The Care Quality Commission
  • Remote clinical advice

Archived: Forward Clinical Limited

Overall: Good read more about inspection ratings

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

Provided and run by:
Forward Clinical Limited

All Inspections

13 April 2022

During an inspection looking at part of the service

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

27 July and 4 August 2021

During a routine inspection

Letter from the Chief Inspector of General Practice

We rated this service as Requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced first comprehensive inspection of the service over two days, 27 July and 4 August 2021, as part of our inspection programme.

Forward Clinical Ltd (the provider) was registered by CQC on 20 May 2021. It operates an online consultation service using an application called Juno, whereby people can engage in a secure instant text message exchange using their iPhones and Android Smartphones with a clinician to discuss and receive advice on maternity and children’s healthcare issues. People using the service pay a monthly subscription. The service does not include providing treatment, prescribing drugs or medications, or referral to secondary healthcare providers.

At this inspection we found:

  • The provider had processes to monitor the performance of the service, but these were limited due to senior clinical staff having restricted access to records, preventing full and effective assessment, monitoring and clinical auditing.
  • We could not establish that all service users’ records were complete as in some cases information was recorded outside the main Juno service system.
  • Governance policy documents had not been sufficiently reviewed and amended to be appropriate and specific to the service. Some contained discrepancies and errors.
  • The provider had 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.
  • The provider routinely reviewed the effectiveness and appropriateness of the advice it gave service users. It ensured that this was delivered in accordance with evidence-based guidelines.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Service users could access the service within an appropriate timescale for their needs. User feedback that we saw, and which was provided directly to us, was consistently positive regarding caring and responsive aspects of the service.

The area where the provider must make improvements is:

  • It must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care