Archived: Videodoc Ltd

Updated 11 February 2019

VideoDoc LTD registered with CQC in June 2016 and started providing services to patients in January 2017. Services were accessed through a web portal and mobile application that allowed patients to consult with a doctor through a secure internet healthcare service. This included confidential on-line video health assessments with a GP and the private prescription of medicines. VideoDoc LTD’s aim is to provide a high quality, internet healthcare service which includes confidential on-line health assessments with a medical practitioner and the private prescription of medicines. We inspected the online service at the following address: VideoDoc, International House, Yarmouth Place, Mayfair, London, W1J 7BU, England. At the time of inspection, the provider had applied to change their location.

VideoDoc LTD (UK) owns VideoDoc Limited, whose main patient base is in Ireland where 1.4 million patients access the service. VideoDoc LTD had two directors, a clinical lead, a Human Resources (HR) manager, a GP Recruitment Specialist, five GPs based in the UK and back office support from a care team, graphic designer and marketing colleague.

The service was available to patients from Monday to Sunday, 8am until 10pm. Patients paid a one-off consultation fee or they could subscribe to the service for 12 months at additional cost. A subscription allowed an unlimited number of consultations during the 12-month period.

Patients aged two and over could access the service. However, children under the age of 16 years could only use the service if they were a dependant of an adult already registered. Patients could contact VideoDoc LTD for the following support, care or treatment; diagnosis and treatment of everyday illness, prescription requests, when they are worried about a personal health or medical issue, for a referral or second opinion, to request a sick note, if considering attending A&E for a non-emergency situation, if they were not comfortable talking to their own doctor about a health or wellness problem, when their usual doctor was unavailable or when travelling and in need of medical care.

The Chief Executive Officer was the registered manager. A registered manager is 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.

How we inspected this service

Our inspection team was led by a CQC Inspector, a GP Specialist Adviser, a second GP Specialist Adviser and a member of the CQC medicines team.

Before the inspection we gathered and reviewed information from the provider. During this inspection we spoke to the Registered Manager and members of the management and administration team, including one GP and a Human Resources Manager.

To get to the heart of patients’ experiences of care and treatment, we 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.

Why we inspected this service

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.

Updated 11 February 2019

Letter from the Chief Inspector of General Practice

(Previous inspection 28 July 2017, when the service was found to be meeting some areas of the regulations)

We carried out an announced comprehensive inspection at VideoDoc Ltd on 4 December 2018, to follow up on breaches of regulations identified at the previous inspection.

VideoDoc LTD provides a web portal and mobile application allowing patients to consult with a doctor through a secure internet healthcare service. The core focus of the business is the corporate market, providing online health and wellbeing services to employers. This includes confidential on-line video health assessments with a GP and the private prescription of medicines. VideoDoc LTD (videodoc.co.uk) provides services to patients in England. Videodoc LTD also owns VideoDoc Limited (VideoDoc.ie), which is a company based in Ireland who provide the same service to over 1.4 million patients. We did not inspect this service during this inspection. There is a governance team for the UK service and both platforms have separate governance processes. For example, patients are seen by General Medical Council (GMC) registered doctors only on videodoc.co.uk, who follow policies and procedures specific to the UK service only. The online systems, reporting and patient feedback, which were reviewed at this inspection will be referenced in this report.

We found this service provided effective, caring and responsive services in accordance with the relevant regulations. Some improvements are required in safe and well led.

Our findings in relation to the key questions were as follows:

Are services safe? – we found some areas where the service was not providing a safe service in accordance with the relevant regulations. Specifically:

• Although arrangements were in place to safeguard people and staff had received safeguarding training relevant to their role, the provider needed to ensure that the safeguarding policy in place was operating effectively. 
• We were not provided with evidence of health and safety risks assessments or action taken to mitigate any risks identified. This was in relation to health and safety assessments, including Display Screen Equipment (DSE) assessments for remote workers.
• Suitable numbers of staff were employed. Recruitment and induction procedures had improved; however, a mandatory training schedule was not in place. 
• Prescribing was constantly monitored. The provider needed to implement an integrated prescribing system and ensure safe warfarin prescribing in accordance with their guidelines. The newly implemented policy required a review.
• Arrangements were in place to check patient identity.
• In the event of a medical emergency occurring during a consultation, systems were in place to ensure emergency services were directed to the patient and the patient followed up 24 hours later.

Are services effective? - we found the service was providing an effective service in accordance with the relevant regulations, although in some areas, improvement was required. Specifically:

• The provider had implemented a programme of quality improvement activity, including clinical audit such as prescribing; however, there was no clear evidence of quality improvement following analysis of the audit data collection.
• Although staff received the appropriate training to carry out their role, there were still gaps in mandatory training including information governance and there was no mandatory training schedule.
• Following patient consultations information was appropriately shared with a patient’s own GP in line with GMC guidance.

Are services caring? – we found the service was providing a caring service in accordance with the relevant regulations. Specifically:

• The provider carried out checks to ensure consultations by GPs met the expected service standards.
• Patient feedback reflected they found the service treated them with dignity and respect.
• Patients had access to information about GPs working at the service.

Are services responsive? - we found the service was providing a responsive service in accordance with the relevant regulations. Specifically:

• Information about how to access the service was clear and the service was available seven days a week.
• 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 some areas where the service was not providing a well-led service in accordance with the relevant regulations. Specifically:

• There were gaps in governance processes such as mandatory training procedures and health and safety risk assessments for remote workers. 
• The service had clear leadership.
• A range of information was used to monitor and improve the quality and performance of the service.
• Patient information was held securely.

The areas where the provider should make improvements are:

• Take action to ensure that the regular audits carried out demonstrate clear evidence of improvement.
• Take action to implement a prescribing formulary of medicines and take action to improve safer prescribing of high-risk medicines and improve the prescribing policy to clarify what medicines the service can provide and ensure that they are audited.
• Implement protocols to notify Public Health England of any patients who have notifiable infectious diseases.
• Consider setting up a United Kingdom advisory group to provide advice on the strategy for improving the quality of care provided by the service.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice