Archived: Freedomhealth Limited

Updated 27 March 2018

We carried out this comprehensive inspection combined with a follow up inspection of the inline service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC inspected the online service on 23 August 2017, we issued a requirement notice under the following regulations:

Regulation 12: Safe care and treatment

Regulation 17: Good governance

We asked the provider to make improvements regarding; ensuring that care and treatment was delivered in accordance with evidence based guidelines and ensuring that patient records were complete and accurate. We checked these areas as part of this combined follow up inspection of the online service and comprehensive inspection and found these concerns had been resolved. The online service had redesigned their system including developing patient questionnaires so that it now captured all communication between patient and clinician and now included an area for clinical notes. A significant change was the on-line service now required patients’ consent to providing GP details (specifically patients requesting medicine for asthma), failure to provide this information now results in prescriptions not being issued.

Since the last follow up online inspection in August 2017 Freedomhealth Limited had suspended their online service. However, since October 2017 they had started this up again and had updated their online systems and processes. The online service had been moved from www.freedomhealthonline.co.uk to www.co-operativeonlinedoctor.co.uk where patients could place orders for medicines seven days a week. However, orders would only be processed Monday to Friday 9am to 4pm, with a four hour processing time frame.

The service is available for patients in the UK only, aged over 18 years. Patients can access the service by email from 9am to 5pm, Monday to Friday. This is not an emergency service. Subscribers to the service pay for their medicines when making their on-line application.

Our inspection team was led by a CQC Lead Inspector and included a GP specialist adviser, a second CQC inspector and a member of the CQC medicines team.

Before visiting, we reviewed a range of information we hold about the service and asked other organisations to share what they knew. During our visit we:

• Spoke with staff including the service director and GP, the pharmacist advisor, service manager and reception staff.
• Reviewed a sample of the personal care or treatment records of patients.
• Reviewed service policies, procedures and other relevant documentation.
• Inspected the premises and equipment in use.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 27 March 2018

We carried out an announced comprehensive inspection on 8 December 2017 of the face to face private medical service at Freedomhealth Limited. We also followed up the inspection of the online service at Freedomhealth Limited, which we previously inspected on 23 August 2017. The report of the 23 August 2017 inspection can be found by selecting the ‘all services’ link for Freedomhealth Limited on our website at www.cqc.org.uk

At our previous inspection of the online service on 23 August 2017 we found the provider had not ensured that care and treatment was delivered in accordance with evidence based guidelines and the provider had not ensured that patient records were complete and accurate. We issued a requirement notice under the following regulations:

Regulation 12: Safe care and treatment

Regulation 17: Good governance.

At this announced comprehensive inspection, combined with the follow up inspection of the online services, on 8 December 2017 we found the service had addressed the issues identified at the last inspection. We asked the service the following key questions; Are services safe, effective, caring, responsive and well-led?

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.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Freedomhealth Limited provides private GP services from its location at 60 Harley Street, London, W1G 7HA, as well as an online service providing patients with prescriptions for medicines that they can obtain from the affiliated registered pharmacy. The online service is provided by a separate company Midcounties Co-operative. The GP working for the online service also works in the service as the director. The GP provides private general practice, specialist sexual health services and cosmetic treatments which are available to any fee paying patient. The service is operated by one GP supported by a service manager and reception staff.

The private GP service is open Monday to Thursday from 8.30am until 6.30pm and Friday 8.30am to 5.30pm. The service is not open on the weekend and does not offer out of hours services.

Freedomhealth Limited was originally established in 1997, and has evolved to provide an online service (since 2011) that allows patients to request prescriptions through a website (the online service). Patients are able to register with the website, select a condition they would like treatment for and complete a consultation form which is then reviewed by a GP and a prescription is issued if appropriate. Once the consultation form has been reviewed and approved, a private prescription for the appropriate medicine is issued. This is sent to the affiliated pharmacy before being dispensed, packed and sent to the patient by secure post (the pharmacy is regulated by the General Pharmaceutical Council and does not form part of this inspection).

The service has a registered manager, a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service is registered with the Care Quality Commission (CQC) to provide the regulated activities treatment of disease, disorder or injury, diagnostic and screening procedures and family planning.

CQC inspected the online service on 23 August 2017, we issued a requirement notice under the following regulations:

Regulation 12: Safe care and treatment

Regulation 17: Good governance

We asked the provider to make improvements regarding; ensuring that care and treatment was delivered in accordance with evidence based guidelines and ensuring that patient records were complete and accurate. We checked these areas as part of this combined follow up online inspection of the online service and comprehensive inspection of the face to face service and found these concerns had been resolved. The online service had redesigned their system including developing patient questionnaires so that they captured all communication between patient and clinician and included an area for clinical notes. The service now required patients’ consent to providing GP details (specifically patients requesting medicine for asthma), failure to provide this information now resulted in prescriptions not being issued.

As part of our inspection we also asked for CQC comment cards to be completed by patients prior to our inspection. We received 49 comment cards which were all positive about the standard of care received.

Our key findings were:

• The provider had a clear vision to deliver high quality care for patients.
• The provider had updated their online website so that it verified patients’ identity.
• The clinical records relating to the online service now had facilities that enabled an audit trail.
• The provider had updated the questionnaire used to obtain patient information for the online service.
• The service shared information about treatment with the patient’s own GP with their consent, for example, the provider’s online service would only prescribe medicines for asthma if the patient had provided their GP details.
• There were systems and processes in place for reporting and recording significant events and sharing lessons to make sure action could be taken to improve safety in the practice.
• The service had clearly defined systems, processes and practices to minimise risks to patient safety.
• Staff had the skills and knowledge to deliver effective care and treatment.
• Staff sought and recorded patients’ consent to care and treatment in line with legislation and guidance.
• The service had systems and processes in place to ensure that patients were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The service had systems in place to collect and analyse feedback from patients.

There were areas where the provider could make improvements and should:

• Review how patients with hearing impairments and whose first language is not English are supported.
• Review online patient questionnaires and patient ID checking to ensure they continue to follow best guidance.
• Review quality improvement initiatives which may include completed clinical audits.
• Review the arrangements for treating emergencies following a risk assessment.