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Archived: Doctor Matt Ltd

Inspection Summary


Overall summary & rating

Updated 6 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Doctor Matt Ltd on 10 January 2017. Dr Matt is an online service providing patients with prescriptions for medicines that they can obtain from the affiliated registered pharmacy

We found this service did not provide safe, effective, responsive and well led services in accordance with the relevant regulations.

Our key findings were:

  • Practice policies were available but staff had no awareness of the policies. For example, the adult safeguarding policy.
  • Risks to patients were not appropriately assessed or managed. For example, we found patients being prescribed large quantities of inhalers for the treatment of respiratory disease but there was a lack of monitoring or follow up for these patients whose condition could put them at serious risk of harm.
  • There service did not follow current evidence based guidelines and standards.
  • There was no formal programme in place for quality improvement, for example clinical audits, to assess the service provision including organisational learning from significant events.
  • The service did not have a business continuity plan in place to deal with disruption to the service or staff absence.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • We found that the service was not following their own recruitment policy which stated that all new employees would receive a Disclosure and Barring Service (DBS) check, but we found that some DBS checks were carried over from previous employment.
  • We found that there was no system in place to monitor training, and some staff had not completed training relevant to their role.
  • Some patients were not treated in line with best practice guidance.
  • Information about services and how to complain was available.
  • 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 must make improvements are:

  • Ensure there are robust governance arrangements in place that includes a programme of quality improvement and that practice policies, such as the recruitment policy, are followed.
  • Ensure that questionnaires completed by the patient are fully assessed.
  • Ensure there is a system in place for receiving and acting upon medical and patient safety alerts.
  • Ensure that patient records are complete and accurate and that care and treatment is delivered in accordance with evidence based guidelines.
  • Ensure consent and capacity is adequately assessed, and the identity of a patient is confirmed to ensure the people receiving the medicines are over the age of 18.
  • Ensure medical indemnity is in place for clinicians working for the service.
  • The service must have a system in place to manage medical emergencies should they arise while a patient is accessing the service.
  • Ensure all staff have completed safeguarding training.

The areas where the provider should make improvements are:

  • Consider documenting team meetings to ensure learning is disseminated.
  • Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available

We have suspended the registration of this provider for six month until 29 June 2017 in order to protect patients.

Inspection areas

Safe

Updated 6 April 2017

We found that this service was not providing safe care in accordance with the relevant regulations.

  • There was a system in place for assessing a patient’s identity but this was not effective. Prescribing and analysing patient questionnaires were not consistently monitored and there was no system in place for clinical peer review or support.
  • The clinician had received safeguarding training relevant to their role, but non clinical staff had not completed any safeguarding training.
  • We found examples of unsafe care where national guidance had not been followed. Patients were being prescribed medicines that required follow up and regular monitoring, which was not happening.
  • There were systems in place to protect all patient information and ensure records were stored securely. The service was registered with the Information Commissioner’s Office.
  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, there was no system in place to confirm patients’ medical history and previous prescribing decisions for prescribing medicines, and no system for managing medical safety alerts.
  • There was no process in place for managing emergencies, should they develop while a patient was accessing the service.

Effective

Updated 6 April 2017

We found that this service was not providing effective care in accordance with the relevant regulations.

  • The service had ineffective systems in place to verify a patient identity. This meant that there was a risk to minors accessing medicines and decisions could be made on false information.
  • Consent to care and treatment was not sought in line with the Mental Capacity Act 2005, there was no provider policy relating to capacity and consent.
  • We were told that each GP assessed patients’ needs but there was evidence that care was not in line with relevant and current evidence based guidance and standards, such as the National Institute for Health and Care Excellence (NICE) best practice guidelines. We reviewed a sample of anonymised patient records that demonstrated inconsistent record keeping.
  • The service did not have arrangements in place to coordinate care and share information appropriately.
  • If the provider could not respond with the patient’s request, this was not adequately explained to the patient but a refund was issued.
  • There were induction, and appraisal arrangements in place for staff but not all staff had received training relevant to their role. For example, some non-clinical staff had not received any safeguarding training.

Caring

Updated 6 April 2017

We found that this service was providing caring care in accordance with the relevant regulations.

  • Systems were in place to ensure that all patient information was stored and kept confidential.
  • We did not speak to patients directly on the days of the inspection but we did review feedback data left on Feefo (an online feedback website) which showed that patients responded positively to the service.

Responsive

Updated 6 April 2017

We found that this service was providing responsive care in accordance with the relevant regulations.

  • There was information available to patients to demonstrate how the service operated.
  • Patients registered on the provider’s website could access a variety of medicines by completing a questionnaire designed to assist the GP in making a decision if a prescription should be issued. Patients could also access other medicines not listed on the website by entering in a ‘free chat’ system with the GP. The website was accessible 24 hours a day.
  • Patients could access a brief description of the clinicians available but at the time of the inspection, there was only one clinician working at the service.

Well-led

Updated 6 April 2017

We found that this service was not providing well-led care in accordance with the relevant regulations.

  • The provider told us they had a clear vision to provide an accessible and responsive service. However, our inspection found that systems and processes to govern activity were not effective.
  • During the inspection the provider of the service failed to demonstrate they had the experience, capacity and capability to run the service and ensure high quality care.
  • Practice policies were available but staff had no awareness that they existed.
  • There was no formal system in place for quality improvement of the service. For example, clinical audit.
  • Staff told us that team meetings took place but as they were not minuted we were unable to find evidence of this.

  • There was a management structure in place and the staff we spoke with understood their responsibilities.
  • The service encouraged patient feedback. There was evidence that staff would respond directly to feedback left by patients.