The Care Quality Commission
  • Doctor
  • Independent doctor

Archived: Videodoc Ltd

International House, 1-6 Yarmouth Place, Mayfair, London, W1J 7BU (020) 3675 0385

Provided and run by:
VideoDoc Ltd

Important: This service is now registered at a different address - see new profile

All Inspections

4 December 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

(Previous inspection 28 July 2017, when the service was found to be meeting some areas of the regulations)

We carried out an announced comprehensive inspection at VideoDoc Ltd on 4 December 2018, to follow up on breaches of regulations identified at the previous inspection.

VideoDoc LTD provides a web portal and mobile application allowing patients to consult with a doctor through a secure internet healthcare service. The core focus of the business is the corporate market, providing online health and wellbeing services to employers. This includes confidential on-line video health assessments with a GP and the private prescription of medicines. VideoDoc LTD (videodoc.co.uk) provides services to patients in England. Videodoc LTD also owns VideoDoc Limited (VideoDoc.ie), which is a company based in Ireland who provide the same service to over 1.4 million patients. We did not inspect this service during this inspection. There is a governance team for the UK service and both platforms have separate governance processes. For example, patients are seen by General Medical Council (GMC) registered doctors only on videodoc.co.uk, who follow policies and procedures specific to the UK service only. The online systems, reporting and patient feedback, which were reviewed at this inspection will be referenced in this report.

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

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

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

  • Although arrangements were in place to safeguard people and staff had received safeguarding training relevant to their role, the provider needed to ensure that the safeguarding policy in place was operating effectively. 
  • We were not provided with evidence of health and safety risks assessments or action taken to mitigate any risks identified. This was in relation to health and safety assessments, including Display Screen Equipment (DSE) assessments for remote workers.
  • Suitable numbers of staff were employed. Recruitment and induction procedures had improved; however, a mandatory training schedule was not in place. 
  • Prescribing was constantly monitored. The provider needed to implement an integrated prescribing system and ensure safe warfarin prescribing in accordance with their guidelines. The newly implemented policy required a review.
  • Arrangements were in place to check patient identity.
  • In the event of a medical emergency occurring during a consultation, systems were in place to ensure emergency services were directed to the patient and the patient followed up 24 hours later.

Are services effective? - we found the service was providing an effective service in accordance with the relevant regulations, although in some areas, improvement was required. Specifically:

  • The provider had implemented a programme of quality improvement activity, including clinical audit such as prescribing; however, there was no clear evidence of quality improvement following analysis of the audit data collection.
  • Although staff received the appropriate training to carry out their role, there were still gaps in mandatory training including information governance and there was no mandatory training schedule.
  • Following patient consultations information was appropriately shared with a patient’s own GP in line with GMC guidance.

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

  • The provider carried out checks to ensure consultations by GPs met the expected service standards.
  • Patient feedback reflected they found the service treated them with dignity and respect.
  • Patients had access to information about GPs working at the service.

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

  • Information about how to access the service was clear and the service was available seven days a week.
  • The provider did not discriminate against any client group.
  • Information about how to complain was available and complaints were handled appropriately.

Are services well-led? - we found some areas where the service was not providing a well-led service in accordance with the relevant regulations. Specifically:

  • There were gaps in governance processes such as mandatory training procedures and health and safety risk assessments for remote workers. 
  • The service had clear leadership.
  • A range of information was used to monitor and improve the quality and performance of the service.
  • Patient information was held securely.

The areas where the provider should make improvements are:

  • Take action to ensure that the regular audits carried out demonstrate clear evidence of improvement.
  • Take action to implement a prescribing formulary of medicines and take action to improve safer prescribing of high-risk medicines and improve the prescribing policy to clarify what medicines the service can provide and ensure that they are audited.
  • Implement protocols to notify Public Health England of any patients who have notifiable infectious diseases.
  • Consider setting up a United Kingdom advisory group to provide advice on the strategy for improving the quality of care provided by the service.

