Archived: Online services

Updated 31 January 2019

Background

Bluezone Health Ltd registered with CQC in April 2018; initially the service was piloted by a small number of patients, and was made available to the public in November 2018.

The service operates via an online app, which allows patients to enter information about the injury or health condition they require advice on; this information is then reviewed by a doctor (a consultant in emergency medicine), who will contact the patient and either provide advice (and a prescription where necessary) remotely, or will make arrangements for the patient to be seen in person by a Bluezone doctor at HCA Chiswick Outpatient & Diagnostic Centre (HCA), where Bluezone staff have access to HCA’s diagnostic and treatment facilities. During face to face consultations at HCA, doctors worked under practicing privilages granted by HCA, and therefore, this aspect of the service did not form part of the inspection.

At the time of the inspection the service only provided face to face consultations from a single site, but planned to expand to provide consultations from further sites in other parts of London and selected areas throughout the rest of England.

How we inspected this service

This inspection was carried out by a CQC Lead Inspector, a member of the CQC medicines team, and two GP Specialist Advisors.

Before the inspection we gathered and reviewed information from the provider. During this inspection we spoke to the Registered Manager, members of the management and clinical teams and representatives from the contractors used to develop the online app and provide the patient records system.

To get to the heart of patients’ experiences of care and treatment, we ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Why we inspected this service

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.  

Updated 31 January 2019

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bluezone Health Ltd on 5 December 2018 as part of our inspection programme.

Bluezone Health Ltd operates via an online app, which allows patients to contact a doctor (a consultant in emergency medicine) for an online consultation via a text “chat”, video call or voice call. Where the consulting doctor considers it necessary for the patient to be seen in person, they can arrange for the patient to be seen by a Bluezone doctor at HCA Chiswick Outpatient & Diagnostic Centre (HCA), where staff have access to HCA’s diagnostic and treatment facilities. During face to face consultations at HCA, doctors worked under practicing privileges granted by HCA, and therefore, this aspect of the service did not form part of the inspection.

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:

• Arrangements were in place to safeguard people, including arrangements to check patient identity.
• Overall, prescribing was in line with national guidance; any unusual prescribing was identified and discussed in clinical team meetings. The service had not prescribed any medicines for use outside of their licence but we were told that should they do so, the patient would have any risks associated with this fully explained to them.
• Suitable numbers of staff were employed and appropriately recruited.
• Risks were assessed and action taken to mitigate any risks identified.

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

• Following patient consultations, information was appropriately shared with a patient’s own GP (with the patient’s consent) in line with GMC guidance.
• Quality improvement activity, including clinical audit, took place.
• Staff received the appropriate training to carry out their role.

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

• The provider carried out checks to ensure consultations by doctors met the expected service standards.
• Patient feedback reflected that they found the service treated them with dignity and respect.
• Patients had access to information about doctors working at the service.

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

• Overall, information about how to access the service was clear; however, from the information on their website it was not immediately apparent that face to face consultations were only available from a single site.
• The provider did not discriminate against any client group.
• Information about how to complain was available and processes were in place to handle and learn from complaints.

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

• The service had clear leadership and governance structures.
• A range of information was used to monitor and improve the quality and performance of the service.
• Patient information was held securely; however, the provider did not have arrangements in place to ensure that patient records would be stored in line with guidelines should they cease to trade.

The areas where the provider should make improvements are:

• Put in place arrangements in order to store patient records in line with guidance should the service cease to trade.
• Consider routinely enquiring and recording the location of the patient at the beginning of consultations.
• Put in place processes to ensure that arrangements in respect of the use of personal computers are adhered to by all staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice