Teledoctor HQ

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

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

The service was exceptionally responsive to people’s feedback. People spoke very highly about how they were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. We found that the service was proactive at looking at solutions to issues raised by patients and staff, and worked creatively to bring about improvements to the service. The service had just started a young person’s post diagnostic group following feedback from young people, in addition to the parental support provided. The service was also looking at ways to create safe access to a community for people diagnosed with autism or ADHD.

The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. The service had shortened the time people waited for assessment by 70%. The service worked to reduce health and care inequalities through training and feedback. People were involved in planning their care. Managers had plans to develop a post diagnostic support group for people who did not receive a diagnosis of ADHD or autism but had some neurodiverse traits.

This service scored 89 (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 had taken clear steps to ensure that people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. The service’s flexible, person-centred approach demonstrated a commitment to inclusivity and responsiveness, particularly for clients with complex needs or communication barriers.
 

A review of clinical records showed patients were consistently supported to understand their condition and were involved in planning for their care needs. Patients we spoke with confirmed that they were involved in decisions about their care.

The service had a team that assisted people to fill out the forms required for assessments. They were able to be flexible about appointments to avoid religious or cultural commitments. Amongst the staff team there were approximately 13 different languages available for people who did not speak English as a first language. As part of the service’s reasonable adjustments approach, they offered interpretation and translation services where clinically appropriate. In exceptional cases, where remote assessment may compromise the validity or effectiveness of the diagnostic
process, they arranged in-person, face-to-face assessments demonstrating that they prioritised clinical need and client outcomes.

The service had recently completed a review of and proposal for how to improve the offer of reasonable adjustments to support clients. Staff could offer gender preference for therapists and assessors and could lengthen consultations if necessary.

Staff noted that since the right to choose initiative, they were seeing more complex clients, who needed more support, which they would facilitate through the multidisciplinary team processes.

The service was looking at improving screening patient referrals to the service, to identify some of the complex cases who were not suitable for an online only service.

The service hosted regular ‘Spotlight Sessions’ open to all staff, aligned with national awareness events such as Pride and Men’s Mental Health Month. These sessions were designed to deepen understanding of broader social and cultural issues, while exploring how neurodiversity intersects with them. Many of the spotlight sessions were led by individuals with lived experience of
neurodevelopmental conditions, offering valuable first-hand perspectives and fostering a more inclusive, reflective workforce.

The service had an exceptional understanding of the diverse health and care needs of neurodiverse people. Care was joined-up, flexible and supported choice and continuity.

The service was seeing approximately 25,000 neurodiverse clients each year, of which 23,000 were for assessments, approximately 1900 per month. Following the February 2024 roll out of Right to Choose for adults, and February 2025 launch of Right to Choose for children, staff were aware of the service’s increased waiting times for assessments. There was a significant growth in people presenting with neurodiverse needs and the service was addressing this with 12-week screening of all patients waiting for assessment.

Services were provided online between 9am and 5.30pm, but staff would provide appointments out of hours when possible. At the time of the inspection, the service did not have guaranteed services out of hours but clinicians were happy to work overtime, so there were instances when slots were available.

Services were funded by NHS direct funding of a block contract and through the Right to Choose, as well as through insurers and universities. The Right to Choose contract included post diagnosis support, and prescription of medicines when needed.

The service had thought carefully about how to develop appropriate, accurate and up-to-date information in formats that were tailored to individual needs and their patient group.

The service had actively recruited individuals with lived experience of neurodevelopmental conditions to help design and improve their website content and user experience. Their insights were instrumental in ensuring communications were accessible, inclusive, and a better reflective of the needs of the neurodivergent community.

All staff were located in the UK, and all data was kept in the UK. The service was registered with the information commissioner’s office as appropriate.

The service had access to interpreter services, including British Sign Language. Information provided by the service met the Accessible Information Standard. Patients were informed as to how to access their personal records.

The service’s electronic records system was locked down, so that only appropriate staff could access specific patient information. Video calls used for assessments and other consultations were not recorded.

The service enabled people to share feedback and ideas, or raise complaints about their care, treatment and support. They always involved people in decisions about their care and told them what had changed as a result.

The service received approximately 50 complaints/concerns each month, which was about 0.2% of active clients. Most common causes of complaints included delays to reports (especially ADHD) of over 4 weeks, communication about appointments, and delays in call answering and email responding (taking 24-48 hours), and delays or lost prescriptions for ADHD medicines.

We saw that complaints were managed in line with the service’s policy. Learning from complaints was evident and staff were able to identify changes made as a result of patient feedback, including complaints.

Plans to address delayed ADHD reports included changes to the team leader and clinical lead structures, a new, more efficient report writing solution, and tracking overdue reports and bottlenecks by the senior leadership team.

Where there were complaints about individual clinicians, increased monitoring of their work including shadowing appointments was undertaken.

Management were aware of areas for improvement and had plans to automate manual tasks which were subject to error, and further improvement of the service’s technology systems. Managers were proud of the service’s ability to make changes responsively, and encouraged staff to make suggestions for improvement.

They noted that 50% of complaints to the service came from patients who had received a negative diagnosis following assessment. The service was looking at how to provide more support for people in this category who might have some areas of neurodiversity although not sufficient for a full diagnosis.

The service ensured people could access the care, support and treatment they needed when they needed it. Average waiting times were 20-24 weeks for an ADHD assessment, 25-30 weeks for an autism assessment and 16-20 weeks for medication assessments (following ADHD diagnosis). This information was made available on the service’ website, and updated monthly, and also shared with an ADHD charity. It was defined as the waiting time from the point at which the service had been provided with all the information needed to complete an assessment or consultation.

The service employed BSL assessors, had 13 different languages amongst its staff as well as using an online interpretation service. They were able to provide out of hours assessment slots, and accommodate preferences for male or female assessors. They were collecting data about patients’ mental health conditions, but noted that many patients preferred not to provide this information.

The service did not offer private assessments to clients, patients needed to access it through referral by their GP, Right to Choose, or insurance arrangements. However, if patients were receiving talk therapy, and funding stopped, they were able to continue receiving this as a self-paid service.

The service did not provide crisis or out of hours arrangements, with patients directed to contact emergency services when needed. They endeavoured to make reasonable adjustments for patients, providing longer appointments, or adjusting the format of appointments to meet people’s needs. Management were aware that some patients might be excluded due to lack of access to IT, and were working on ways to address this. In Northern Ireland, they were looking at the possibility of providing some face-to-face assessments.

A core part of the service was to ensure that all patients attending for assessment had access to post treatment support including medication, talk therapy and psychoeducation.

Following a policy change by Health and Social Care Northern Ireland (HSCNI) patients who had a neurodevelopmental diagnosis made remotely, without an initial medical review, were no longer accepted, impacting on a significant number of the service’s clients who had received diagnoses. The service worked collaboratively with the insurer to address this issue introducing an additional in-person medical review appointment at no extra cost. They have since liaised directly with HSCNI to confirm and discuss their approach so as to better serve their clients.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide tailored care, support and treatment in response to this.

The senior management team looked at barriers to care, support and treatment, and were very aware that online services were not suitable for all clients. They had developed clear suitability criteria for those who are appropriate, especially considered complex cases. They were working hard to recruit more staff, to decrease waiting times and increase the scope of the service.

The service was aware that the most unhappy patients, were those who did not receive a diagnosis, but had some neurodiverse needs. They were looking at ways to improve support to this cohort of patients.

People were given a high level of support to make informed decisions about their future plans and living with their diagnoses. The service was aware that the most unhappy patients, were those who did not receive a diagnosis, but had some neurodiverse needs. They were looking at ways to improve support to this cohort of patients.

The service was working on a three-year plan. They had developed a research department alongside clinical pathway development and planned work with a UK university. They were looking at needs based assessment tools for patients and support for patients up to 5 years after diagnosis, and the normalisation of neurodiversity within society. They were also looking at developing dual pathways, and more complex work such as with patients with other conditions.