Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Babylon Healthcare Services Ltd on 4 July 2017.

Babylon Healthcare Service Ltd provides an online GP consultation service. They employ GPs on the General Medical Council (GMC) GP register to work remotely and undertake patient consultations. Patients are able to book a 10 minute consultation with a GP 24 hours a day and seven days a week. Consultations are undertaken through video call or phone call. Subscribers to the GP consultation service can pay a monthly fee or pay for each consultation.

This report sets out our findings and details of the regulatory requirements are set out at the end of this report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 21 July 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Babylon Healthcare Services Ltd. employs GPs on the GMC GP register to work remotely in undertaking patient consultations. Patients are able to book a 10 minute consultation with a GP between the hours of 8.00am and 8.00pm every day. This is not an emergency service.

Subscribers to the GP consultation service can pay a monthly fee or pay for each consultation.

For the past two years Babylon has engaged in a partnership with the NHS, whereby they can provide NHS patients with consultations via their smartphone and computer. This service is currently provided to patients registered with two NHS GP practices in Southend, Essex. These patients do not individually pay a fee for the service.

Babylon also provides general healthcare advice under an ‘Ask a Question’ service by which people can text a medical question and receive an answer from a doctor or nurse. No diagnosis or prescription is provided. All previous questions can be seen by the GP during any subsequent on line consultation. However, the sole focus of our inspection was the on line GP consultation service.

Other services provided, which were outside the scope of our inspection, included a facility to order essential health and medical kits for patients to monitor their health; a health monitor application and a recently launched symptom checker application; and an on line psychotherapy service. There is also an on line GP consultation service in Ireland but this was also outside the scope of our inspection as our remit only applies to regulated activities provided to people who live in England.

The Chief Executive is the registered manager. (A registered manager is a person who is registered with the Care Quality Commission 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).

Before our inspection we asked the provider to email patients for their views about the service and send them directly to CQC. The 13 responses we received were all positive about the care and treatment they received and the flexibility and accessibility of on-line consultations. There was also mostly positive feedback about the service on the provider’s website.

Our key findings were:

• There was an effective system in place for reporting and recording incidents and significant events. All opportunities for learning from incidents and events were maximised.
• Risks to patients were always assessed and well managed, including those relating to recruitment checks.
• Systems were in place to protect personal information about patients and the company was registered with the Information Commissioner’s Office (ICO).
• The service had a governance framework in place which supported the delivery of the service and good quality care. There were appropriate policies and procedures to govern activity which were subject to regular review.
• Staff at headquarters we spoke with were fully engaged with, and committed to, the organisational mission and values and told us they felt well supported and that they could raise any concerns with the provider or managers.
• Patient feedback was used proactively to inform improvements in the service being provided.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients’ written feedback said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a healthcare professional, at a time convenient to them.
• There was a clear vision and strategy with quality and safety as a top priority.
• There were strong and visible clinical and managerial leadership and governance arrangements and staff felt valued and supported by management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

• Ensure ICO registration is updated to reflect the new headquarters’ address.
• Arrange monitoring of the receipt of manual (inked) prescriptions by the pharmacy to check the 72 hour delivery time was met.

Letter from the Chief Inspector of General Practice

We previously inspected location name on 4 July 2017. The full comprehensive report on inspection can be found by selecting the ‘all services’ link for location name on our website at .

At our previous inspection on 4 July 2017 we found that in some areas the service was not providing safe and effective care. We issued a requirement notice in relation to Regulation 12, Safe Care and Treatment.

We carried out an announced comprehensive inspection at Babylon Healthcare Services Ltd on 7 February 2019 to follow up on the breach of regulation identified during the previous inspection. At this inspection, we found the provider had addressed the issues identified at the last inspection.

Babylon Healthcare Service Ltd provides an online GP consultation service. They employ GPs on the General Medical Council (GMC) GP register to work remotely and undertake patient consultations. Patients are able to book a ten minute consultation with a GP, 24/7, 365 days a year. Consultations are undertaken through video call or phone call. Subscribers to the GP consultation service can pay a monthly fee or pay for each consultation.

Our findings in relation to the key questions were as follows:

Are services safe?

We found the service was providing a safe service in accordance with the relevant regulations.

Are services effective?

We found the service was providing an effective service in accordance with the relevant regulations.

Are services caring?

We found the service was providing a caring service in accordance with the relevant regulations.

Are services responsive?

We found the service was providing a responsive service in accordance with the relevant regulations.

Are services well-led?

We found the service was providing a well-led service in accordance with the relevant regulations.

The areas where the provider should make improvements are:

• Implement a system for identifying the location of each patient at the time of their consultation, in order that help can be sent to them in an emergency.
• Improve the written information supplied to patients who are prescribed medicines for unlicensed indications.
• Continue to review the management of clinical risk in video consultations.
• Develop quality improvement activities to improve outcomes in the quality of care patients receive.
• Continue to review and implement the policy relating to the clinical circumstances where information should be shared with the NHS GP especially in relation to the treatment of long-term conditions.
• Improve the arrangements for patients wishing to book an appointment with a GP of a specific gender.
• Improve the whistleblowing policy to ensure it includes external organisations for reporting concerns.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice