Archived: Push Dr Main Office

We previously inspected Push Dr Main Office in March 2017 when the service was found not to be meeting some areas of the regulations.

We carried out an announced focused inspection at Push Dr Main Office on 9 August 2017 to follow up on breaches of regulations identified during the previous inspection in the safe, effective and well-led domains.

Push Dr is an online service that patients can use to access a GP appointment using video calling services from 6am to 11pm seven days per week. Patient services can be accessed through the provider’s website at www.pushdoctor.co.uk using any smartphone, Android, tablet or PC device.

Patients are able to use the service for any health condition they may have. However, this is not an emergency service. Subscribers to the service pay for their prescription when their application has been assessed and approved. Once approved by the prescriber, prescriptions are sent to a

pharmacy of the patient’s choice.

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

Are services safe? – we found an area where the service was still not providing a safe service in accordance with the relevant regulations. The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low once it has been put right. Specifically:

• The provider had improved their identity verification and safeguarding arrangements to govern the treatment of children under the age of 16.
• The provider had a system in place to seek consent from patients to share information with their usual GP when registering with the service and at the start and end of every consultation. However, this information was not visible to the GPs so could not help them in determining whether treatment in an online environment was appropriate. In addition, the provider had not considered which medicines were appropriate for prescribing where consent to share the information had not been granted.
• The provider had reviewed and improved the system for managing blood and other test results.
• Patient safety alerts were cascaded appropriately and a system was in place to ensure relevant alerts had been acted upon.
• Recruitment policies and procedures had been reviewed and retrospective pre-employment checks had been completed.
• Prescriptions were being produced in accordance with The Human Medicines Regulations 2012.

Are services effective? - we found the service was providing an effective service. Specifically:

• The majority of care was being delivered in line with relevant and current evidence based guidance and standards, for example, National Institute for Health and Care Excellence (NICE) evidence based practice. However, patient records we reviewed were not always comprehensive and lacked details such as assessment of severity of condition and discussion regarding unlicensed use of medicines.
• Staff had undertaken training in relation to the Mental Capacity Act (MCA) 2005. The consent policy had been updated to reflect roles and responsivities in relation to the MCA.
• All staff had undertaken training in relation to equality and diversity

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:

• Although there was limited evidence of clinical audit activity a schedule for future development had been implemented.
• There was evidence of staffing and service delivery audit and quality improvement activity.
• The provider had appointed additional members of staff and contracted an external care consultancy to aid improvement and support clinical development.
• Governance board arrangements had been reviewed and included strengthened clinical oversight.
• Policies had been reviewed and updated and a policy control tool was in operation. However some policies we viewed were undated and did not contain a version number or date for review.
• A staff appraisal system was now in place for all staff, including non-clinical staff.
• A schedule of meetings had been implemented and minutes were recorded for all meetings, including significant event meetings.
• We found that the provider had taken actions to ensure improvement and support development of the service. However, it was clear that some changes needed additional time to fully embed.

The areas where the provider should make improvements are:

• Improve the system for recording the unlicensed use of medicines and to ensure patients are being given clear information in relation to unlicensed use, that they acknowledge they understand this information and that they are issued with additional written information to guide the patient when and how to use these medicines safely.
• Review the operational policies available to their staff to ensure they are up to date and in line with current processes.
• Ensure GP’s are able to easily see whether consent to share information with a patient’s usual GP has been granted to enable them to make an informed judgement as to whether treatment in an online environment is appropriate. The provider should also consider which medicines are unsafe to prescribe if consent to share the information is not granted.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards.

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