Archived: Ada Digital Health Ltd

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ada Digital Health Ltd on 2 May 2017.

Ada Digital Health Ltd operates a free app which can be downloaded onto a mobile device, where patients can enter information about their symptoms and medical history; the app will then provide suggested diagnoses. The patient then has the option to pay for one of Ada’s GPs to review the answers they provided via the app, along with additional information provided in free-text by the patient; the GP will then provide a tailored opinion, and will issue a prescription if appropriate, which is sent directly to the pharmacy of the patient’s choice.

Overall, we found this service provided effective, caring, and responsive and well led services in accordance with the relevant regulations; however, we identified some areas relating to the safe provision of services where the provider must make improvements.

Our key findings were:

• Patients access the service via a free app, with the option of paying for a personalised consultation with a GP. Consultations were primarily conducted via a web chat; however, there was the facility for GPs to phone patients if necessary. Once a patient had paid for a personalised consultation and supplied relevant information about their symptoms, the service aimed to respond the same day (if submitted before 7pm).
• Systems were in place to protect personal information about patients. The company was registered with the Information Commissioner’s Office and supporting procedures were in place to ensure that individuals were aware of their responsibilities with regards to the security of patients’ information.
• There was a comprehensive system in place to check the patient’s identification prior to advice and treatment being provided.
• The service shared information about treatment with the patient’s own GP in line with General Medical Council guidance.
• Prescribing was monitored to prevent any misuse of the service by patients and to ensure GPs were prescribing appropriately.
• 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.

• Overall, there were appropriate procedures in place in relation to the recruitment of staff, and these were followed in the recruitment of clinical staff; however, when recruiting non-clinical staff the provider had not always ensured that appropriate background checks were carried-out. The provider’s policy relating to pre-employment background checks was not effective to enable the provider to be sure that candidates were safe to work with vulnerable people.

• An induction programme was in place for all staff and GPs registered with the service received specific induction training prior to treating patients. Staff, including GPs working remotely, also had access to all policies.
• Patients were treated in line with best practice guidance and appropriate medical records were maintained.
• Information about services and how to complain was available. At the time of the inspection the service had not received any formal complaints; however, we saw evidence that mechanisms were in place for complaints to be discussed and used to drive improvement.
• Patient feedback and consultation records we viewed showed that patients were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 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.

We identified regulations that were not being met (please see the requirement notices at the end of this report). The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

• Consistently follow their newly introduced appraisal arrangements for non-clinical staff.
• Provide training on the Mental Capacity Act to all staff.

• Put processes in place to monitor when staff training is due.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice