Expert Health Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm. At our last assessment, we rated this key question as good. At this assessment, the rating has remained the same.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and made improvements. Lessons were learnt to continually identify and embed good practice. Managers encouraged staff to raise concerns when things went wrong. Staff and managers could provide examples of learning from incidents and actions being put in place to prevent recurrence. During staff meetings, the whole team discussed and learnt from clinical issues. Staff told us there was an open culture, and that safety was a top priority.

The provider had processes for staff to report incidents, near misses and safety events in the system. There was a system to record and investigate complaints, and when things went wrong, staff told us they would apologise and offer people support. There was a process which allowed learning from incidents and complaints to result in changes that improved care for others.

The service worked with people and local healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. For example, leaders told us the service worked in partnership with Sexual health London (SHL) for commissioned sexual health services, which enabled shared records, safeguarding escalation and clinical communication. They made sure there was continuity of care and relevant information was securely shared with patients’ GPs with consent via Docman Connect, which facilitates electronic communication between health care providers and supports 97% of GPs in England. Staff would signpost clients to other services such as the local pharmacy and the client’s own GP when needed and the service sought consent to share information with the client’s own GP. There were systems in place for processing information relating to new patients. Test results requested for personal checks including cholesterol, HbA1c and liver function tests were reviewed by one of the clinicians on the same day they are received and this is communicated to the patients. We saw that in urgent circumstances; patients would receive a phone call.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

There were safeguarding children and adult policies which were easily available to staff, who were appropriately trained in safeguarding procedures. We found evidence of safe systems and processes. For example, the service had built in alerts on the system for vulnerable people and these were on patients’ profiles for those patients with known safeguarding concerns. The safeguarding lead was involved in external safeguarding meetings with Chelsea and Westminster NHS Trust, as the service provided remote service for patients that consented to this treatment. The service had a proactive approach to learning from safeguarding which were discussed in internal meetings and were highlighted in service wide newsletters.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Patients received information about treatment options, benefits and monitoring requirements. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. The service did not deal with patients on the premises and so there was no emergency equipment or medicine onsite, which was appropriate for the online service.

There were safe and effective systems in place, and leaders and staff told us their equipment, facilities and technology supported the delivery of safe care. Contracts were in place to ensure the premises were maintained. There were arrangements for identifying, recording and managing risks from staff and these could be traced and tracked on the system. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. Emergency exits were clear, and the premises had smoke detectors, fire signage and fire extinguishers. There was a business continuity plan in place which was monitored and reviewed.

The service made sure there were enough qualified, skilled and experienced staff using a clinical workforce resourcing model to forecast clinical demand, required clinical capacity and staffing hours across the service. Staff received effective support, supervision and development.

There were a range of clinical and non-clinical roles. We found learning and development needs of staff were managed appropriately, and staff were working within their agreed areas of competence. Staff underwent an internal process for training to ensure competence and consistency.

Lloyds Pharmacy Online Doctor/Expert Health Limited is an independent health service that provides online care. This quality statement is not relevant for this service.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff involved people and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident prescribing medicines relevant for the service. Staff followed protocols to ensure they prescribed all medicines safely and we saw that the online system had built in prompts based on guidance for clinicians to follow when prescribing. For example, emergency contraception requests were highlighted on the system so they could be identified and reviewed first, due to the urgency. There were no medicines stored at the premises, patients could collect prescriptions from over 700 pharmacies, parcel shops or opt for tracked home delivery services.

The service carried out regular audits to ensure prescribing was in line with best practice guidelines for safe prescribing. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. For example the service introduced video verification that’s required from patients before being prescribed medicines for weight loss, which was an initiative proposed by the senior clinical leadership team. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including unlicensed medicines. Prescribing data reviewed as part of our assessment confirmed this. The service had effective systems to manage and respond to safety alerts and medicine recalls and as a result of this they were not prescribing asthma medicines at the time of this assessment. We saw that systems highlighted allergies, contraindications and clinical risk factors to ensure safe prescribing. For example, if a patient requested an order sooner than when this was next due or needed to provide a blood pressure. Leaders also carried out regular prescribing audits to ensure consistency in prescribing decisions.