Archived: Online services

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