Letter from the Chief Inspector of General Practice
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? – Outstanding
We previously inspected Push Dr Limited in February 2017, August 2017 and April 2018. The full comprehensive reports for these inspections can be found by selecting the ‘all services’ link for Push Dr Limited on our website at www.cqc.org.uk.
We carried out an announced comprehensive inspection at Push Dr on 13 May 2019. The purpose of this inspection was to follow up the requirement notice we issued following our last inspection undertaken in April 2018; and in accordance with our updated methodology to inspect all key questions and provide a quality rating.
This inspection identified that Push Dr had implemented action to meet the requirement notice issued at the previous inspection for regulation 12 Safe care and treatment. Systems to monitor antibiotic prescribing and prescribing practice in accordance with national guidelines were safe and effective.
Push Dr are an online (digital) GP service that offers private appointments to patients through the use of a software application on either a smart phone, tablet or laptop computer. The software allows the patient and GP to have a face to face video consultation. This is a fee based service, which is available in England. Consultations are available to adults and children following identity verification.
Push Dr also has a contract with a very large GP practice partnership (Modality Partnership) and provides NHS appointments via video to patients registered with this GP practice.
At this inspection we found:
- The Push Dr leadership team were a driving force, united in their commitment to deliver and prioritise safe care to private and NHS patients. They effectively used the skills and abilities of their staff team to provide innovative and accessible care, treatment and support to their patients.
- The service’s underpinning ethos was that patient safety was central to all its activities. It strived to ensure care and treatment was delivered according to evidence- based guidelines.
- The service had clearly defined and embedded systems to minimise risks to patient safety. A comprehensive quality improvement strategy effectively monitored the service provided to assure safety and patient satisfaction.
- Staff demonstrated commitment and engagement with the vision for the service. They were proud to work for the organisation.
- Patient satisfaction with the service they received was monitored and action taken to ensure a safe effective service was provided.
- There was a commitment and appetite to work with external partners including the NHS and the third sector to make the service as accessible as possible.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
We saw two areas of outstanding practice:
- The culture of the service was underpinned with the ethos ‘patient safety first’. The leadership team facilitated this culture by investing in staff training and development, encouraging team work and innovation, listening to patient feedback and implementing a continuous quality improvement audit programme.
- Comprehensive systems for the monitoring of service delivery were established, with 10% of all GP consultations reviewed monthly. Where areas for development and improvement were identified this was shared with the GP and they were asked to reflect on the issues and directed to additional training as required. The GPs really valued this for their professional development as well as service improvement.
The areas where the provider should make improvements are:
- Continue to encourage the evidence-based prescribing of antibiotics to improve antimicrobial stewardship
- Review the information supplied to patients when medicines are prescribed ‘off-label’.
- Implement the planned improvement strategy identified at inspection, including the referral review and pathway.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care