Archived: Express Dispense

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Express Dispense Ltd on 13 February 2017. We found the service was not providing Safe, Effective and Well-led services in accordance with the relevant regulations. However, we found they were providing Caring and Responsive services in accordance with the relevant regulations.

Following the February 2017 inspection, we served a Warning Notice to the provider on the 2 May 2017 under Section 29 of the Health and Social Care Act 2008 which required the provider to become compliant by 2 June 2017. The full comprehensive report of the 13 February 2017 inspection can be found by selecting the ‘all reports’ link for Express Dispense on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 16 August 2017 to confirm that 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 February 2017. This report covers our review of the Warning Notice and findings in relation to those requirements.

Our key findings were:

• There were systems in place to confirm the patient’s identity and ensure the resulting delivery of medicines was appropriate. However, these should be improved to ensure they are effective.
• There were systems in place to ensure staff had the information they needed to deliver safe care and treatment to patients, including national guidance such as Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts, National Institute for Health and Care Excellence (NICE) guidance and General Medical Council (GMC) guidelines.
• The provider had a programme of ongoing quality improvement in place to monitor and improve the service provided to patients.
• There were processes in place to monitor the training needs of clinical staff and staff had received training relating to safeguarding, the Mental Capacity Act 2005 and duty of candour.
• The provider had formalised staff meetings to ensure all staff were regularly updated with service developments.
• All staff, including the GP and pharmacists, had access to all policies, including the safeguarding policy.

We found the provider had taken actions to make improvements to meet the requirements of the Warning Notice and was now providing safe, effective and well-led services in accordance with the relevant regulations.

The areas where the provider should make improvements are:

• The provider should assure themselves that their process for verifying patient identity is effective given the nature of the format of their consultations.

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 Express Dispense Ltd on 13 February 2017. Express Dispense Ltd was established in 2010 and registered with the Care Quality Commission in March 2016. Express Dispense operates an online clinic for patients via a website (www.expressdispense.com), providing consultations and both NHS and private prescriptions.

We found this service was not providing safe, effective, and well led services in accordance with the relevant regulations. We found this service was providing a responsive and caring service in accordance with the relevant regulations.

Our key findings were:

• The provider used credit/payment card and telephone directory checks to verify the identity of patients using the service. There was no evidence that the doctor clarified medical history or treatment with the patient’s NHS GP. This put patients at potential risk of harm as it meant that the provider was reliant upon the patient entering accurate and truthful information about their medical history.

• We were not assured the doctor had a comprehensive understanding of relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.

• There was no system in place to assist the doctor to assess patients’ needs and deliver care in line with relevant and current evidence based guidance. There were no evidence-based support tools in place for the doctor to utilise.

• The system of quality improvement including clinical and internal audit required improvement. There had been no audits undertaken to analyse the overall operational performance of the service or clinical audits undertaken.

• There was a range of service specific policies which had been developed however not all staff were aware of the existence of these.

• We were not assured all staff were aware of the requirements of the Duty of Candour.

• Systems were in place to protect personal information about patients. The provider was registered with the Information Commissioner’s Office.

• Prescribing was monitored to prevent any misuse of the service by patients and to ensure the doctor was prescribing appropriately.

• There were systems in place to mitigate safety risks including analysing and learning from significant events.

• There were appropriate recruitment checks in place for all staff.

• An induction programme was in place for all staff. The doctor and pharmacists received specific induction training prior to treating patients.

• Information about services and how to complain was available. 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 told us they felt well supported and that they could raise any concerns.

• The service encouraged feedback from both patients and staff.

The areas where the provider must make improvements are:

• Ensure patient identity is confirmed for each prescription and the resulting delivery of medicines is appropriate.

• The provider should take due account of national guidance such as safety alerts, National Institute for Health and Care Excellence (NICE) guidance and General Medical Council (GMC) guidelines and ensure clinicians deliver evidence based healthcare and treatment in accordance with them.

• Ensure there is a programme for quality improvement such as clinical audit to monitor and improve the service provided to patients.

• Ensure there are processes in place to monitor the training needs of clinical staff and appropriate staff have received training of the Mental Capacity Act and Duty of Candour.

The areas where the provider should make improvements are:

Formalise staff meetings to ensure all staff are updated with service developments regularly. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice