We carried out an announced comprehensive inspection at Medical Solutions Inspired on 19 April 2018. We undertook this inspection as part of our inspection programme of independent health care providers.

Medical Solutions Inspired provides GP telephone consultations to eligible members of various organisations across the UK. Member organisations offer their clients, employees (and sometimes their family members) a 24 hour telephone service and access to a mobile phone app and dedicated website.

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

Are services safe? – We found that this service was not providing safe care in accordance with the relevant regulations. Specifically:

• Arrangements were in place to safeguard patients from abuse.
• We found the lead for safeguarding was not trained to the appropriate level and the provider had not ensured all GPs had received safeguarding training or checked competence.
• Individual GP prescribing and performance was reviewed regularly, but prescribing audits had not been carried out.
• Suitable numbers of staff were employed and there was a recruitment process in place.
• We found recruitment files for GPs had some documents missing and induction records were inconsistently recorded and retained.
• Most risks were assessed and action taken to mitigate any risks identified, although the provider had not identified any significant events or incidents that had affected the service.

Are services effective? - We found that this service was not providing safe care in accordance with the relevant regulations. Specifically:

• Following patient consultations information was appropriately shared with a patient’s own NHS GP in line with GMC guidance.
• There was evidence of an audit program but it did not drive quality or improve patient outcomes.
• Non-clinical staff received the appropriate training to carry out their role.
• The provider relied on GPs receiving appropriate training from their NHS employment and requested their certificates of safeguarding training to confirm this had been undertaken. However, no other training certificates were requested and the provider did not have a process to check clinician knowledge or understanding.

Are services caring? – We did not have enough information about this service to establish if they were providing a caring service in accordance with the relevant regulations. We have been unable to form a judgement on caring.

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

• Information about how to access the service was clear and the service was available seven days a week.
• The provider did not discriminate against any client group.
• Information about how to complain was available and complaints were handled appropriately.

Are services well-led? - We found some areas where the service was not providing a well-led service in accordance with the relevant regulations.  Specifically:

• The service had clear leadership and governance structures.
• A range of information was used to monitor the quality and performance of the service, although audits were tailored to individual performance and not used to drive quality improvement.
• Patient information was held securely, although the provider had no arrangements in place to securely transfer patient notes if they ceased to trade.

The areas where the provider should make improvements are:

• The safeguarding lead should receive safeguarding training at an appropriate level for their role.
• Review the arrangements for confirming the location of the patient at the time of the consultation taking place.
• Actively seek the views of stakeholders, including patients using the service, to specifically identify where improvements or changes to patient care may be required.

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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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