Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hexpress Healthcare Ltd on 22 August 2018.

Hexpress Healthcare Ltd registered with the Care Quality Commission in June 2018. Hexpress Healthcare Ltd operates an online clinic for patients via the following website: www.healthexpress.co.uk; providing consultations and private prescriptions.

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. Specifically:

• The service had clear systems to keep people safe and safeguarded from abuse.
• There was a comprehensive system in place to check the patient’s identity.
• There were systems in place to mitigate safety risks including analysing and learning from significant events and safeguarding.

• There were appropriate recruitment checks in place for all staff.

• Prescribing was monitored to prevent any misuse of the service by patients and to ensure doctors were prescribing appropriately.

• There were systems to ensure staff had the information they needed to deliver safe care and treatment to patients.
• The service learned and made improvements when things went wrong. The provider was aware of and complied with the requirements of the Duty of Candour.

Are services effective? - we found the service was providing an effective service in accordance with the relevant regulations. Specifically:

• Patients were treated in line with best practice guidance and appropriate medical records were maintained.
• The service had a programme of ongoing quality improvement activity.
• An induction programme was in place for all staff and doctors registered with the service received specific induction training prior to treating patients. Staff, including doctors, also had access to all policies.
• The service shared information about treatment with the patient’s own GP with their consent.

Are services caring? – we found the service was providing a caring service in accordance with the relevant regulations. Specifically:

• We were told that doctors working remotely undertook consultations in a private room in their own home. The provider carried out checks to ensure doctors were complying with the expected service standards and communicating appropriately with patients.

• Patient survey information we reviewed showed the latest Trust Pilot score for the service was ‘9.4 out of 10’ and rated as ‘Excellent.’ Patients comments included satisfaction with the provider’s delivery times and the convenience of using the service.

Are services responsive? - we found the service was providing a responsive service in accordance with the relevant regulations. Specifically:

• There was information available to patients to demonstrate how the service operated.

• Patients could sign up to receive this service either by android or iOS application.

• There was a complaints policy which provided staff with information about handling formal and informal complaints from patients.

• Consent to care and treatment was sought in line with the provider policy. All of the GPs had received training about the Mental Capacity Act.

Are services well-led? - we found the service was providing a well-led service in accordance with the relevant regulations. Specifically:

• Staff we spoke with were aware of the organisational vision, objectives and values and told us they felt well supported and that they could raise any concerns.
• There were clinical governance systems and processes in place to ensure the quality of service provision.
• The service encouraged and acted on feedback from both patients and staff.
• Systems were in place to protect personal information about patients. The service was registered with the Information Commissioner’s Office.

The areas where the provider should make improvements are:

• Increase the health information available to patients about leading healthier lives.

• Providing information for patients about the doctors undertaking the consultations for the service.

• Develop ways to assist patients accessing the service who are hard of hearing, deaf or speech impaired to communicate with hearing people using the telephone network.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice