Archived: Push Dr Main Office

Updated 23 August 2018

Push Dr Ltd is a digital service that patients can use to access a GP appointment online using video calling services from 6am to 11pm seven days per week. Each consultation lasts approximately 10 minutes and costs £20. If the consultation results in a prescription being issued this costs a further £8. There is also an option for patients to sign up to a subscription membership at the cost of £20 per month which includes consultation and prescription costs. Patient services can be accessed through the providers website at www.pushdoctor.co.uk using any smartphone, android, tablet or PC device.

Patients are able to use the service for any health condition they may have. However, this is not an emergency service. Subscribers to the service pay for their prescription when their application has been assessed and approved. Once approved by the prescriber, prescriptions are sent to a pharmacy of the patient’s choice.

A large team of independent contractor GPs provide their services on Push Doctor's online platform and between them carry out several thousand consultations per month. Push Dr Ltd employ a large team of non-clinical staff, including management, administrative, IT and customer experience staff. We visited the providers location at Arkwright House, Parsonage Gardens, Manchester, M2 3LF which houses the non-clinical staff as part of this inspection.

Push Dr Ltd registered with the CQC at their current location in April 2018. A registered manager is in place. A registered manager is a person who is registered with the CQC 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.

Our inspection team was led by a CQC Lead Inspector. The team also included a GP specialist adviser and a second CQC inspector.

We undertook a review inspection of Push Dr Ltd on 26 April 2018 to check whether progress had been made to address the concerns we had identified during our previous inspections on 7 March 2017 and 9 August 2018. This follow-up inspection focused on two of the five questions we ask about services; is the service safe and well-led. This is because concerns were identified in these two areas during our previous inspection.

Updated 23 August 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Push Dr Ltd on 1 March 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. Two warning notices were issued on 13 April 2017 under Section 29 of the Health and Social Care Act (HCSA) 2008 which required the provider to become compliant by 15 May 2017.

On 9 August 2017 we carried out an announced follow up inspection. This was to confirm that the provider had taken action to address the breaches in regulations that we identified during the inspection in March 2017 in the safe, effective and well-led domains. We found that improvements had been made and the provider was now delivering effective services. However, there were still areas within the safe and well-led domains where further improvement was required. Requirement notices were issued for Regulations 12 (safe care and treatment) and 17 (good governance) of the HSCA 2008.

This announced focused inspection was carried out on 26 April 2018 to check whether further improvement had been made to ensure the provider was now delivering safe and well-led services. This report covers our findings in relation to the requirement notices issued as a result of the August 2017 inspection, additional improvements made since the last inspection and other areas of concern that we identified.

The full comprehensive reports on the 1 March 2017 and 9 August 2017 inspections can be found by selecting the ‘all reports’ link for Push Dr Main Office on our website at www.cqc.org.uk.

Our key findings were:

• The provider had addressed the majority of concerns raised during the previous inspections. Some improvement was still ongoing but we felt assured that work undertaken to date and planned second cycle audits would lead to an improvement in patient care or outcomes as a result.
• The provider had further improved and strengthened their governance arrangements. This had included the appointment of a chief medical officer whose role would include improving links between the medical team and senior leadership team to ensure clinical oversight as well as monitoring GP performance.
• Prescribing protocols had been improved to ensure patients were being given sufficient information when medicines were prescribed outside their licensed use.
• Some care and treatment was still not being delivered in line with current evidence-based guidance. We were not assured that the provider was prescribing safely or following best practice evidence based guidance in relation to the prescribing of certain antibiotics.
• Policies and procedures had been reviewed and updated and a version control system was now in operation.

There were areas where the provider was still not providing safe services.

The provider must:

• Ensure that care and treatment is provided in a safe way for service users.

They should also:

• Continue to develop their proposed programme of clinical audit activity. 

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice