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