PrivateDoc Limited

We rated this service as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection of PrivateDoc Limited on 10 May 2017 and found that the provider was not providing safe, effective and well led care in accordance with the requirements of the Health and Social Care Act 2008. We issued Requirement Notices and a Warning Notice to the provider to drive improvement.

We undertook a desk-based review on 3 August 2017 to check that the provider had followed their action plan and to confirm that the requirements of the Health and Social Care Act 2008 had been met following our Warning Notice.

Following the review on 3 August 2017, we found that the provider had responded appropriately to our findings and had met the requirements set out in our enforcement action.

We carried out an announced comprehensive inspection on 25 January 2018 and found the improvements made had been embedded and the provider had met all of the standards.

We carried out an announced comprehensive inspection at PrivateDoc Limited on 1 July 2019 as part of our inspection programme to rate independent healthcare providers. Shortly after the inspection, CQC received an enquiry via our National Customer Service Centre raising multiple concerns and carried out a second announced visit on 15 July 2019. Following that inspection, we imposed urgent conditions on the provider’s registration, in relation to breaches of Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act. The service was rated as inadequate overall and in all key questions.

We carried out an announced comprehensive inspection at PrivateDoc Limited on 26 February 2020 as part of our regulatory response to breaches of regulation we identified at our July 2019 inspection. We rated the provider as Inadequate overall and the service was placed in special measures as insufficient improvements had been made such that there remained a rating of inadequate for safe, effective and well-led services. We took action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. The service was kept under review and provided regular information detailing the improvements they had made. Based on the assurances from the provider on the improvements made and in light of the COVID-19 pandemic, we withdrew our proposal to cancel the providers registration and issued a serious concerns letter detailing the monitoring arrangements for the service until such time as we could safely inspect.

We carried out this inspection on 20 October 2020 and found the improvements made had been implemented, sustained and were effective.

Details of the previous inspection and reports can be found by following the links for the provider on our website www.cqc.org.uk.

At this inspection, we rated the provider as Good for providing safe services because:

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.

Improvements made since our last inspection included;

• Continued improvement of identification checks including anti money laundering checks and development of facial recognition technology.
• The service ensured patient records and patient contacts were always completed and recorded, with the quality of patient records monitored through quality improvement activity.
• Systems and processes were strengthened to provide assurance that the named account holder was the person receiving and using the medicines ordered and ensuring the facility of using an alternative delivery address kept patients safe.
• Improved processes and procedures to manage or respond to emergency medical situations in the event a patient presented with an emergency situation.

At this inspection, we rated the provider as Good for providing effective services because:

• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

Improvements made since our last inspection included;

• The service had further improved and embedded an effective quality improvement program.
• There was a clear audit trail of the clinician’s rationale for approving or declining each prescription request. This was monitored through the services quality improvement activity.
• The service had improved their consultation review process which was extended to all patients at fourteen days after the initial consultation. This formed part of the service’s quality improvement activity and was effective in identifying issues and concerns and driving improvements for patients.
• There were now clear and effective processes in place for contacting and reviewing patients who were on medicine for weight loss and who had not achieved the manufacturer’s suggested weight loss.

At this inspection, we rated the provider as Good for providing caring services because:

• Team members treated patients with kindness and respect and involved them in decisions about their care.
• The service was rated as “Excellent” in 95 percent of 2,886 online reviews with an average rating of 4.9 out of five stars.

At this inspection, we rated the provider as Good for providing responsive services because:

• Patients could access care and treatment from the service within an appropriate timescale for their needs.

Improvements made since our last inspection included;

• The service had improved processes for identifying, managing and responding to complaints which drove improvement.

At this inspection, we rated the provider as Good for providing well-led services because:

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

Improvements made since our last inspection included;

• The service had acted upon all of the concerns identified from our previous inspections.
• Governance structures, systems and processes were improved, embedded and were effective.
• There was a comprehensive programme of quality improvement activity in place to monitor and improve the performance of the service.
• There were effective systems in place to ensure care and treatment records were complete, accurate of sufficient quality and contained information on the decision-making process of the clinicians.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

• We found the provider had not acted upon all of the concerns identified during our July 2019 inspection visit.
• We found there was not effective governance structures and systems in place.
• There were minimal checks in place to monitor the performance of the service and we found the provider’s review process of consultations was ineffective.
• Care and treatment records were not complete or always accurate and did not contain information on the decision-making process of the clinicians.

The area where the provider must make improvements as they are in breach of regulations are:

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

The areas where the provider should make improvements are:

• Continue to review and improve systems to conform with General Pharmaceutical Council guidance on prescription only medicines.
• Implement systems to ensure side effects for each prescribed medicine are correctly listed during the patient self-declaration.

This service was placed in special measures in July 2019. Insufficient improvements have been made such that there remains a rating of inadequate for safe, effective and well-led services. Therefore we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care