Archived: MD Direct Ltd

Updated 3 March 2017

MD Direct Ltd. is an online service that allows patient to purchase medicines through a website. Patients are able to register with the website www.assetchemist.co.uk and complete a health questionnaire which is then reviewed by a doctor and a prescription is issued. Patients are also able to access medicines if they already have a prescription which may have been issued outside of the UK and want to purchase medicine through www.assetchemist.co.uk. Asset Chemist has a contract in place with MD Direct to provide the prescribing service. Patients using the service pay for their medicines when their on-line application has been assessed and approved by a clinician. Once approved by the prescriber working for MD Direct, medicines are dispensed by Asset Chemist, packed and posted; they are delivered by a third party courier service. MD Direct has issued over 3200 prescriptions in the last 12 months.

MD Direct employs a doctor on the GMC register to work remotely in undertaking patient consultations when they apply for prescriptions on-line. The service is accessed 24 hours a day seven days a week through a website and orders would be processed seven days a week and is available to patients worldwide. This is not an emergency service.

MD Direct was registered with the CQC on 19 May 2015. 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).

We conducted our inspection on 13 December 2016 when we visited MD Direct Limited’s operating site in Essex. We spoke with the registered manager and the sole clinician working there. We also visited the Asset Chemist location, with the permission of the Superintendent Pharmacist as Asset Chemist is not regulated by CQC. We looked at policies, other documentation and anonymised patient records.

To get to the heart of people’s experiences of care, we always ask the following five questions of every service and provider:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

Our inspection team was led by a CQC Lead Inspector. The team included a GP specialist adviser, a second CQC inspector, a member of the CQC medicines team, and a further specialist advisor.

We inspected this service as part of our comprehensive inspection programme. We carried out a comprehensive inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service.

Updated 3 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at MD Direct on 13 December 2016. MD Direct is an online service that allows patients to obtain a prescription and purchase medicines.

Our key findings across all the areas we inspected were as follows:

• There were no effective systems in place for recording, reporting and learning from significant events or safety alerts.
• Risks to patients were not appropriately assessed or managed. For example, we found patients being prescribed large quantities of inhalers but there was a lack of monitoring or follow up for these patients whose condition could put them at serious risk of harm.
• Some non-clinical staff with no formal training assessed patients’ needs. Staff training was ineffective and training of clinical staff had not been assessed or monitored by the provider.
• Information about services was available on the provider’s website. Information on how to complain was located within the terms and conditions section of the website. The provider told us that they did not document complaints.
• There was little understanding of continuous improvement.
• The clinician was working outside of her scope of practice, and told us they were not competent to carry out the role. The service had some policies which staff were not aware of and were ineffective.
• During the inspection the provider of the service failed to demonstrate they had the experience, capacity and capability to run the service and ensure high quality care.
• The service did not proactively seek feedback from staff or patients.
• The service did not have vision or values that were shared with staff.
• The provider was aware of the requirements of the duty of candour.

After the inspection we wrote to the provider outlining the seriousness of our concerns and our intention to take enforcement action. The provider responded saying they would voluntarily cancel their registration and stop providing services to patients immediately.

Had the provider remained registered we would have required them to take the following actions:

• Ensure there is a system to ensure recording, assessing and managing significant events.
• Ensure prescribing decisions are made appropriately and in line with clinical best practice and that appropriate safety advice is provided with each prescription.
• Ensure systems are in place to deal with emergency situations.
• Ensure systems are in place to assess capacity and obtain consent.
• Ensure systems are in place to action patient safety and MHRA alerts.
• Ensure systems are in place to confirm a patient’s identity.
• Ensure feedback from patients and staff is gathered to improve services.
• Ensure there is effective governance in place and that staff have received the training needed to perform their role and that they have access to policies and procedures.
• Ensure there is a policy in place for data security, safeguarding, and that the practice has an effective business continuity plan.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice