Expert Health Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment, we rated this key question as outstanding, howeverwe found that some of those elements previously regarded as outstanding practice are now embedded throughout most services. Whilst the service had maintained this good practice, the threshold to achieve an outstanding rating overall has not been reached with this assessment.

This service scored 82 (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 very clear shared vision, strategy, culture and set of values. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an understanding of the challenges and the needs of digital health care. The senior leadership team were dedicated to delivering the mission of the service and maintained the core founding values with a realistic strategy on how to maintain this. The service’s values are centred around patients with the acronym “PATIENT” (purposeful, ambitious, trusted, inventive, excellent, nurturing and team-focussed). Staff understood the vision and values of the service and how they contributed to this.

The service continues to grow and increase, and they have over 4 million registered patients with repeated positive high levels of patient and staff feedback indicating the service was delivering their vision and the culture was embedded. The direction of the service was under constant review and shared with staff. Leaders highlighted the importance of reviewing the plan as changes continue within the wider healthcare sector.

There were a variety of daily, weekly and monthly meetings for the service and there was evidence of collaboration across teams to deliver the service vision. We saw that some leaders and staff were involved in research relating to digital health and sexual health, with credible bodies including British Medical Journal (BMJ), The Journal of Sexual Medicine and International Journal of Pharmacy Practice (IJPP).

Leaders and managers supported staff. Clinical and operational staff had actively contributed to the development of the service, and we saw that staff were encouraged to raise ideas, concerns and challenges. For example, the service had made changes in response to the staff survey and introduced team working days, quiet zones in the office space and revamped structured lunch and learn sessions for staff. The service promoted an open culture of learning and inclusion by continually improving systems and processes and ensuring staff had appropriate skills and knowledge. Shared direction and culture were actively maintained through leadership communication, structured planning, measurable objectives and operational delivery. For example, we saw that the service had regular staff wellbeing checks referred to as ‘temperature checks’, data showed 94% of staff reported feeling supported by management.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. This was reflected in how the service was structured to support shared leadership. The senior leadership team consisted of senior clinicians, medical technology specialists and operational leaders with a multidisciplinary team approach.

Leaders had the skills, knowledge, experience and credibility to lead effectively backed with years of experience in digital health. Leaders were available to provide remote support to staff 24/7. They did so with integrity, openness and honesty. We saw that the service website contained information of the clinicians for patients to know who was handling their care, this included, a photo, qualifications, UK registrations and any research they had been involved in.

The service had and open and transparent culture. We were told by staff that leaders were approachable, modelled the values of the service, and responded to any concerns raised. Leaders demonstrated compassion and highlighted the importance of staff wellbeing to support them in maintaining good outcomes for patients. There were arrangements in place for flexible and hybrid working for staff. Leaders informed us on initiatives implemented in response to staff feedback which included menopause support, staff development opportunities, well-being initiatives, and further employee benefits.

The leaders told us they used a structured programme to obtain patient feedback, the service carried out annual patient surveys, requested patient feedback after each consultation and regularly monitored feedback from an online reviews’ website. This is used for learning and improvements to the service. We saw that the leaders had a framework to address concerns in response to patient feedback, for example there were regular meetings with delivery partners for performance reviews that focused on patient experience. In addition, data gathered from the service in 2022 showed the online model reduced access barriers for emergency hormonal contraception in underserved groups, including those from black ethnic backgrounds (25.9% Caribbean ethnicity users and 17.9% African ethnicity users, compared with 23.2% White British users) and those living in areas of deprivation (53% of users lived in deprived areas).

Staff also told us they were passionate about their individual roles and contribution to the service, and some staff spoke about the benefits and opportunities they had received to further develop, educate and train into managerial roles with support from the service leaders. Leaders had an in depth understanding of the wider challenges and priorities faced by digital services and have collaborated and worked with credible bodies such as British Association for sexual Health HIV and European Society of Sexual Medicines relating to digital healthcare access by transgender individuals.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. We saw that staff feedback was also gathered through regular surveys.

The practice had a whistle blowing policy in place and established freedom to speak up arrangements. Staff were aware of how to raise concerns, and we saw examples where staff had used the arrangements in place to positive effect that led to direct changes in patient safety pathway design and clinical governance.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and procedures to promote diversity and equality were in place. Adjustments had been made to ensure all staff were valued, for example we saw adjustments for flexible and hybrid working were in place to support staff. Staff also had access to an employee assistance program that included menopause support, well-being initiatives and further benefits.

The service had clear roles, responsibilities, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. We saw the leadership team worked with other providers and were engaged in the development of digital healthcare. They always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The service had a clear management structure in place, which provided clarity for staff regarding day-to-day management, as well as reporting structure for any concerns. Staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. All staff had regular supervision and leaders also worked with staff and there were regular audits and skills reviews. The service provided evidence that showed improvements above 95% in call performance in areas such as greeting, security checks and resolution skills. These processes provided the opportunity for constructive support and dialogue between staff and leaders and the opportunity for leaders to assure themselves staff were competent in their roles.

The service had established governance processes that were appropriate for their service. Staff could access all required policies and procedures, which had been reviewed and updated. Managers held regular meetings that included clinical governance meetings, operational reviews, patient advise team meetings and whole service updates, during which they discussed clinical concerns and emerging risks, and we saw that the service held daily huddles. Managers clearly recorded any actions arising from these meetings and these were shared with staff, for example in service wide newsletters.

The service carried out a range of audits, either in relation to an identified need within the service or as requested locally or nationally. These audits were used to drive improvements, were monitored and results were shared with relevant staff members and external agencies including health and community services for ongoing shared learning and improvement. The service routinely audited capacity and demand and used this information on an ongoing basis to ensure sufficient consultations and staffing levels. Assigned workstreams were used to manage and deliver high-quality, sustainable care, treatment and support. Leaders showed us the rota, and the service was consistently overstaffed in case of any staff absences to meet patient demands. In addition, the service had an audit trail of when records were accessed, who had access and from where.

The service identified emerging governance risks following acquisition and service transition. They implemented workflow with clearer clinical, compliance, ethics training, and introduced weekly prioritisation and capacity planning. They also initiated a group-level clinical, regulatory and quality decision-making review to map governance forums, escalation routes, multidisciplinary decision-making and board-level assurance.There were systems in place to routinely manage and act on performance data in a range of areas including ongoing analyses of consultations and patient feedback. Leaders responded to staff and patient feedback and used this to help improve the service. When considering service developments or changes, the impact on quality and sustainability was assessed by leaders. There was a business continuity plan that also addressed weekends and bank holiday arrangements.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement. For example, we saw information being communicated with patients GPs for patients who requested to receive weight loss medicines but had a low BMI that did not meet the threshold. This allowed for joint collaborative care, mitigated risk and the service took appropriate action. Staff and leaders engaged with meetings with DiCE, national clinical conferences and leaders have presented to the London Assembly on improving equitable access to medicated weight loss services. One of the leaders was part of a Health Committee report concerning weight loss medicines in London (the health committee reviews health and wellbeing issues).

The service collaborates with system partners, contributes to policy and professional debate, shares learning externally, and uses its digital healthcare experience to support safer care beyond the organisation. They worked with other providers within their local network including collaboration with Sexual Health London, Chelsea and Westminster NHS Trust and community pharmacies. The service worked in partnership with a nutritional health service used to provide nutritional and lifestyle support for patients. For example, we saw that patients on weight loss medicine received regular email updates to offer lifestyle advice and support to help with their weight loss journey. The service also offered nutritional coaching services that patients could pay for. Where treatment was omitted, patients were advised on relevant services to seek care and support.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. There was a focus on continuous improvement by regular audits concerning clinical and non clinical staff. They encouraged creative ways of delivering equality of experience, outcome and quality of care for people; for example the provider conducted educational events for clinicians (see above planning for the future section) and educational support videos are available for patients to access from their website. Staff and leaders told us about regular lunch and learn sessions that were available to staff to help educate and support on varied topics with some delivered by external consultants. They actively contribute to safe, effective practice and research and we saw learning was also shared externally, as the service presented at conferences and educational events with NHS England to promote safe digital care.

The service had a quality improvement road map for the year ahead to help drive improvements in services. This focussed on changes to pathways, algorithms and services being analysed, and evaluated. All staff were encouraged to put forward and test out new ways of working. For example, there was built in forms in the system that staff used to make any service improvement suggestions, and we saw examples of this being implemented by the service (see prior section on medicine optimisation).

We saw evidence of a range of audits and quality improvement projects. Projects were designed to improve performance, outcomes and patient experience. Leaders showed strong commitment by regularly listening to staff and patient feedback. They also invested significant time and resources to support staff. We saw that pathways, algorithms and digital tools were developed, monitored and continuously improved. This ensured the service prioritised safety and innovation, and leaders reported a reduction in clinical incident rate (see workforce wellbeing and enforcement section). The provider told us they strove to ensure their digital consultations reflected evidence-based practice and digital records were maintained in compliance with data protection and IT security standards.

Leaders told us that patients were asked for feedback following consultations and the service also carried out annual patient feedback. In addition to this, the service also monitors and reviews feedback from an online reviews website. The service uses all feedback to identify themes, learning and opportunities to improve the service. For example, by implementing regular prescribing audits to ensure consistency in prescribing decisions. Furthermore, the service provided evidence of internal research in relation to structured user testing which was used to make improvements to patients’ experience of using the service. We also saw collaborations with external providers in the wider health sector and nationally as the provider had been approached to present their service delivery to care outcomes as the rise to digital healthcare progresses.