Total Access Medical Diagnosis

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

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:

• Risks relating to the environment and premises had not been identified.
• The suitability of staffing could not be assured due to an absence of recruitment checks, training and supervision records.
• There were limited systems to ensure oversight that medicines were being prescribed safely.

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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had processes for staff to report incidents, near misses and safety events. During staff meetings, the team discussed and learnt from clinical issues. Clinical staff were clear of how to report significant events and gave examples of the learning process. They told us they had multiple opportunities for sharing learning including weekly case studies.

However, some non-clinical staff felt that they were not always told of the outcome of incidents and how updated processes affected their ways of working.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Where the service initiated tests, the results were shared with the patient’s usual GP.

Consent to share information with the patient’s usual GP was routinely requested. For higher-risk medicines, this was mandatory. In these instances, a red flag appeared on the system to alert the prescriber.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures.

Whilst Total Access and Medical Diagnosis did not provide treatment for children, policies were in place for safeguarding children if those at risk of abuse became known to the service. Safeguarding was a standing agenda item during regular meetings.

Whilst the provider worked nationally, they had a directory of safeguarding teams so that referrals could be made to the correct entity. Evidence was seen to confirm that appropriate referrals were made.

The service worked with patients to understand and manage risks. We saw that prescriptions were put on hold where risks or further checks and monitoring was required and followed up with the patient or NHS GP as appropriate.

Safety netting information (warnings and advice to keep patients safe) was included in the questionnaire that patients completed to request medicines, such as warnings not to take certain medicines during pregnancy. Information was provided if a medicine was being used “off licence” (outside the manufacturer’s approved uses). Patients had to acknowledge and accept this information before proceeding.

Whilst the premises were not accessible to patients, the service did not always detect and control potential risks in the environment which may pose a risk to staff and visitors.

Evidence was not provided of a health and safety risk assessment, nor a legionella risk assessment. The fire risk assessment identified a number of remedial actions required, and evidence was sent to confirm that these were in hand by the landlord. Fire safety training had been completed by some staff.

There was a business continuity plan in place which was monitored and reviewed.

The service did not provide evidence to demonstrate that staff were recruited safely, or had the skills and experience to undertake their roles. They did not always make sure staff received effective support, supervision and development.

Staff generally felt supported and confident in their roles. However, there were gaps in training and recruitment procedures.

We checked four staff files. The provider’s Staff File Data Matrix was inconsistent with the evidence that was provided. This document recorded all staff and locums as compliant with recruitment checks, support and training, however, multiple omissions were identified. These gaps included appraisals, references, employment history and terms of employment. Disclosure and Barring Service (DBS) certificates were present, but one was illegible as it had not been scanned clearly. The provider assured us that the original was seen at the time of recruitment. Identification checks were undertaken.

Whilst staff told us that appraisals occurred every four months, there were no supervision and appraisal records in the files to evidence this. Although the matrix recorded an appraisal date for one staff member, no supporting documentation was provided. Staff told us that they received an induction, although no induction records were seen in any of the files. After the inspection, we received appraisal records for six members of staff. However, only one of these related to a staff member whose files we had reviewed. As a result, we could not be assured that appraisals were carried out for all staff.

The provider followed the Digital Clinical Excellence Framework (DiCE), which stated that infection prevention and control (IPC) policies for remote services should be proportionate to the service provided. Standard IPC protocols for in-person care were not applicable, but staff were expected to understand general IPC principles. In line with this, the provider trained staff in IPC relevant to digital care and maintained safe environments for remote clinical assessments.

On the day of the inspection, we found the premises clean and suitable for the activities being delivered on site.

The service did not always make sure that medicines and treatments were safe and met people’s needs.

Patients requested medicines through completion of a digital and asynchronous (not in real time) questionnaire. Each request was reviewed by a prescriber. If approved, the medicine was usually dispensed by the provider’s in-house pharmacy and sent directly to the patient. The provider followed appropriate General Medical Council professional standards on remote prescribing for most consultations.

However, medicines were not always prescribed safely for long-term conditions, such as high blood pressure, diabetes, or asthma, and further, prescribing errors were identified. Searches could not be easily completed of the clinical system to enable an overview of patients at risk due to possible unsafe prescribing practices.

We saw examples of medicines being incorrectly prescribed. For example, one patient was supplied treatment for their thyroid at a requested dose that did not match with that prescribed by their GP. We reviewed one case where a patient requested both a diabetes medicine and a blood pressure medicine, and the wrong formulation of the diabetes medicine was supplied.

After the inspection, the provider sent us evidence to confirm the action taken to improve. This included improvements to Standard Operating Procedures (SOPs), mandatory requirements and rejection criteria during the prescribing process. We saw screenshots to evidence how software had been updated so that these changes were incorporated into routine prescribing systems.

The provider followed antimicrobial stewardship guidance (rules to prevent overuse of antibiotics and reduce resistance) when supplying antibiotics. Inappropriate requests for antibiotics were challenged.

There was an effective system to receive and disseminate safety alerts and medicines recalls.