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Hexpress Health Support Office Good

Reports


Inspection carried out on 9 May 2019

During a routine inspection

Letter from the Chief Inspector of General Practice

We rated this service as Good overall. (Previous inspection July 2018 – compliant with all regulations (not rated)).

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 at Hexpress Health Support Office on 9 May 2019 as part of our inspection programme.

Hexpress Health Support Office (Hexpress) provides an online prescribing service to patients aged 18 years and over. Patients wishing to use the service access it via one of their websites, where they are able to select the medicine they wish to obtain from a list of available medicines; patients are then required to provide information to verify their identity and complete an online questionnaire relating to their medical history. The information supplied by the patient is then reviewed by one of Hexpress’ doctors, and where appropriate, a prescription is issued, and the medicine is dispensed to the patient by Hexpress’ own pharmacy, where it is delivered by post, courier, or via a collection point.

At this inspection we found:

  • 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.
  • The service had policies in place for activities such as recruitment and staff training; however, whilst we were satisfied that these activities were undertaken in line with the requirements of regulations, the service did not always follow their own policies.
  • The provider had processes in place to ensure patient confidentiality. Doctors worked from their personal laptops, but the provider’s system could only be accessed via an encrypted, password protected portal.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided via reviews of samples of patient records; however, it did not carry-out clinical audits for areas such as antibiotic prescribing to demonstrate a commitment to learning and improving the quality of service it provides. The service had risk-assessed each of the medicines available to be prescribed and had limited the medicines available according to the level of risk.
  • The information requested from patients prior to a prescription being issued allowed the service to appropriately verify the patients’ identity and enabled prescribing doctors to consider the patients’ medical history when making prescribing decisions. Patients were asked to input information about their presenting condition and information about any relevant monitoring tests, but there was no facility for supporting information (such as photographs in the case of skin conditions, or copies of test result letters in the case of conditions such as diabetes) to be uploaded to the system to support clinical decision making and review progress.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Patients could access care and treatment from the service within an appropriate timescale for their needs.
  • The provider had given some thought to how patient records would be stored for the legally required retention period in the event that they ceased to trade; however, they had not made specific provision for this.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Review the appropriateness of their service model with reference to the General Pharmaceutical Council’s guidance on distance supply of prescription only medicines.
  • Review whether it would be beneficial to add the facility for patients to upload documents and photographs as part of the prescribing process.
  • Review the need to carry-out clinical audit for areas such as antibiotic prescribing to ensure that national guidance is being followed.
  • Ensure that the working practices of the service reflect internal policy.
  • Put in place provision for patient records to be stored in line with legal requirements should the service cease to trade.
  • Review whether there are any benefits to issuing staff with specific laptops for undertaking reviews of patient information.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 22 August 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hexpress Healthcare Ltd on 22 August 2018.

Hexpress Healthcare Ltd registered with the Care Quality Commission in June 2018. Hexpress Healthcare Ltd operates an online clinic for patients via the following website: www.healthexpress.co.uk; providing consultations and private prescriptions.

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

Are services safe? – we found the service was providing a safe service in accordance with the relevant regulations. Specifically:

  • The service had clear systems to keep people safe and safeguarded from abuse.
  • There was a comprehensive system in place to check the patient’s identity.
  • 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 doctors were prescribing appropriately.

  • 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.

Are services effective? - we found the service was providing an effective service in accordance with the relevant regulations. Specifically:

  • Patients were treated in line with best practice guidance and appropriate medical records were maintained.
  • The service had a programme of ongoing quality improvement activity.
  • An induction programme was in place for all staff and doctors registered with the service received specific induction training prior to treating patients. Staff, including doctors, also had access to all policies.
  • The service shared information about treatment with the patient’s own GP with their consent.

Are services caring? – we found the service was providing a caring service in accordance with the relevant regulations. Specifically:

  • We were told that doctors working remotely undertook consultations in a private room in their own home. The provider carried out checks to ensure doctors were complying with the expected service standards and communicating appropriately with patients.

  • Patient survey information we reviewed showed the latest Trust Pilot score for the service was ‘9.4 out of 10’ and rated as ‘Excellent.’ Patients comments included satisfaction with the provider’s delivery times and the convenience of using the service.

Are services responsive? - we found the service was providing a responsive service in accordance with the relevant regulations. Specifically:

  • There was information available to patients to demonstrate how the service operated.

  • Patients could sign up to receive this service either by android or iOS application.

  • There was a complaints policy which provided staff with information about handling formal and informal complaints from patients.

  • Consent to care and treatment was sought in line with the provider policy. All of the GPs had received training about the Mental Capacity Act.

Are services well-led? - we found the service was providing a well-led service in accordance with the relevant regulations. Specifically:

  • Staff we spoke with were aware of the organisational vision, objectives and values 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.

The areas where the provider should make improvements are:

  • Increase the health information available to patients about leading healthier lives.

  • Providing information for patients about the doctors undertaking the consultations for the service.

  • Develop ways to assist patients accessing the service who are hard of hearing, deaf or speech impaired to communicate with hearing people using the telephone network.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice