Archived: PostMyMeds

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at PostMyMeds Limited on 9 May 2017.

The service provides on-line prescribing of medicines for specified treatment areas following the review of an online consultation questionnaire by a GMC registered GP. The service operates from a high street location which is also the location of the organisation’s affiliated pharmacy which dispenses the medicines prescribed. The pharmacy is registered and regulated by the General Pharmaceutical Council (GPhC).

We found this service was providing caring, effective, responsive and well led care in accordance with the relevant regulations. However, improvements were required in relation to providing safe care.

Our key findings were:

• The service had clear systems to keep people safe and safeguarded from abuse.
• There was a system in place to check identity which consisted of a credit card check; a check against the electoral roll, IP address and duplicate orders from the same address.
• There were systems in place to mitigate safety risks including analysing and learning from significant events. 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.
• Improvements were made to the quality of care as a result of complaints.
• There were appropriate recruitment checks in place for staff. However, not all staff had undergone a Disclosure and Barring Service (DBS) check and a risk assessment had not been undertaken to identify potential risks this posed to service users. The provider took immediate action to address this and provided evidence of the DBS check application.
• Prescribing was monitored to prevent any misuse of the service by patients and to ensure that prescribing by the GP was appropriate.
• There were systems to ensure staff had the information they needed to deliver safe treatment to patients.
• Patients were treated in line with best practice guidance and safety alerts were acted on appropriately.
• Appropriate medical records were maintained which reflected the condition treated and medicine prescribed.
• The service had a programme of ongoing quality improvement.
• All staff, including the GP, had access to policies and procedures. However, not all policies were fully personalised to reflect the needs of the service and some did not include a date of issue or date for future review.
• The service encouraged the sharing of information about treatment with the patient’s own GP.
• Consultation records we viewed showed that patients were treated with compassion, and respect and they were involved in their care and decisions about their treatment.
• Comprehensive, closed-question disease and medicine specific consultation templates were used. However, the language used was sometimes not sufficiently clear for all service users to understand and one did not include the facility for patients to record all relevant information. Some templates did not include all appropriate medicine interactions. However, the provider took immediate action to address these issues.
• There was a clear business strategy and plans in place.
• There were clinical governance systems and processes in place to ensure the quality of service provision.
• The service encouraged and acted on feedback from both patients and staff.
• Systems were in place to protect personal information about patients. The company was registered with the Information Commissioner’s Office.
• The service encouraged and acted on feedback from both patients and staff.

We identified regulations that were not being met and the provider must make appropriate improvements (please see the requirement notice at the end of this report).

Care and treatment was not being provided in a safe way for service users.The provider was not doing all that is reasonably practicable to mitigate risks to service users regarding the proper and safe management of medicines.

The provider must ensure that current and future consultation questionnaires are reviewed to ensure that:

• the language used can be understood by all service users.
• they include reference to all relevant medicine interactions.
• they include the facility for patients to enter all relevant information.

The areas where the provider should make improvements are:

• The provider should keep under review the systems they have in place to confirm the identity of patients using the service, so that they can be assured that care and treatment is provided in a safe way.
• The provider should carry out an assessment of risk to service users to determine if a Disclosure and Barring Service check should be carried out for employed staff.
• The provider should ensure that all policies are personalised to reflect the needs of the service and should include a review date.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice