Letter from the Chief Inspector of General Practice

We rated this service as Requires improvement overall. (Previous inspection 30 May 2018, when we found the provider was meeting the relevant standards)

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? – Good

We carried out an announced comprehensive inspection at FMC Marketing Ltd on 11 April 2019, as part of our inspection programme.

FMC Marketing Ltd has management offices at 69 Old Street, EC1V 9HX London. It is run by two directors who are based at the management offices, and two GPs who work remotely from the management offices. It operates as an online doctor service via the following four websites: www.deutsch.prima-med.com; www.firstmed.co.uk; www.pharma.myonlinedoctor.co.uk; and www.myonlinedoctor.co.uk.

At this inspection we found:

• Staff personnel files we looked at did not contain evidence of up to date mandatory training.
• Not all prescribing was within national guidelines.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients could access care and treatment from the service within an appropriate timescale for their needs.
• There were no medical health questionnaires to identify age-related health issues amongst the service’s aging patient population
• There was a clear organisational structure and staff were aware of their roles and responsibilities.

The areas where the provider should make improvements are:

• Consider updating service websites to provide links to additional sources of information about health conditions.
• Encourage patients to re-complete a full health history questionnaire on a regular basis to ensure the service has full knowledge of any changes in patient’s health since a full medical history was last taken.
• Review and encourage all staff to undertake mandatory skills training on a regular basis.
• Consider changing the system for reviewing alerts coming into the service to ensure these are always seen and acted upon by a clinician.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We inspected FMC Marketing Ltd on 30 May 2018.

We previously inspected FMC Marketing Ltd on 5 December 2017. At that time the service was found not to be meeting some areas of the regulations. The full comprehensive report from the December 2017 inspection can be found on our website at http://www.cqc.org.uk/location/1-4160491831/reports.

The purpose of our most recent inspection in May 2018 was to confirm the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified during our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

FMC Marketing Ltd has management offices at 69 Old Street, EC1V 9HX London. It is run by two directors who are based at the management offices, and two GPs who work remotely from the management offices. It operates as an online doctor service via the following four websites: www.firstmed.co.uk, www.prima-med.com, www.myonlinedoctor.co.uk and www.pharmadoctor.co.uk.

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

Are services safe?

We found that this service was providing safe care 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:

• To continue to monitor and work to increase the numbers of patients who are willing to provide their NHS GP contact details, and who consent to sharing of information with their NHS GPs.
• Review plans for records retention by a third-party provider that specialises in the safe, secure and confidential storage of healthcare records to ensure effective implementation should this prove necessary.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 17 April 2017, at the following location: Grand Union Studios 1.21, 332 Ladbroke Grove, London, W10 5AD. At this inspection we found that the provider was providing responsive services. However, they were not providing safe, effective, caring and well-led services. 

In August 2017 the provider removed this location from their registration and added the following location to their registration: 69 Old Street, London, EC1V 9HX. We carried out an announced comprehensive inspection on 5 December 2017 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 not always 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 in some areas this service was not providing a well-led service in accordance with the relevant regulations.

Our key findings were:

• The provider identified, assessed and mitigated most risks to patients. However, there were risks associated with identification checking and security of data if the provider ceased to continue trading and a lack of ability to share information with a patient’s GP.
• There were systems to learn from incidents and events. Safeguarding processes were in place and staff had relevant training.
• Assessments of patients’ needs and documentation related to treatment were thorough and comprehensive. The provider offered treatment in line with national guidance.
• Consent procedures were in place and these were in line with legal requirements. There was an appropriate system for recording and updating patient care and treatment information.
• Patients’ individual needs were included in their assessments. There was timely access to treatment once requested.
• There was a complaints process and we saw complaints were investigated and responded to.
• According to patient feedback obtained by the provider, services were delivered in a compassionate and caring manner and their privacy and dignity was respected.
• Although qualifications were checked, there was not a system to ensure staff maintained skills and experience on an ongoing basis.
• The process for monitoring safety alerts needed to evidence that alerts were reviewed upon receipt.
• The system for checking the identity of patients and gaining consent to share information with a patients GP needed reviewing to ensure all risks were mitigated.
• There was a clear ethos of patient centred care. Governance arrangements were mostly in place and enabled the day to day running of the service and identified where improvements may be required to the quality of the service. Patient feedback was encouraged and considered in the running of the service.

We identified regulations that were not being met and the provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice