available for when that element of the service was reinstated. The provider had 17 managerial, administrative and technical staff working in the service, being either directly employed or contractors.

Information regarding the service can be found on the provider’s website –

https://access.hellopando.com/

How we inspected this service

Before the inspection we gathered and reviewed information from the provider. We conducted the inspection by online interviews with the provider’s the registered manager, the clinical lead and the deputy clinical lead. We reviewed a range of the provider’s policies and procedures and service user consultation records.

The inspection focused on the key questions Safe, Effective and Well-led.

Overall inspection

Good

Updated 4 May 2022

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of this service commencing on 13 April 2022. It was a focused inspection, following up on our inspection of August 2021, looking at the key questions Safe, Effective and Well-led. The report of our previous inspection can be accessed at the following page of our website - https://www.cqc.org.uk/location/1-10364931827/reports

We have rated this service as Good overall.

The key questions are rated as:

  • Are services safe? – Good
  • Are services effective? – Good
  • Are services well-led? – Good

We did not review the ratings for the key questions Caring and Responsive which were rated Good at our previous inspection.

Forward Clinical Ltd (the provider) was registered by CQC on 20 May 2021. It operates an online consultation service called Pando Access, whereby people can engage in a web-based secure instant text message exchange using their iPhones, Android Smartphones or desktop devices with a clinician to discuss and receive advice on women’s health and maternity / midwifery healthcare issues. The service is provided under contractual arrangements with third party organisations. It does not include providing treatment, prescribing drugs or medications, or referral to secondary healthcare providers.

At our previous inspection in August 2021 the service was being provided using a proprietary application (app) called Juno. That was replaced by the Pando Access web-based system in February 2022. We had identified some issues relating to the Juno system, which limited the provider’s ability to fully monitor and audit the service or to ensure that complete records were maintained and be accessible to clinical staff. Some governance policy documents had not been sufficiently reviewed and amended to be appropriate and specific to the service. Some contained discrepancies and errors. We rated the service as requires improvement for the key questions Safe, Effective and Well-led and we served a requirement notice citing a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to Good governance.

At this inspection we found the provider had taken action to address the matters we had identified previously. The new Pando system allowed for the maintenance of complete records of the provider’s contacts with service users and enabled full monitoring, review and auditing by senior clinicians. We noted the new system did not currently require service users to submit a full medical history, or link new contacts with past ones, for review by clinicians. However, we saw evidence this would be addressed in a planned system update to be implemented shortly after our inspection.

We saw that the provider’s governance and policy documents had been reviewed and revised, with new ones introduced and there were arrangements in place to ensure their regular review moving forward.

The area where the provider should make improvements is:

  • Proceed with the planned service system update so that full medical histories of users will be recorded, and clinicians will have access to past consultation exchanges for review when providing healthcare advice.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care