We carried out an announced focused inspection at Antrobus Medical Limited on 9 January 2018 to follow up on breaches of regulations found during the previous inspection.

We previously inspected Antrobus Medical Limited on 11 May 2017. The full comprehensive report of this inspection can be found by selecting the ‘all services’ link for location name on our website at www.cqc.org.uk.

Antrobus Medical Limited operates an online consultation and prescription service, through the website www.webmedpharmacy.co.uk, which specialises in treatment of conditions primarily concerning sexual health. A medical questionnaire is completed by each patient and a doctor can seek more information prior to prescribing by using a secure messaging system.

Our findings in relation to the key questions were as follows:

Are services safe? – We found the service was providing a safe service in accordance with the relevant regulations. Specifically:

• A new system was in place where upon registering with the service, patient identity was verified; this was being undertaken for patients returning to the service and requiring a consultation, where they had previously not been required to prove their identity, as well as for new patients. On further consultations, a secondary check was conducted to confirm the identity of the patient if a prescription was issued.
• Conversations regarding patients were now completed through the internal messaging system and automatically recorded in the patients’ notes so they could be reviewed if necessary.

Are services effective? - We found the service was providing an effective service in accordance with the relevant regulations. Specifically:

• When a patient contacted the service, they were asked if the details of their consultation could be shared with their registered GP. If patients agreed, we were told that a letter was sent to their registered GP in line with GMC guidance. If they did not consent then a letter was dispatched with the medicines, which the patient could give to their GP.
• An automated solution had been initiated to ensure patients who had two separate records were flagged and the patient contacted to amalgamate the records into their preferred account.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Abney Hall, Suite 11 on 11 May 2017.

Antrobus medical limited operates an online consultation and prescription service through the website www.webmedpharmacy.co.uk which specialises in treatment of conditions primarily concerning sexual health. A medical questionnaire is completed by each patient and a doctor can seek more information prior to prescribing by using a secure messaging system.

Overall, we found this service provided caring, and responsive and well led services in accordance with the relevant regulations; however, we identified some areas relating to the safe and effective provision of services where the provider must make improvements.

Our key findings were:

• The service did not have arrangements in place to coordinate care and share information appropriately. Patients’ registered GPs were not directly informed when a prescription was issued for a non-sexual health condition.
• We saw that the computer system allowed patients to have more than one account and accounts were not automatically linked which meant that a prescriber may not have a full list of an individual’s treatment. The provider told us that a manual search had been conducted and they were investigating an automatic electronic solution to this.
• We saw that not all conversations regarding a patient were recorded within the clinical records which meant that a full record of the reasoning for decisions made may not be available to all clinicians treating an individual.
• On registering with the service, patient identity was checked through a basic credit card check. However this would not enable them to fully confirm whether the patient is who they said they were, whether they were male or female and over the age of 18.
• There were systems in place to mitigate safety risks including analysing and learning from significant events and safeguarding.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• There were appropriate procedures in place in relation to the recruitment of staff, and these were followed.
• An induction programme was in place for all staff and GPs registered with the service received specific induction training prior to treating patients. Staff, including GPs working remotely, also had access to all policies.
• Patients were treated in line with best practice guidance and appropriate medical records were maintained.
• Information about services and how to complain was available. We found the systems and processes in place to manage and investigate complaints were effective.
• Patient feedback and consultation records we viewed showed that patients were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There were no formal business plans although the provider discussed the plans for the next two years with us, which included scaling up the current business.
• The service encouraged and acted on feedback from both patients and staff.

We identified regulations that were not being met (please see the requirement notices at the end of this report). The areas where the provider must make improvements are:

• Ensure arrangements are put in place to verify that the identity of each patient is known prior to clinical advice or treatment being provided.
• Ensure that all conversations regarding a patient are recorded in the clinical record.

We identified areas where the provider should make improvements:

• The service should obtain GP details to facilitate information sharing if a safeguarding concern was identified or to allow information sharing in line with GMC guidance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice