Archived: Yakub Chemist Limited

We carried out an announced comprehensive inspection at Yakub Chemist Limited on 10 April 2017, during which we found that the service was not providing safe, effective or well-led services. However, we found that they were providing caring and responsive services in accordance with the relevant regulations.

Following our April 2017 inspection we issued two warning notices under Section 29 of the Health and Social Care Act 2008 which required the provider to become compliant by 28 August 2017. We issued one on 24 April 2017 in relation to breaches of Regulation 17 Good Governance and one on 28 July 2017 for breaches of Regulation 12 Safe Care and Treatment. The full comprehensive report on the 10 April 2017 inspection can be found by selecting the ‘all reports’ link for Yakub Chemist Limited on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 and 11 September 2017. This was to check whether the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in April 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were:

• The provider was still not providing safe, effective or well-led services.
• The provider had not actioned the majority of concerns identified during the last inspection.
• Care was still not being delivered in line with current evidence based guidance. Policies did not reflect current guidance and medical questionnaires that patients completed did not reflect the policies.
• There was no evidence of effective clinical oversight.
• Identification checks were not taking place routinely, nor were they completed when patient and cardholder details did not match. We saw evidence that identity checks had only been performed on nine patients since June 2017.
• Prescribing was still not monitored to ensure it was safe and in line with remote prescribing guidance.
• The provider was unable to demonstrate that medicine safety alerts issued by the MHRA or NICE guidance were acted upon or distributed to staff.
• The safeguarding policy was not specific to an online environment, did not reflect national current guidance and did not include sufficient information to protect patients.

• We were told that if a patient consented to their information being shared with their GP the provider would share the information appropriately; however, we reviewed evidence and found that information had not been shared with any GPs since April 2017. There were over 400 patient contacts that should have been shared with GPs. The administrator told us that this was a back log to be completed. The clinician was not aware of this and told us that the provider shared information with the patients GP immediately.

• The provider did not have an effective business continuity plan in place to provide a safe and effective service should the sole clinician or the information technology staff member be absent. This meant that if there was an alert or a patient safety incident when this staff member was unavailable, the provider would not be able to identify any patients at risk or take appropriate action.
• Following our previous inspection the provider had forwarded an action plan. This documented all the concerns from the warning notices previously issued and all but one of the actions required had been marked as complete. Evidence on the day of the inspection showed that this was not the case and that the provider did not have the understanding of the actions that they were required to take in relation to the breaches identified.

We identified regulations that were not being met and the provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We have taken urgent action in response to the concerns identified at Online Clinic (UK) Limited; we have suspended the provider’s registration until 13 January 2018.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Yakub Chemist Limited on 10 April 2017. Yakub Chemist Ltd is an online service that allows patients to request treatment for a specific condition through the website www.medicines2u.com; this request is reviewed by a GP who then prescribes a medicine to treat the condition. This medicine is dispensed by a third party pharmacy and delivered by an external courier service. Medicines were dispatched through an affiliated pharmacy.

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

Our key findings were:

• Patients accessed the service through a website and were able to select treatment for a variety of conditions that included asthma, diabetes, erectile dysfunction and sexual health.
• We found systems were in place to protect personal information about patients but information being sent to the GP working for the service was not secure. Both the company and individual GPs were registered with the Information Commissioner’s Office.
• There was a policy in place to check the patient’s identification but this was only done under certain circumstances. For example, if the patient gave contradictory answers when completing the medicine request questionnaire.
• The service shared information about treatment with the patient’s own GP in line with General Medical Council Guidance.
• Prescribing was not monitored to prevent any misuse of the service by patients or to ensure the GP was prescribing appropriately but the service was planning on employing a clinician to monitor prescribing.
• 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 recruitment checks in place for all staff.
• Patients were treated in line with best practice guidance and appropriate medical records were maintained.
• Information about services and how to complain was available.
• 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 was a lack of clinical governance systems and processes in place to ensure the quality of service provision.
• The service did not have arrangements in place to provide cover for when the GP was unavailable.
• The service did not have a system in place to ensure patient safety and medicine alerts were disseminated to staff.
• The service encouraged and acted on feedback from both patients and staff.

We identified regulations that were not being met and the provider must:

• Provide care and treatment in a safe way for service users.

• Assess the risks to the health and safety of service users of receiving the care or treatment and do all that is reasonably practicable to mitigate any such risks.
• Assess, monitor and improve the quality and safety of the service.
• Maintain secure, encrypted records in respect of each service user.
• Employ sufficient numbers of suitably qualified staff and ensure they receive appropriate training.

The areas where the provider should make improvements are:

• Consider the need to minute all team meetings

We are now taking further action against the provider Yakub Chemist in line with our enforcement policy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice