Letter from the Chief Inspector of General Practice

We previously inspected Pharmacy2U Limited on 14 February 2017. At that time the service was found not to be meeting some areas of the regulations relating to safe, effective or well-led services. The full comprehensive report for that inspection can be found by selecting the ‘all reports’ link for location name on our website at www.cqc.org.uk.

On 18 December 2017, we carried out an announced comprehensive inspection at Pharmacy2U Limited,1 Hawthorn Park, Coal Road, Leeds, West Yorkshire LS14 1PQ, to check that the service was now meeting all the regulations.

Pharmacy2U Limited provides online doctor consultation, treatment and prescribing services relating to a range of medical conditions. Details of the services provided can be accessed via their website www.pharmacy2u.co.uk/onlinedoctor. Pharmacy2U Limited also offers pharmacy and NHS prescription services which are not regulated by the Care Quality Commission.

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 regulations. Specifically:

• Arrangements were in place to safeguard people, including arrangements to check patient identity.
• Prescribing was in line with national guidance, and people were told about the potential risks associated with any medicines used off-label or outside of their licence.
• Suitable numbers of staff were employed and appropriately recruited.
• Risks were assessed and action taken to mitigate any risks identified.

Are services effective?

We found the service was providing an effective service in accordance with the regulations. Specifically:

• Following patient consultations information was appropriately shared with a patient’s own GP in line with consent and GMC guidance.
• Quality improvement activity, including clinical audit, took place.
• Staff received the appropriate training to carry out their role.

Are services caring?

We found the service was providing a caring service in accordance with the regulations. Specifically:

• The provider carried out checks to ensure consultations by GPs met the expected service standards.
• At the end of every consultation patients were asked for their feedback via email.
• The provider used an online external customer satisfaction service to monitor and react to patient feedback.

Are services responsive?

We found the service was providing a responsive service in accordance with the regulations. Specifically:

• Information about how to access the service was clear and the service was available seven days a week via the provider website.
• The provider did not discriminate against any client group.
• Information about how to complain was available and complaints were handled appropriately.

Are services well-led?

We found the service was providing a well-led service in accordance with the regulations. Specifically:

• The service had clear leadership and governance structures
• A range of information was used to monitor and improve the quality and performance of the service.
• Patient information was held securely.

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 Pharmacy2u Limited on 14 February 2017. Pharmacy2u Limited has been established since 1999. The company operates an online clinic for patients providing consultations, prescriptions and medicines. Pharmacy2u Limited contracts GPs on the GMC GP register to work remotely in undertaking patient consultations when they apply for medicines on-line. GPs have the opportunity to ask for additional information not supplied on the patient’s application should they require it.

We found this service provided caring, and responsive services but not safe, effective or well led services in accordance with the relevant regulations.

Our key findings across all the areas we inspected were as follows:

• There were systems in place for recording and learning from significant events or clinical alerts and a form for reporting significant events was in place. No significant events had been recorded to date.
• Systems were in place to protect personal information about patients. Both the company and individual GPs were registered with the Information Commissioner’s Office.
• Staff induction and training was comprehensive and effective. 
• The service managed patients’ applications for medicines in a timely way.
• The provider used an external service (Trustpilot) to measure customer satisfaction; it was rated as 8.9 out of 10 at the time of the inspection based on over 20,000 reviews. Other customer satisfaction surveys were conducted by the provider which demonstrated high levels of satisfaction. Patient survey information showed that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available on the provider’s website. Improvements were made to the quality of care as a result of complaints.
• There was an ethos of continuous improvement and innovation. Staff were encouraged to become involved in making suggestions and attended a number of structured meetings.
• There was a clear leadership structure. The service proactively sought feedback from staff and patients.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Ensure capacity and consent policies make reference to the Mental Capacity Act (MCA) 2005 and clarify staff responsibilities in relation to this. 
• Update medical questionnaires in order to capture all potential relevant information and ensure all are based on current best practice guidance.
• Ensure there is focus on quality improvement and system of audit.
• Ensure medical emergencies procedures and protocols are effective.
• Maintain contracted GPs’ training records.
• Ensure contracted GPs are assessed and appraised for their work within Pharmacy2u Limited.
• Ensure recruitment processes for non-clinical staff include medical fitness declarations.
• Ensure there is an effective patient identification process.

The areas where the provider should make improvement are:

• Update the safeguarding policy to include details of how to escalate concerns to relevant local authorities.
• Strengthen the advice provided to patients around account security.

We have asked the provider to take action and report on what they have done in order to meet the regulations.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

People who used the service understood the care and treatment choices available to them. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We read feedback from people who had used the service. The majority of people had reported high satisfaction levels with the service. The service had received over 8,500 reviews. On average; the overall score for the service based on these reviews was 9.1 out of 10.

People’s needs were assessed and care and treatment was planned and delivered in line with their health needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Appropriate checks were undertaken before staff began work to make sure that they had the relevant experience and skills for the role.

The provider had an effective system to regularly assess and monitor the quality of service that people received.