Archived: Push Dr Limited

Updated 26 June 2019

Push Dr Limited is a digital service that patients can use to access a GP appointment online using video calling services from 7am to 8pm seven days per week. The head office for the service is located at Arkwright House, Parsonage Gardens, Manchester, M2 3LF.

Push Dr offers patients private consultations for a fee. Two options are offered, a pay as you go service with a one-off fee for an appointment and additional charges for other services if required. Alternatively, the service offers an annual subscription service with a monthly fee and a reduced consultation fee, which includes additional services as required.

Push Dr also works in partnership with an NHS GP partnership that offers primary care at scale. (Primary Care at Scale is several GP practices working together under one registration across a wide geographical area). Patients registered with these NHS GP practices can also access an online GP consultation via their GP practice appointment service. There is no fee payable by the patient for this service. Patients from this practice are not able to pay for private appointments.

Patient services can be accessed through the provider’s website at www.pushdoctor.co.uk using any smartphone, android, tablet or PC device.

Patients can 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 the Push Drs online platform and between them carry out several thousand consultations per month. A team of GPs work at the main office to quality assure consultations and offer support and guidance to GPs. The provider also employs a pharmacy officer to support with safety and quality of prescribing.

Push Dr also employ a large team of non-clinical staff, including management, administrative, IT and customer experience staff.

Push Dr is registered with the CQC to provide the regulated activities Treatment of disease, disorder or injury and Transport services, triage and medical advice provided remotely

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.

How we inspected this service

Before the inspection we gathered and reviewed information from the provider. During this inspection we spoke to the registered manager who was also the Chief Medical Officer for the service, members of the medical team including medical officers, a pharmacist, platform GPs who provide consultations and members of the management team, customer service team, operations and marketing teams. We also spoke with an NHS stakeholder.

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.

Updated 26 June 2019

Letter from the Chief Inspector of General Practice

We rated this service as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Outstanding

We previously inspected Push Dr Limited in February 2017, August 2017 and April 2018. The full comprehensive reports for these inspections can be found by selecting the ‘all services’ link for Push Dr Limited on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Push Dr on 13 May 2019. The purpose of this inspection was to follow up the requirement notice we issued following our last inspection undertaken in April 2018; and in accordance with our updated methodology to inspect all key questions and provide a quality rating.

This inspection identified that Push Dr had implemented action to meet the requirement notice issued at the previous inspection for regulation 12 Safe care and treatment. Systems to monitor antibiotic prescribing and prescribing practice in accordance with national guidelines were safe and effective.

Push Dr are an online (digital) GP service that offers private appointments to patients through the use of a software application on either a smart phone, tablet or laptop computer. The software allows the patient and GP to have a face to face video consultation. This is a fee based service, which is available in England. Consultations are available to adults and children following identity verification.

Push Dr also has a contract with a very large GP practice partnership (Modality Partnership) and provides NHS appointments via video to patients registered with this GP practice.

At this inspection we found:

• The Push Dr leadership team were a driving force, united in their commitment to deliver and prioritise safe care to private and NHS patients. They effectively used the skills and abilities of their staff team to provide innovative and accessible care, treatment and support to their patients.

• The service’s underpinning ethos was that patient safety was central to all its activities. It strived to ensure care and treatment was delivered according to evidence- based guidelines.

• The service had clearly defined and embedded systems to minimise risks to patient safety. A comprehensive quality improvement strategy effectively monitored the service provided to assure safety and patient satisfaction.

• Staff demonstrated commitment and engagement with the vision for the service. They were proud to work for the organisation.

• Patient satisfaction with the service they received was monitored and action taken to ensure a safe effective service was provided.

• There was a commitment and appetite to work with external partners including the NHS and the third sector to make the service as accessible as possible.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

• The culture of the service was underpinned with the ethos ‘patient safety first’. The leadership team facilitated this culture by investing in staff training and development, encouraging team work and innovation, listening to patient feedback and implementing a continuous quality improvement audit programme.

• Comprehensive systems for the monitoring of service delivery were established, with 10% of all GP consultations reviewed monthly. Where areas for development and improvement were identified this was shared with the GP and they were asked to reflect on the issues and directed to additional training as required. The GPs really valued this for their professional development as well as service improvement.

The areas where the provider should make improvements are:

• Continue to encourage the evidence-based prescribing of antibiotics to improve antimicrobial stewardship

• Review the information supplied to patients when medicines are prescribed ‘off-label’.

• Implement the planned improvement strategy identified at inspection, including the referral review and pathway.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care