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This service was previously registered at a different address - see old profile

Inspection Summary


Overall summary & rating

Updated 28 July 2017

We carried out an announced comprehensive inspection of Now GP on 14 June 2017. Now GP provides an online service for patients, via a smartphone application (app). This allows patients access to online video consultations and healthcare advice with a GP. All prescribed medicines are dispensed to patients from either an affiliated or third party pharmacy (which we do not regulate).

We found this service provided safe, effective, caring, and responsive and well-led services in accordance with the relevant regulations.

Our key findings were:

  • All clinicians were qualified GPs (general practitioners) who were registered with the General Medical Council (GMC). Patients could access a brief description of the clinicians available and had the choice of a male or female GP.
  • There were appropriate recruitment checks and induction programmes in place for all staff. GPs registered with the service received specific induction training and a GP handbook prior to treating patients. All the staff had access to all policies.
  • There were comprehensive systems in place to check the patient’s identity and to protect personal information about patients.
  • The service had clear systems to keep people safe and safeguarded from abuse.
  • There were systems to ensure staff had the information they needed to deliver safe care and treatment to patients. Patients were treated in line with best practice guidance and appropriate medical records were maintained.
  • With the patient’s consent, the service shared information about treatment with the patient’s own GP in line with the GMC and the provider’s guidance.
  • A range of medicines were prescribed in line with the provider’s medicine formulary (a list of medicines GPs can prescribe from). Prescribing was monitored to prevent any misuse of the service by patients and to ensure GPs were prescribing appropriately.
  • There were systems in place to mitigate safety risks including analysing and learning from significant events and safeguarding.
  • The service learned and made improvements when things went wrong. The provider was aware of and complied with the requirements of the Duty of Candour.
  • There were clinical governance systems and processes in place to ensure the quality of service provision.
  • The service had a programme of ongoing quality improvement activity, which included regular reviews of consultations.
  • There were clear business strategy and future development plans in place.
  • The service encouraged and acted on feedback from both patients and staff.
  • Survey information we reviewed showed that patients said they were satisfied with the care, treatment and service they received.
  • Staff we spoke with were aware of the organisational ethos and philosophy and told us they felt well supported and that they could raise any concerns.
  • Both the company and individual GPs were registered with the Information Commissioner’s Office.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Updated 28 July 2017

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

  • There were safeguarding policies and easy to read flowcharts, informing staff how to manage safeguarding and make a referral to local authority if necessary. All staff had received safeguarding training appropriate for their role.

  • Patient identity was checked on registration, at every consultation and when prescriptions were issued. Children were only registered after a verification check of a parent or legal guardian (which included parental/guardian responsibility).

  • There were enough GPs and staff to meet the demand of the service. We saw evidence of comprehensive recruitment checks and records in place for all staff.

  • In the event of a medical emergency occurring during a consultation, systems were in place to ensure emergency services were directed to the patient.

  • The service had a business contingency plan, which was updated as needed.

  • Prescribing was constantly monitored and all consultations were monitored for any risks.

  • There were systems in place to meet health and safety legislation and to respond to patient risk.

  • There were systems in place for identifying, investigating and learning from incidents relating to the safety of patients and staff members. The provider was aware of and complied with the requirements of the Duty of Candour and encouraged a culture of openness and honesty.

Effective

Updated 28 July 2017

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

  • Each 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.

  • Patients were requested to provide the details of their own GP and consent to sharing of information with that GP.

  • The service had arrangements in place to coordinate care and share information appropriately, with the consent of patients. For example, when patients were referred to other services

  • Patients could access information to help support them to lead healthier lives, via the smartphone app. Information on healthy living was provided during consultations as appropriate.

  • The service had a programme of ongoing quality improvement activity. For example, audits, review of consultations, feedback to clinicians and reviews of prescribing trends.

  • There were induction, training, monitoring and appraisal arrangements in place to ensure staff had the skills, knowledge and competence to deliver effective care and treatment.

  • GPs were regularly reviewed to ensure consultations and prescribing was appropriate and within guidance.

Caring

Updated 28 July 2017

We found that this service was providing caring services in accordance with the relevant regulations.

  • We were told that GPs undertook consultations in a private room, for example in their own surgery or own home. We saw evidence that the provider carried out random spot checks to ensure GPs were complying with the expected service standards and communicating appropriately with patients.

  • The provider acted as a ‘mystery shopper’ and carried out random video spot checks to ensure the GPs were complying with the expected service standards and communicating appropriately with patients.

  • We did not speak to patients directly on the day of the inspection. At the end of every consultation, patients were sent an email asking for their feedback. We saw patient feedback, which commented on the “great” service and stated the GPs were professional, knowledgeable and “fantastic”. Patients expressed satisfaction that they felt listened to and that their condition had been assessed and explained.

Responsive

Updated 28 July 2017

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

  • Details of the service were available on the provider’s website. Patients signed up to receiving this service via a smartphone app. There was information available to patients to demonstrate how the service operated.

  • Patients could access the service via the smartphone app, email or telephone, 24 hours a day. The GP consulting service operated between 8am and 8pm seven days a week. Consultation times were set at a maximum eight minutes. However, patients could book more than one appointment if needed and the GPs could call the patient back if appropriate.

  • The smartphone app allowed people to contact the service from abroad.

  • Video consultations supported the GP to assess the well-being of a patient and observe any conditions which were visible, such as a skin infection, rash or sunburn.

  • Patients had access to information about the GPs working for the service; this included which GPs were available, a short biography of that GP’s experience/speciality, details of any non-English languages they may speak and whether they were male or female. This information enabled patients to book a consultation with a GP of their choice.

  • 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. All of the GPs had received training about the Mental Capacity Act.

Well-led

Updated 28 July 2017

We found that this service was providing well-led care in accordance with the relevant regulations..

  • There were business plans and an overarching governance framework to support clinical governance and risk management.

  • 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 at the end of each consultation. 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. Both the service and the GPs were registered with the Information Commissioner's Office.