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Inspection Summary


Overall summary & rating

Updated 29 October 2018

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at DiMedic Limited on 16 November 2017 during which we found the service was not providing safe services and issued a requirement notice. However, we found they were providing effective, caring, responsive and well-led services in accordance with the relevant regulations. The full comprehensive report on this inspection can be found by selecting the ‘all services’ link for location name on our website at www.cqc.org.uk.

We carried out this announced focused inspection at DiMedic Limited on 18 September 2017. We inspected the ‘Are services safe?’ key question to check the service met the requirements of regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment and had made the necessary improvements.

DiMedic Ltd provides an online clinic, consultation, treatment and prescribing service for a limited number of medical conditions to patients primarily from England, Poland and Germany. As the provider’s website was in Polish the service could only be accessed by Polish speaking patients.

Our findings in relation to the key questions were as follows:

Are services safe? – we found the service was providing a safe service in accordance with the relevant regulations. Specifically:

  • Arrangements were in place to safeguard people, including arrangements to check patient identity. Where a patient consented there were processes in place to share information with their own GP.
  • There were systems in place to receive, disseminate and consider National Institute for Health and Care Excellence (NICE) and other clinical guidelines and national patient safety alerts.

The area where the provider should make improvement is:

  • Develop and implement processes, in line with GMC guidance, for communicating with patients who choose not to consent to information about their participation in the programme being shared with their registered GP.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Updated 29 October 2018

At our previous inspection on 16 November 2017 we found the service had not fully assessed the risks to the health and safety of patients receiving care and treatment. We issued a requirement notice in relation to Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

At this inspection, 18 September 2018, we found the service had addressed the issues identified at the last inspection.

We found that this service was now providing safe care in accordance with the relevant regulations.

Keeping people safe and safeguarded from abuse

In November 2018, we found the safeguarding policy did not make it clear that concerns should be reported to the local authority where the patient resided.

In September 2018, we found the provider had updated their safeguarding policy to include details of how to contact relevant local authorities should concerns arise in relation to patients resident in England.

Monitoring health & safety and responding to risks

In November 2017, we found the provider did not have a process in place to discuss or monitor the implementation of NICE guidance and told us that they relied on the GP obtaining relevant information through their role in the NHS.

In September 2018 we found arrangements had been implemented to keep clinical staff up-to-date with NICE and other relevant guidance. They had implemented quarterly clinical meetings, where these were a standing agenda item. They had created a resource pack on the provider’s shared drive for ease of reference to guidelines relevant to the range of conditions treated and medicines prescribed. They had also created an induction pack to update new staff about relevant guidelines. They showed us a sample of patient records where requests for medicines were rejected, in line with national guidelines, as patients were contraindicated for the medicines.

Prescribing safety

In November 2017, although there were some protocols in place for identifying and verifying the patient we were not assured that these would prevent fraudulent or inappropriate requests for service from patients within England. In September 2018, we found the service had made improvements. Patients were required to undergo verification processes, prior to provision of the service. This was achieved by either the patient undertaking a nominal bank transfer or providing identity documents (such as driving licence or passport) to prove their identity. If a patient was unable to verify their identity their request for service was refused. There were processes in place to ensure multiple requests from the same person were not submitted via different accounts. Prior to implementing this change, we were told the provider had written to all existing account holders to inform them of the new identity verification system.

At the last inspection, we also found the provider did not have a system in place to gain details of a patient’s own GP or to ask patients if details of their consultation could be shared with their registered GP. In September 2018, the service had addressed this by amending their website to include this facility. Where a patient indicated they wished the information to be shared, this generated a letter. The provider told us this letter was then sent by recorded delivery to the GP practice of choice. This facility was in place from July 2018, but as yet no patient had consented to their information being shared with their own GP.

Management and learning from safety incidents and alerts

In November 2017, the provider did not have a significant event or incident policy. The provider did not have a system in place to receive or disseminate national patient safety alerts from the Medicines and Healthcare Products Regulatory Authority (MHRA).

In September 2018, we found improvements had been made. A significant events policy was now in place. The medical director had signed up to all relevant national patient safety alerts through the central alerting system and the Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit. There was a standing agenda item on the quarterly clinical meeting to discuss any relevant alerts received with all staff.

Effective

Updated 29 October 2018

Caring

Updated 29 October 2018

Responsive

Updated 29 October 2018

Well-led

Updated 29 October 2018