We carried out an announced comprehensive inspection of Now GP on 14 June 2017. Now GP provides an online service for patients, via a smartphone application (app). This allows patients access to online video consultations and healthcare advice with a GP. All prescribed medicines are dispensed to patients from either an affiliated or third party pharmacy (which we do not regulate).

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

Our key findings were:

• All clinicians were qualified GPs (general practitioners) who were registered with the General Medical Council (GMC). Patients could access a brief description of the clinicians available and had the choice of a male or female GP.
• There were appropriate recruitment checks and induction programmes in place for all staff. GPs registered with the service received specific induction training and a GP handbook prior to treating patients. All the staff had access to all policies.
• There were comprehensive systems in place to check the patient’s identity and to protect personal information about patients.
• The service had clear systems to keep people safe and safeguarded from abuse.
• There were systems to ensure staff had the information they needed to deliver safe care and treatment to patients. Patients were treated in line with best practice guidance and appropriate medical records were maintained.
• With the patient’s consent, the service shared information about treatment with the patient’s own GP in line with the GMC and the provider’s guidance.
• A range of medicines were prescribed in line with the provider’s medicine formulary (a list of medicines GPs can prescribe from). Prescribing was monitored to prevent any misuse of the service by patients and to ensure GPs were prescribing appropriately.
• There were systems in place to mitigate safety risks including analysing and learning from significant events and safeguarding.
• 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.
• There were clinical governance systems and processes in place to ensure the quality of service provision.
• The service had a programme of ongoing quality improvement activity, which included regular reviews of consultations.
• There were clear business strategy and future development plans in place.
• The service encouraged and acted on feedback from both patients and staff.
• Survey information we reviewed showed that patients said they were satisfied with the care, treatment and service they received.
• 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.
• Both the company and individual GPs were registered with the Information Commissioner’s Office.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This inspection was undertaken as part of the Independent Health pilot to test out the Care Quality Commission’s methodology. At the inspection it became clear that we needed to focus specifically on the appropriateness of the methodology in relation to these new types of service i.e. digital health care providers. As a result of this we have used the learning from the initial pilot to further refine the methodology for digital health providers, hence the decision to undertake the inspection of Now GP (also known as Dr Now) on two separate occasions.

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Our key findings were:

• Appointment availability was good. Patients could access a brief description of the GPs available. Patients could choose either a male or female GP or one that spoke a specific language or had a specific interest.
• There were recruitment checks in place for all GPs and the provider stipulated GPs had to also be working within the NHS and have a minimum qualification of MRCGP.
• GPs registered with the service had to receive specific induction training prior to treating patients. GPs also received access to all policies, handbooks on how the IT system worked; the consultation process and a newsletter when any changes were made. GPs told us they received excellent support if there were any technical issues or clinical queries.
• There were systems in place to mitigate safety risks including analysing significant events and safeguarding.
• Systems were in place to protect personal information about patients. Both the company and individual GPs were registered with the Information Commissioner’s Office.
• Patients were treated in line with best practice guidance and appropriate medical records were maintained. Prescribing was monitored to prevent any misuse of the system by patients and to ensure GPs were prescribing appropriately.
• 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 with the provider or the manager.
• There were clinical governance systems and processes in place to ensure the quality of service provision including, the use of consultation and prescribing audits, random spot checks, weekly monitoring reports and meetings.

• Patients could rate the service they received. This was constantly monitored and if fell below the provider’s standards, this would trigger a review of the consultation to address any shortfalls. In addition, patients were emailed at the end of each consultation with a link to a survey they could complete or could also post any comments or suggestions online.