Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Expert Health Limited on 17 May 2017.

Expert Health Limited provides an online primary care consultation service and medicines ordering service. Patients register for the service on the provider’s website which uses the trading name Lloyds Pharmacy Online Doctor.

We found this service provided safe, effective, caring, and responsive and well led services in accordance with the relevant regulations.

Our key findings were:

• The service had clear systems to keep people safe and safeguarded from abuse.
• There was a comprehensive system in place to check the patient’s identity. Checks included, systems that identified duplicate patients, similar names or addresses, gender name checks, payment card checks and IP addresses to ensure the patient was UK based; and requested photographic evidence where necessary.
• There were systems in place to mitigate safety risks including analysing and learning from significant events and safeguarding.
• There were appropriate recruitment checks and induction programmes in place for all staff. A new system was being introduced to improve access and management oversight of HR records.
• Prescribing was monitored to prevent any misuse of the service by patients and to ensure GPs and the independent prescribing pharmacist were prescribing appropriately.
• There were systems to ensure staff had the information they needed to deliver safe care and treatment to patients.
• The service learned and made improvements when things went wrong. The provider was aware of and complied with the requirements of the Duty of Candour.
• Patients were treated in line with best practice guidance and appropriate medical records were maintained. Prescribers from the service met with local specialists on a regular basis to maintain knowledge and skills.
• The service had a programme of ongoing quality improvement activity, which included clinical and non-clinical audit.
• Consultation templates had been reviewed by internal and external GPs to ensure quality and consistency.
• The service shared information about treatment with the patient’s own GP, however, this was not always in line with General Medical Council guidance. The service responded immediately when this was raised and ensured improved processes were put into place.
• Improvements were made to the quality of care as a result of complaints.There was a clear business strategy and plans in place.
• Staff we spoke with were aware of the organisational ethos and philosophy and told us they felt well supported and that they could raise any concerns.
• There were clinical governance systems and processes in place to ensure the quality of service provision.
• The service encouraged and acted on feedback from both patients and staff.
• Systems were in place to protect personal information about patients. Both the company and individual GPs were registered with the Information Commissioner’s Office.

The areas where the provider should make improvements are:

• Ensure oversight of HR systems and processes are effectively implemented and maintained.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

People using the service were invited to give their feedback using various independent companies. There was a high level of satisfaction with the service, particularly for the speed, efficiency and confidentiality of the service. An example was "I found the whole process efficient and discreet". Overall, people were satisfied with the care and treatment received.

We saw that people were given enough information about the service and were involved in making decisions about what care and treatment they would receive. Medical histories were taken for each person and the doctors could seek more information prior to prescribing.

The service had systems in place to ensure that people were protected from the risk of abuse. Staff received suitable training, supervision and appraisal. There was evidence that there was an effective process to review and monitor the quality and safety of the service provided.