The quality of online primary care services, such as those that provide GP consultations and prescriptions through independent websites and apps, has improved over the last 12 months but further action from providers and the wider system is needed to ensure they are as safe as general practice in physical premises.
This is according to the quality regulator of health and adult social care, the Care Quality Commission (CQC), which has inspected every company in England that provides these services for people in this country.
CQC has published a report today (Friday 23 March) on its overall findings based on 55 inspections since November 2016.
CQC assesses providers of online primary care services against five key areas – whether they are safe, caring, effective, responsive to people’s needs and well-led. It does this by inspecting the provider’s registered location, reviewing its systems and policies, examining how it delivers its care, and by analysing the information that CQC holds about the provider, which could include feedback from people who have used or have come into contact with its services. Questions CQC’s inspectors ask include how the service makes sure they know the identity of the patient and how the patient’s NHS GP is kept informed of any treatment.
In this report, CQC states that at 28 February 2018:
- 97% of the providers were meeting the regulations around being ‘caring’. An example of where this has worked well was a company that provided sexual health services online, which offered partner notification services (whereby with the person’s consent, it could confidentially trace their sexual contacts to flag to those who may have been at risk and encourage them to be tested).
- 90% of the providers were meeting the regulations around being ‘responsive’ to people’s needs. Examples CQC identified included providers that made ‘type talk’ available for patients with hearing loss and one provider responding to a significant uptake in the number of Chinese students requesting services and producing an information leaflet in Mandarin.
CQC has found that online consultations have the potential to improve access and convenience for some patients, such as those with physical impairments for whom attending face-to-face appointments could be difficult, those with a sensory impairments, and those who live in rural areas and have poor transport links.
Safety is where CQC found the greatest concerns but also, where CQC has seen the greatest improvement with some providers even addressing issues on the day of inspection itself; such as, by deciding to no longer prescribe certain medicines or by introducing new policies.
As of 28 February 2018, 43% of the providers CQC inspected were found not to be providing ‘safe’ care in accordance to the relevant regulations. This is an improvement from 86% not fully meeting these regulations on their first inspections. Specific concerns CQC had included:
• inappropriate prescribing of antibiotics, including lowered thresholds for antibiotic prescribing as a physical examination was not possible, and prescribing high volumes of opioid-based medicines without talking to the patient’s registered GP
• unsatisfactory approaches to safeguarding children and those who may not have the mental capacity to understand or consent to a consultation
• not collecting patient information or sharing information with a patient’s NHS GP, who should have an accurate and up to date record of their previous and current treatments and health problems
• inappropriate prescribing of medicines for long-term conditions, including failures to monitor the volume of asthma inhalers being prescribed to individuals when their condition should be regularly checked.
CQC will continue to hold these providers to account and it will share the good practice it finds in order to encourage further improvement.
Also, CQC is helping the public to understand even more about the quality and safety of online services in England by progressing its plans to rate these providers using the same approach as other services, giving ratings of outstanding, good, requires improvement or inadequate. This follows confirmation from the Department of Health and Social Care in January 2018 and it will bring CQC’s approach in line with how it regulates other services, including physical general practices. Subject to the outcome of a recent consultation, CQC expects to begin to rate these providers from April 2019.
Professor Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said:
“New methods of service delivery that increase access to care and give patients more control over how and when they see a GP have huge potential not only for patients but for the wider health system.
“However, while innovation should be encouraged, it must never come at the expense of quality. As with all health care services, patient safety must be at the heart of all decisions around what kind of care is offered and how it is delivered.
“This is why we have taken action where we have seen risks to patients – and why we have been encouraged to see many providers take note of our findings and make swift improvements to how they operate.
“This way of delivering primary care has an important place in the future of health provision – but it are still evolving. We must all work together – providers by using our inspection findings to learn and improve, and oversight bodies by working together and continuing to have a positive dialogue with providers – to ensure that this model fulfils its promise of accessible, responsive care while ensuring that the care delivered is always safe and high quality.”
Elsewhere in its report, CQC has restated its commitment to work with the Department of Health and Social Care and with its partners outside of England to close the gaps in the regulation of online services that fall outside of CQC’s remit, which could lead to people in this country being exposed to poor care.
When CQC is made aware of information of concern about a service that is not within its power to regulate – such as, a provider that is based outside of England but offering online services to people in England – it will alert its system partners and the most appropriate agency