Teledoctor HQ

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This is the first assessment for this service. This key question has been rated Good.

People were treated with kindness and compassion and described kind, approachable and well-informed staff, who listened to them and explained the processes well. Staff protected their privacy and dignity, and treated them as individuals and supported their preferences, making reasonable adjustments when possible. People had choice in their care and treatment, and were very positive about the post diagnosis psychoeducation sessions provided by people with lived experience. Some patients said that it could take a long time to get through to the service, and some wanted more information about shared care arrangements.

The service supported staff wellbeing and managers had taken action following the results of the most recent staff survey, to ensure that staff had better support and wellbeing opportunities. This included introducing a wellbeing team and champions, improved communication, and reducing staff teams to 8 staff per team.

This service scored 80 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service consistently treated people with kindness, empathy and compassion and respected their privacy and dignity. We observed staff engaging sensitively and positively with patients and carers on an assessment call. Staff demonstrated a strong knowledge and understanding of patients’ individual needs, often with lived experience themselves.

Patients and carers we spoke with were very positive about their experience of the service. They described staff as kind, polite, helpful and knowledgeable, putting them at ease. Parents spoke of particularly good support in helping them to support their children. Post diagnosis, patients spoke exceptionally positively about the neuro-affirmative, psychoeducation sessions provided by people with lived experience of neurodiversity. Patients said they felt they were given time to speak about their experiences, and the process was not rushed. Managers noted the importance of giving people time to talk about their life experiences as an essential part of the service provided.

Staff actively and successfully collected patient feedback. Staff asked for feedback at the end of the assessment and post diagnosis pathway, using an electronic survey. Most recent result for the service indicated an approval rate of 4.5 out of 5. Client feedback consistently indicated that individuals felt safe, respected, and understood. Staff practice was grounded in a neuro-affirming approach, and reports were written to reflect this.

Arrangements were in place to promote patients’ privacy, with relevant information kept securely, and only those staff directly involved in the care pathway given access.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.Staff received training in equality and diversity, so they understood, valued, and celebrated difference.

Patient communication needs were met to enable them to be fully involved in their care.The communication needs of patients was supported with operations and clinical teams working in collaboration to offer support. Patients identified as requiring additional support were passed to the Intake Team and supported in telephone calls to complete pre-assessment forms verbally, through conversation and at a slower pace, to capture information to support the assessment.

Prescribers were able to provide support and advice regarding perimenopause and other issues that patients might need to discuss with their GP. 

Some patients expressed concerns about lack of consistency between prescribers, and delays in getting through to the service. The service had provided additional Frequently Asked Questions to their website, and a direct email address provided for patients to contact the ADHD Medication team.Patients generally fed back that the service made reasonable adjustments for their needs in completing assessments. Patients were keen to have the opportunity of developing a community support group following the post diagnostic groups, and the service was looking at how this could be facilitated safely. Other patients said that they would like the service to provide them with more information about shared care, and to develop more expertise into dual diagnosis. The service advised that it hadclinicians who were highly experienced in dual diagnosis and all clinical staff had access to continuous professional development on topics such as trauma, psychosis, neurodisability, emotionally unstable personality disorder, bipolar and eating disorders. The service had been delivering cross training for clinicians trained in both autism and ADHD.
 
Where patients had queried the assessment outcome due to a non-diagnosis, the service conducted independent clinical reviews led by senior clinicians and when required, by the clinical advisory group.  
 

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients said staff provided good, clear information about the service, and that the website and portals were easy to navigate.

Following diagnosis, patients were offered options for post diagnostic support and treatment, such as psycho-education groups and webinars, ADHD medication and talk therapy with practitioners trained in neurodiversity. Patients were given time to consider the options and chose the ones that best suited their individual needs. Patients who chose not to access post diagnostic support at the time, were able to come back to the service at a later date to access support.

Those having medicines prescribed said staff gave them clear information about side effects and helpful information to inform their choice of medicines.

The service had recently started a post diagnostic support group for young people, as well as having a more longstanding group for parents.

The service listened to and understood people’s needs, views and wishes. Although there were waiting times for assessments, there were three-monthly reviews of people’s needs whilst waiting. The waiting times for assessments were considerably faster than those available on the NHS, and patients described sat op isfaction in using their Right to Choose, in accessing this service. However, being an online only service, if a patient had an immediate need for urgent support, staff would redirect them to local services that could provide this support. Clinicians would assess the current risk and when required, take immediate action to contact local services, while staying in contact via video or telephone call with the patient.

Staff understood how to request welfare checks, make referrals to local Crisis teams, and follow up with the patient’s GP and CMHT and other agencies. The team were supported to consider appropriate actions and make supported onward referrals, with outcomes recorded in the patient record and patients kept informed through telephone calls and in writing.

The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care. Staff reported being supported if they were struggling at work.

A staff survey was sent out by the people’s team every 3 to 6 months anonymising their feedback. The most recent survey results, approximately four months prior to the inspection, showed a decrease in staff satisfaction. Following this feedback, the management team had put in place extra support for staff includingtraining a cross section of staff as mental health first aiders, providing weekly activities such as yoga, online coffee breaks, quizzes and games, as well as increasing the opportunities for in person meet ups in different parts of the country. As part of the company’s commitment to community engagement, staff were offered one days paid leave to engage in volunteer activities each year. Staff teams were reduced to 8 staff per team leader, and there was some reorganisation of the neurodevelopment pathway, including holding joint zoning meetings.

To improve clinician wellbeing, following feedback that some ADHD clinicians were finding it difficult to manage the target of completing 10 ADHD assessments each week, the number was reduced to 7 assessments per week and investment was made in additional tools to support transcribing and report writing.

Staff were offered private medical insurance but had the choice of whether to take this up. The management team noted that the staff team included a significant proportion of neurodivergent people, and that they needed to make reasonable adjustments to working practices accordingly.

Shortly after the inspection, 70% of staff were due to attend an all-staff celebration, with the service shut for 2 business days.