Archived: STADN Limited

Updated 6 December 2019

STADN Limited was established in 2006 and currently provides access to doctors via telephone for self-funding patients and employees or members of other organisations with whom the service has contracts in place.

Prior to this inspection, the majority of provider’s activity related to the delivery of telephone and video consultation services for a single insurance company client using software and infrastructure owned by the client. Medical records relating to this service were managed and stored on the client’s computer servers, to which the provider no longer had access because this contract had been terminated.

At the time of this inspection, the service was in the final stages of restructuring the organisation and had ceased providing video consultations. A pay-per-call telephone advice service currently represented the majority of those regulated activities which are within the scope of registration. The pay-per-call telephone service is limited to providing medical advice only and a pre-recorded announcement message at the beginning of each call advises patients the service is not designed to replace a face to face consultation with a medical professional. The message also states the service is not an emergency service and does not provide a diagnosis or prognosis. Patients requiring urgent treatment are advised to dial 999. Patients using the telephone advice service pay a one-off consultation each time they use the service, and this can be done by credit card or by using a premium rate telephone number. The provider does not prescribe medicines to people using the pay-per-call telephone service. Consultations with employees of corporate clients and members of insurance companies are funded according to the respective terms agreed with each organisation.

The telephone advice service is available twenty-four hours per day. People who have used the system previously can request an appointment with a specific doctor using the doctor’s unique PIN number or enter the call queuing system for the next available clinician. Doctors, working remotely, provide telephone advice to patients. At the time of this inspection, doctors did not make referrals to other services and did not carry out any prescribing activity.

The service’s clinical team consists of a clinical director who is an Accident and Emergency (A&E) consultant, and five self-employed doctors, three of whom also work as GPs in NHS practices and two of whom are A&E doctors who also work in hospitals. There is a registered manager who is also a director of the organisation and six non-clinical staff.

STADN Limited, the provider, registered with CQC in May 2014 to provide the following regulated activities; transport services, triage and medical advice provided remotely and treatment of disease, disorder and injury. The service registered its current registered location at: South Terrace, Nova South, 160 Victoria Street, London, SW1E 5LB in January 2019. However, when this inspection was announced, the provider told us it had relocated to new premises located at China Works, 100 Black Prince Road, Vauxhall, SE1 7SJ. The provider had not made an application to CQC to change location details prior to relocating. This inspection was carried out at the premises in Vauxhall.

How we inspected this service

Before the inspection we requested information from the provider. However, because the provider had relocated to a different address without making arrangements to forward incoming mail, they did not receive the request.

During this inspection we spoke to the Registered Manager and members of the management and administration team.

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 6 December 2019

Letter from the Chief Inspector of General Practice

We rated this service as Requires improvement overall. The location had not previously been inspected.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Not sufficient evidence to rate

Are services caring? – Not sufficient evidence to rate

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at STADN Limited over two days on 10 and 11 September 2019 as part of our inspection programme.

STADN Limited was established in 2006 and registered with the Care Quality Commission in 2014. It is run by two directors who are based at the management offices. It currently provides a remote clinical advice service delivered by doctors via telephone. It had recently stopped providing video consultation services.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some general exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At STADN Limited, some services are provided to patients under arrangements made by their employer, by an insurance provider with whom the service user holds an insurance policy (other than a standard health insurance policy). STADN Limited also provides: remote clinical advice to other medical professionals without consulting with their patients directly, remote clinical advice to providers who are based and treat patients overseas; clinical and call handling solutions for other health care organisations including NHS commissioners. These types of arrangements are exempt by law from CQC regulation. Therefore, at STADN Limited, we were only able to inspect the services which are provided in England and not arranged for patients by their employers or an insurance provider with whom the patient holds a policy.

At this inspection we found:

•The provider had not notified CQC of a change of address and had not ensured CQC was provided with accurate contact details for the registered manager and nominated individual.

•The provider did not require clinicians to make written notes of calls to the telephone advice service and did not have a process in place to manage any notes produced.

•Arrangements in place to oversee the secure storage of recordings of calls made to the service were not effective.

•The provider had separate prescribing policies for the different services provided but it was not clear which policy applied to each service. The service was not undertaking any prescribing activity at the time of this inspection.

•Doctors were trained to deliver the service in a way that respected privacy and dignity.

The area where the provider must make improvement is:

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

The area where the provider should make improvement is:

•Review systems used to manage personnel records to ensure managers can be assured all required pre-employment checks are in place and required mandatory training is up to date.

•Put a system in place to document home working risk assessments undertaken by staff working remotely, to ensure their working environment is safe.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care