16 June 2021
Livi UK was established in 2018 to provide an online consultation, treatment and prescribing service to patients in the United Kingdom. Its registered address is: 91 Waterloo Road, London, SE1 8RT.
Livi UK is the trading name of Digital Medical Supply UK Limited (The Provider), which is a wholly owned subsidiary of Digital Medical Supply Sweden AB, which itself is a wholly owned subsidiary of Kry International AB, a healthcare company. It provides healthcare services across a range of European and Scandinavian countries. The service is available to patients within England (and other UK Home Nations) within three separate categories:
The service has entered into contracts with a number of NHS GP practices across England. Patients are able to access GP appointments via video. There is no fee payable by the patient and they are unable to register to pay for private appointments with the service. Patients remain able to access all the normal services their NHS GP practice provides.
- Pay-As-You-Go Patients (self-funded patients)
The Service offers patients private GP appointments via video for a per-appointment fee.
- Clients of an international life and health Insurance company
The service works with a leading insurance provider to deliver GP appointments to the insurer’s customers. There is no fee payable by the patient for these appointments.
Patients access consultations via an app on their mobile phone or tablet (iPhone and android versions are available), or by logging on to their account via the Livi UK website. They can book appointments either on the same day or up to seven days ahead. GPs are able to advise on a range of medical issues, so long as no physical examination is required, and they provide prescriptions or referrals to specialist services. Prescriptions are, for most patients, sent to a pharmacy of their choice; for other patient’s prescriptions are sent according to the rules set by their NHS GP. The service is free to use for most patients, however self-funded patients pay one inclusive fee which includes any necessary prescription and/or sick note.
A registered manager is in place. A registered manager is a person who is registered with the CQC 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.
This inspection was carried out on 5 May 2021, and was led by a CQC lead inspector, accompanied by a GP Specialist Adviser and a member of the CQC medicines team.
How we inspected this service
Before the inspection we gathered and reviewed information from the provider. During this inspection we spoke to the Registered Manager, director of operations, several non-clinical staff and several GPs. We also reviewed organisational documents including policies and procedures and patient consultation records.
To get to the heart of patients’ experiences of care and treatment, we ask the following five questions:
- Is it safe?
- Is it effective?
- Is it caring?
- Is it responsive to people’s needs?
- Is it well-led?
These questions therefore formed the framework for the areas we looked at during the inspection.
16 June 2021
Letter from the Chief Inspector of General Practice
We rated this service as
overall. We have not previously inspected this service.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Outstanding
Are services well-led? – Outstanding
We carried out an announced comprehensive inspection at Livi UK on 5 May 2021 as part of our inspection programme.
Digital Medical Supply UK Limited (The Provider) (trading as “Livi UK”) was a wholly owned subsidiary of Digital Medical Supply Sweden AB, which itself was a wholly owned subsidiary of Kry International AB, a healthcare company, which provided healthcare services across a range of European countries. Livi UK (the service)provided access for patients within England (and other UK Home Nations) to healthcare for patients within three separate categories:
- Patients of NHS GP practices with whom Livi UK had entered into contracts;
- Self-funded patients (Pay as you go appointments),
- Clients of an international life and health Insurance company.
Patients signed up to access the service via an app or through Livi Connect. They could book appointments either on the same day or up to seven days ahead. GPs were able to advise on a range of medical issues, so long as no physical examination was required, and provide prescriptions or referrals to specialist services. Prescriptions were, for most patients, sent to a pharmacy of their choice; for other patient’s prescriptions were sent according to the rules set by their NHS GP. The service was free to use for most patients, however self-funded patients paid one inclusive fee which included any necessary prescription and/or sick note.
At this inspection we found:
- The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
- The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
- Staff involved and treated people with compassion, kindness, dignity and respect.
- Patients could access care and treatment from the service within an appropriate timescale for their needs.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
We saw the following areas of outstanding practice:
- On 7 March 2020, at the outset of the Covid-19 pandemic, NHS England asked the service to develop a system for home monitoring of early cases of patients with Covid-19. Within 30 hours of being asked, the service developed and adapted their systems, including expansion of its operational hours to 24 hours a day seven days a week to establish the NHS National Covid Home Monitoring Service (CHMS). CHMS enabled patients to receive access to care without risking potential exposure of others to the virus. In total the service supported 791 patients during the first month of the pandemic. All surviving patients were discharged back to their NHS GP’s on 31 March 2020.
- In March 2020 the service launched Livi Connect (“Connect”), a free web-based platform enabling healthcare professionals (including those with no connection to the service) to conduct secure remote video consultations with their patients. Connect was launched in response to the spread of Covid-19 to make it easy for healthcare professionals to continue with their work remotely, and as a best way of replicating face-to-face contact. Connect was free to use for all doctors and other healthcare professionals and was available in 10 languages: English; French; German; Italian; Spanish; Swedish; Norwegian; Danish; Dutch; and Polish. The provider had launched Connect in other European countries. Since launching Connect, it had enabled 26,473 patients in the UK, and 190,000 across Europe to benefit from video consultations with their healthcare professional.
- The service had implemented a comprehensive range of wellness benefits for staff it employed to ensure their physical and mental wellbeing. The impact of the benefits was demonstrated by the findings of the 2021 staff survey, including: 86% of GPs said the service took positive action on health and wellbeing.
The areas where the provider should make improvements are:
- Review the system for recording GPs NHS appraisals and ensure GP records of these are kept up to date.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care