Zava (Health Bridge Ltd)

Updated 21 April 2023

Health Bridge Limited (“The Provider”) launched an online doctor service in 2011. It is registered to provide the following regulated activities: Diagnostic and Screening procedures and Treatment of Disease, Disorder, Injury (TDDI). Zava (Health Bridge Ltd) (“The service”) registered with the Care Quality Commission in 2011 currently trades under the following website names: ‘Zava’ (www.zavamed.com/UK/), www.onlinedoctor.asda.com (on behalf of Asda Stores Limited) and www.onlinedoctor.superdrug.com on behalf of Superdrug Stores PLC (Superdrug). A separate website, www.zavamed.com(Known as “Zava”), provides a service for residents of, other European countries, including Germany, France and Ireland. Zava Germany, Zava France and Zava Ireland were not inspected as part of this inspection.

The Superdrug online doctor service is available for use by UK residents. The service operates the website, on behalf of customers of Superdrug. Its clinical and customer services staff are responsible for handling the treatment requests from patients whilst the dispensing and dispatching of medicines is undertaken by Superdrug.

The Asda online doctor service is available for use by UK residents. The service operates the website, on behalf of customers of Asda. Its clinical and customer services staff are responsible for handling the treatment requests from patients whilst the dispensing and dispatching of medicines is undertaken by Asda. The Asda online doctor service is open for consultations Monday to Saturday 9am to 5pm and Sunday 10am to 4pm. Patients can access the website, message the service and submit requests 24 hours a day, seven days a week.

The service is open for consultations, for Zava and Superdrug between 9am and 6pm on weekdays 9am to 5pm on Saturdays and 10am to 4pm on Sundays. Patients can access the website, message the service and submit requests 24 hours a day, seven days a week .

It is not an emergency service.

Patients are required to complete a general medical questionnaire to register with the service. Thereafter, for each consultation a patient selects a preferred treatment available on the service’s website after completing the appropriate questionnaire. The provider carries out asynchronous text-based consultations, which do not take place in real time.

The choice of treatments available include: erectile dysfunction; premature ejaculation; hair loss; contraceptive pill; emergency contraception (morning after pill); cystitis; period delay; bacterial vaginosis; female facial hair; rosacea; cold sore; migraine; traveller’s diarrhoea; hay fever; blood pressure; asthma; diabetes; acne; smoking cessation; anti-malaria; genital herpes and genital warts; and jet lag. The service also offers a limited range of tests, including tests for: HIV; Hepatitis; Syphilis; Gonorrhoea; and Chlamydia.

Once a patient had completed and submitted a request, the doctors review the completed questionnaire and determine the appropriateness of the treatment for the patient. Doctors contact patients where necessary to clarify answers given. If the doctor assesses the patient request to be clinically appropriate, they approve the request and the patient will receive the treatment. Alternatively, the doctor can request further information from the patient via their online patient record or by telephone. If the doctor decides not to prescribe a requested medicine, the patient is sent a message to their secure patient account stating the order will not be fulfilled and a refund is processed.

The cost of the service for patients includes the price of the medicine ordered in the UK. Patients can choose to have the prescription sent to their preferred pharmacy.

How we inspected this service

Before the inspection we gathered and reviewed information from the provider. We also reviewed information held by the CQC on our internal systems. We carried out a site visit and spoke with the provider.

We reviewed the provider’s governance policies and looked at forty sets of healthcare records of patients using the service.

To get to the heart of patients’ experiences of care and treatment, we always 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.

Updated 21 April 2023

This service is rated as Good overall. (We previously inspected this service in April 2019 at which time the service was rated good overall and for all key questions).

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 carried out an announced comprehensive inspection at Zava (Health Bridge Ltd) on 23 January and 14 February 2023 as part of our inspection programme.

The Medical Director is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• The service had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.
• There were effective protocols for verifying the identity of patients.
• The provider assessed needs and delivered care in line with relevant and current evidence-based guidance and standards.
• All staff were appropriately qualified. The provider had an induction programme for all newly appointed staff.
• The service gave patients timely support and information.
• Staff communicated with people in a way that they could understand.
• The provider understood the needs of their patients and improved services in response to those needs.
• Information about how to make a complaint or raise concerns was available.
• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.
• Leaders at all levels were visible and approachable. They worked closely with staff and others to make sure they prioritised compassionate and inclusive leadership.
• The service only prescribed unlicensed medicines against valid special clinical needs of an individual patient and where there was no suitable licensed medicine available.

We saw the following areas of outstanding practice:

• Since 2011 the service had provided anyone who had created an account with the facility to ask health-related questions.
  • Patients were not required to pay to access the messaging advice service. Nor were they required to have ever requested a paid service.
  • Doctors working for the service responded to the questions within a maximum of 24 hours, and often much sooner.
  • A recent audit found 36% of messages received were requests for free advice. Ten per cent of these messages were not related to prior paid services.
• During the Covid-19 pandemic (the pandemic), the service, in partnership with the Royal College of Physicians (RCP), developed a free online learning resource to support those adapting to remote consultations during the pandemic.
  • The resource covered a range of information to support clinicians in understanding:
    • What is digital healthcare?
    • When is it appropriate to consider remote care?
    • Types of digital healthcare.
    • Logistics and setting up remote access.
    • The key differences between face-to face and digital consultations?
    • Learning and support in a remote setting
  • The resource remained accessible via the RCP and YouTube. At the time of inspection the resource accessible via YouTube information had been viewed over 4200 times.

The areas where the provider should make improvements are:

• Ensure that clinicians seek corroborating monitoring evidence, such as up to date blood test results, when prescribing medicines for long-term conditions.
• Ensure that recommendations relating to risks identified in legionella risk assessments are addressed in a timely way.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services