Total Access Medical Diagnosis

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them with advice and support. Staff regularly reviewed people’s care and worked with the patient’s usual NHS GP to achieve this.

This is the first inspection for this service since its registration with CQC. This key question has been rated as requires improvement.

The service was in breach of legal regulation in relation to good governance.

The provider did not have effective systems or processes to assess, monitor and mitigate the risks to people who used the services because:

• The systems and processes to ensure patients who were prescribed medicines for their long-term conditions had received appropriate monitoring was not always effective.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health and wellbeing needs with them.

We saw evidence of a case in which the service demonstrated a tailored approach to care for a wheelchair user who was unable to use standard weighing equipment. To ensure safe prescribing of weight-loss medication, the provider adapted its clinical protocol by employing mid-upper arm circumference (MUAC) as an evidence-based alternative to traditional weight measurement. This adjustment was made in collaboration with the patient, who actively participated in the decision-making process and confirmed their understanding and preferences.

The service did not always follow current evidence-based good practice and standards.

Patients requesting inhalers for asthma did not have adequate safeguards in place to ensure they were getting the required monitoring. This should consist of an annual review including an inhaler technique check.

The provider told us they were following DiCE best practice guidance. The providers’ protocol specified that if the patient’s respiratory review was overdue, only one inhaler should be supplied in line with DiCE guidance. We saw one occasion where a prescriber deviated from this protocol with no justification documented. We also saw that no questions were asked about preventer inhalers during the consultation. This was immediately addressed by the provider, and an additional question was asked as part of the consultation about their use of a preventer inhaler and whether their asthma was well controlled.

DiCE guidance also recommends that those requesting short-acting inhalers should not require more than 6 inhalers in 12 months: the provider should consider not prescribing where they are unable to verify inhaler history. However, the current questionnaire does not capture the reason for request, nor a mandatory check of the GP records to be able to verify inhaler history.

Patients prescribed blood pressure medicines should receive a regular review. The frequency of the review will be dependent on the individual. However, we found that one patient had received 7 months’ supply of a blood pressure medication, with no assurance they had received a blood pressure review in the previous 12 months. Furthermore, there were not always checks to obtain evidence of the patients reported weight. Following this, the provider made immediate changes to their prescribing protocol to ensure that patients were requested to add the date of their last review into the online form. If the review was longer than 12 months ago, they were referred to their GP.

During our assessment, we found that there was no check to confirm that a patient prescribed a blood pressure medication had received the required blood tests which included kidney function. The provider responded immediately by updating the consultation process to include questions about required blood tests.

We identified that when patients requested medicines for weight loss, a photo was requested to verify the information given. However, this photo was not cross referenced against the information recorded during the patient registration process.

Total Access Medical Diagnosis worked with other services to ensure continuity of care. This included working with the patients’ usual NHS GP (if the patient had one and had obtained consent), as well as in partnership with a provider who undertook pathology. This was to identify patients with a testosterone deficiency.

The service was also undertaking a pilot project with another provider for gonorrhoea and chlamydia testing. Staff had access to the protocols they needed to appropriately treat people following test results.

The service supported people to manage their health and wellbeing, to live healthier lives, and where possible, to reduce their future needs for care and support.

As a result of patient feedback, the provider had recruited a dietician to support patients prescribed weight-loss medication with nutrition and lifestyle interventions. Health education information was available on the service’s website, including gut health and healthy eating.

After the inspection, the provider submitted additional evidence of how they support patients in leading healthier lives. This included a video podcast series covering common health topics, promoting self-care, and encouraging early recognition of when to seek medical advice to help reduce long-term healthcare needs.

The service did not always monitor people’s care and treatment. They were unable to consistently assure themselves that outcomes were positive and met both clinical expectations and the expectations of people themselves.

There was limited evidence of audit to review appropriate prescribing for patients with chronic conditions. The lack of effective functionality to search the clinical systems impeded the ability to carry out effective and efficient audit to monitor and improve outcomes. We reviewed one audit of a beta blocker medicine prescribed for patients with anxiety that had been completed prior to our inspection. The provider identified that this medicine was being prescribed outside of their guidelines and had subsequently put safeguards in place. This included a video consultation with the patient before a supply was issued. The service monitored and improved prescribing outcomes through some checks and audits. Approximately 5% of prescriptions were reviewed daily to ensure these were prescribed in line with protocols. For new treatments, condition-specific audits were carried out by reviewing every consultation over a set period. A senior pharmacist led quarterly audits using a random sample of consultations to assess prescribing decisions. Clinicians received feedback with suggested actions to support safe and effective practice.

Information about costs of a course of treatment were available prior to a patient providing their consent. The service did not provide services to children, and there were age verification checks in place to safeguard against prescribing to those under the age of 18.

Consent to share information with the usual NHS GP was routinely requested. Information was sent to patient’s GP following the supply of medicines. Higher-risk medicines were not supplied when the patient had not consented to share information with their usual GP.