Archived: Doctor Care Anywhere

We carried out an announced focussed inspection on 14 November 2017 to ask the service the following key questions: are services safe and effective?

Our findings were:

Are services safe?

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

Are services effective?

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

CQC inspected the service on 24 May 2017 and asked the provider to make improvements regarding their arrangements for checking patients’ identities, sharing information with patients’ registered GPs and access to patient records for patients aged 11-18 years. We checked these areas as part of this focussed inspection and found the service had taken prompt action to put in place effective processes to address the areas identified for improvement during the previous inspection.

Doctor Care Anywhere provides consultations with GPs via online conferencing. Patients pay either a subscription to the service or purchase a one-off consultation, and the service also holds contracts with large companies to provide GP consultations to their staff and with insurance companies for the benefit of their members. Patients are able to book appointments at a time to suit them and with a GP of their choice via an online portal. GPs, working remotely, conduct consultations with patients and, where appropriate, issue prescriptions.

Our key findings were:

• The provider had effective systems in place to check the identity of patients, which included checking photographic identity documents.
• The provider had processes in place to ensure that young people, who were assessed as having capacity to make decisions about their care, could keep their medical records private from their parent/guardian. These arrangements complied with national guidance.
• The provider had processes in place to collect information about patients’ registered GPs, and encouraged patients to provide consent for information to be shared with their registered GP. In cases where patients did not provide consent, GPs would make a decision about whether it was in the best interest of the patient to provide treatment.
• The provider had introduced a system for information sharing with the GPs who worked for them, most of whom worked remotely. All GPs working for the service had access to an online platform which was used for information sharing, online discussion, and peer support. We also saw evidence of this platform being used for educational purposes, such as group discussions about case studies.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Doctor Care Anywhere on 24 May 2017.

Doctor Care Anywhere provides consultations with GPs via video or audio conferencing. Patients are able to book appointments at a time to suit them and with a doctor of their choice via an online portal. GPs, working remotely, conduct consultations with patients and, where appropriate, issue prescriptions or make referrals to specialists; consultation notes are available for patients to access. The service also provided a health tracking feature which allowed patients to monitor data about their health and track symptoms.

We found this service provided caring, responsive and well led services in accordance with the relevant regulations; however, we found some areas where the service was failing to provide safe and effective care.

Our key findings were:

• The service had clear systems to keep people safeguarded from abuse.
• At the time of the inspection the service did not have processes in place to check the identity of all patients, and in some cases identity checks were carried-out which were not effective. Following the inspection, the service has changed its processes to ensure that a thorough and effective identity checking process is in place for all patients.
• There were systems in place to mitigate safety risks including analysing and learning from significant events and safeguarding.
• There were appropriate recruitment checks in place for all staff.
• Prescribing was monitored to prevent any misuse of the service by patients and to ensure GPs were prescribing appropriately; however, not all GPs were aware of the service’s policy not to prescribe off-label medicines. (‘Off-label’ use is when a medicine is being used in a way that is different from that described in its licence).
• 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 was aware of and complied with the requirements of the Duty of Candour.
• The service told us that they had the facility to share information with patients’ registered GPs. At the time of the inspection they did not routinely do so; however, they provided examples of information being shared in circumstances where they had safeguarding concerns.
• Patients were treated in line with best practice guidance and appropriate medical records were maintained. At the time fo the inspection the arrangements in place relating to access to records for patients aged 11-18 years was not in line with national guidance; however, this has since been addressed.
• The service had a programme of ongoing quality improvement activity.
• An induction programme was in place for all staff and GPs registered with the service received specific induction training prior to treating patients. Staff, including GPs, also had access to all policies.
• We did not speak to patients directly on the day of the inspection; however, feedback we received prior to the inspection was positive about consultations with doctors at the service. The service also ran their own patient survey, and we noted that in the seven months prior to the inspection patients had rated their overall satisfaction with the service on average as 4.56 out of 5.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints.
• There was a clear business strategy and plans in place.
• 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.
• There were clinical governance systems and processes in place to ensure the quality of service provision.
• The service encouraged and acted on feedback from both patients and staff.
• Systems were in place to protect personal information about patients. The service was registered with the Information Commissioner’s Office.

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

• Ensure that processes are put in place to verify the identity of patients and to ensure that only patients with appropriate parental responsibility are able to access records relating to registered children.
• Ensure that appropriate arrangements are in place in relation to access to patient records for patients aged 11-18 years.
• Ensure that, where appropriate, patient information is shared with patients’ registered GPs.

The areas where the provider should make improvements are:

Ensure that all GPs working for the service are aware of the service’s policy not to prescribe off-lable medicines.

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