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

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

28 July 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Videodoc LTD on 28 July 2017.

Videodoc LTD provides a web portal and mobile application that allows patients to consult with a doctor through a secure internet healthcare service. This includes confidential on-line video health assessments with a GP and the private prescription of medicines. Videodoc LTD (videodoc.co.uk) provides services to patients in England. Videodoc LTD also owns VideoDoc Limited (VideoDoc.ie), which is a company based in Ireland who provides the same service to over 1.4 million patients. We did not inspect this service during this inspection. The two organisations share governance structures, processes and procedures, the online systems, reporting and patient feedback, which were reviewed at this inspection and are referenced in this report.

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

Our key findings were:

  • The service had clear systems to keep people safe and safeguarded from abuse.
  • The provider’s system for checking the identification of a patient when they registered for the service used credit and debit card check authentication and patient verifications. Further authentications and contextual checks were made during video consultations to ensure patients were who they said they were. The provider told us that checks would also be made to confirm the identity of the patient and accompanying adults when consulting with children and their relationship to the child.
  • There were systems in place to mitigate safety risks including analysing and learning from significant events.
  • Recruitment checks were undertaken for all staff. However, on the day of inspection there were missing recruitment and qualification check documents within the three of the four staff files we reviewed. The provider told us the checks had taken place.
  • Prescribing was monitored to prevent any misuse of the service by patients and to ensure GPs were prescribing appropriately. However, there were limited guidelines within the provider’s prescribing policy. For example, in relation to the prescribing of salbutamol inhalers or antibiotics.
  • There were systems to ensure staff had the information they needed to deliver safe care and treatment to patients.
  • The service learned and made improvements when things went wrong. The provider had complied with the requirements of the Duty of Candour.
  • Patients were treated in line with best practice guidance and comprehensive medical records were maintained.
  • The service monitored the quality of consultations and the performance of GPs using the service to drive improvement. There was some on-going clinical improvement activity in relation to patient outcomes, a small number of prescribing audits had been undertaken.
  • An induction programme was in place for all staff and GPs registered with the service received specific induction training prior to treating patients. However, there were no records to confirm inductions had been completed. Staff, including GPs, also had access to all policies.
  • Training was provided to ensure clinical staff had the skills, knowledge and competence to deliver effective care and treatment. Other essential training for staff was limited. There was no clear system to easily identify essential training and when updates were due.
  • Videodoc LTD provided effective training in the provision of clinical services to patients using digital technologies and within a telemedicine environment. There were plans to share this training externally to other telemedicine providers.
  • GPs had completed or were in the process of undertaking their revalidation. At the time of the inspection most non-clinical staff had commenced employment in January or February 2017 and they were not due an appraisal.
  • The service shared information about treatment with the patient’s own GP in line with General Medical Council guidance and the provider’s policy.
  • Survey information provided to us before the inspection showed that patients in England and Ireland were very satisfied with the service they had received. Patient survey data for all patients from England and Ireland showed that 98% were satisfied with the GP they spoke with and 99% said they would use the service again.
  • Information about services and how to complain was not easily accessible. At the time of inspection, information on how to complain could only be found in the frequently asked questions section of the provider’s website. Improvements were made to the quality of care as a result of complaints.
  • There was a clear business strategy and supporting plans in place.
  • Staff we spoke with were aware of the organisational approach and business model. They also felt well supported and that they could raise any concerns.
  • There were clinical governance systems and processes in place to ensure the quality of service provision. However, these were not always clearly documented or recorded.
  • The service encouraged and acted on feedback from both patients and staff.
  • Systems were in place to protect personal information about patients. Videodoc LTD is registered with the Information Commissioner’s Office.

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

  • The provider must ensure they identify, assess and manage risks relating to the health, welfare and safety of patients and others, including comprehensively undertaking qualification checks and providing formalised prescribing guidance for GPs working in Ireland and England.
  • The provider must maintain records necessary to be kept in relation to the management of regulated activities, including recruitment records and having formalised policies and procedures to identify and record significant events or incidents.

The areas where the provider should make improvements are:

  • Continue to develop systems to risk assess the appropriateness of information sharing and when to share information with the patients GP. In addition, Videodoc LTD should provide additional guidance and further training to the GPs.
  • Ensure that complaints information for patients is easily identifiable on the Videodoc LTD website.
  • The provider must ensure they continue to assess, monitor and improve the quality and safety of the services, including the monitoring of clinical outcomes to drive quality improvement.

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