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We are carrying out a review of quality at DiMedic Limited. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 18 September 2018

During an inspection to make sure that the improvements required had been made

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 carried out on 16 November 2017

During a routine inspection

We carried out an announced inspection at DiMedic on 16 November 2017 as part of our comprehensive programme of inspection.

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.

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

Are services safe? – we found the service was not providing a safe service in accordance with the relevant regulations. Specifically:

  • The service had some systems in place to keep people safe and safeguarded from abuse. However, their safeguarding policy needed updating to include details on how to contact the relevant local authority in England.
  • We were not assured that the system in place to confirm a patient’s identity was sufficient to prevent misuse.
  • There were systems in place to mitigate safety risks including analysing and learning from significant events and safeguarding. However, although staff were aware of their roles and responsibilities in relation to significant events the provider did not have a written significant event policy.
  • A system was in place to ensure that any prescription authorised by the GP was double checked by the registered manager who was also a qualified pharmacist.
  • There was a lack of systems in place to ensure staff had the information they needed to deliver safe care and treatment to patients. For example, the GP was expected to access patient safety alert information and National Institute of Health and Care Excellence (NICE) guidance through their work in the NHS.
  • The service did not have a process in place to share information about treatment with the patient’s own GP in line with General Medical Council guidance.

Are services effective? - we found the service was providing an effective service in accordance with the relevant regulations. Specifically:

  • Staff received the appropriate training to carry out their role.
  • The GP assessed patients’ needs and delivered care in line with relevant and current evidence based guidance and standards, for example, National Institute for Health and Care Excellence (NICE) evidence based practice. We reviewed a sample of consultation records which demonstrated appropriate record keeping and patient treatment.
  • The service was able to demonstrate quality improvement and clinical audit activity that had led to improvement in service delivery.

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

  • The GP undertook consultations in a private room, for example in their surgery, at the service or own home.
  • All staff had undertaken data protection and information governance training and the provider was registered with the Information Commissioner’s Office.
  • Patient feedback provided directly to us in advance of the inspection and on the provider’s website indicated that the vast majority were very satisfied with the service they had received. Patients reported that they were treared with dignity and respect.

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

  • There was information available to patients to demonstrate how the service operated.
  • Patients were able to access the service via the providers’ website from any computer, android or iOS device at any time. Consultations were undertaken either the same or following working day. The call centre was open from 9am to 5pm on a Monday to Friday and a live chat facility was also available during these hours.
  • Patients were able to access a brief description of the GP. However, as only one GP was employed by the service patients were unable to choose either a male or female GP or one that spoke a specific language or had a specific qualification.
  • All staff working for the service spoke Polish as well as English.
  • There was a complaints policy which provided staff with information about handling formal and informal complaints from patients and information was made available to patients about how to make a complaint.
  • Consent to care and treatment was sought in line with the provider policy. The GP had received training about the Mental Capacity Act.

Are services well-led? - we found the service was providing a well-led service in accordance with the relevant regulations. Specifically:

  • The provider had carefully considered what conditions they would treat and medicines they would prescribe to minimise risk and promote patient safety.
  • They were planning to extend the range of services delivered but were risk assessing their plans before doing so and had developed an action plan to aid implementation.
  • There was a management structure in place and the staff we spoke with understood their responsibilities. Staff were aware of the organisational ethos and philosophy and they told us they felt well supported and could raise any concerns with the provider or the manager.
  • The service encouraged patient feedback. There was evidence that staff could also feedback about the quality of the operating system and any change requests were discussed.
  • Systems were in place to ensure that all patient information was stored securely and kept confidential. There were systems in place to protect all patient information and ensure records were stored securely. The service was registered with the Information Commissioner’s Office.

The areas where the provider should make improvements are:

  • Update their safeguarding policy to include details of how to contact relevant local authorities should concerns arise in relation to patients resident in England.
  • Introduce a significant event policy to finalise the arrangements currently in place.

We identified regulations that were not being met and the provider must:

  • Ensure a system is introduced to receive, disseminate and consider patient safety alerts
  • Ensure a system is introduced to enable clinicians working for the service to access, discuss, implement and monitor NICE and other relevant best practice guidance
  • Ensure the process in place for confirming patient identity is reviewed to ensure a fail proof system is in operation
  • Ensure a system is implemented to inform a patient’s own GP of any consultation undertaken or medicine prescribed. This system should include obtaining patient consent to do so and a rationale to prescribe when consent has not been obtained.

You can see full details of the regulations not being met at the end of this report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice