Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Q doctor on 23 August 2018 as part of our inspection programme.

Q doctor is an online GP consulation service which allows patients to consult with a GP via video link. Patients can access the service via their own device and can either pay a single consultation fee or pay an annual subscription to the service, which allows them access to a specific number of consultations throughout the year. The service is also available in some pharmacies (which Q doctor has a contract with) where patients can either request an appointment or where pharmacy staff will suggest the service to them in cases where the patient requires a medicine which needs to be prescribed; in which case they will pay for a video consultation, which will be carried-out it a private room at the pharmacy. The service also provides an online GP locum service, whereby GP practices pay for a locum session with one of the service’s GPs, which is carried-out via video link. When Q doctor is delivering the online GP locum aspect of its service, care for patients is delivered under the governance arrangements of the commissioning GP practice, with Q doctor acting as a locum agency; therefore, we did not inspect this aspect of the service.

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:

• Arrangements were in place to safeguard people, including arrangements to check patient identity.
• Prescribing was in line with national guidance.
• Suitable numbers of staff were employed and appropriately recruited.
• Risks were assessed and action taken to mitigate any risks identified.

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

• Following patient consultations information was appropriately shared with a patient’s own GP in line with GMC guidance.
• Quality improvement activity, including clinical audit, took place.
• Staff received the appropriate training to carry out their role.

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

• The provider carried out checks to ensure consultations by GPs met the expected service standards.
• Patient feedback reflected they found the service treated them with dignity and respect. The service did not display patient feedback on their website.
• Patients were able to select whether they saw a male or female GP; however, the service did not display information about GPs working at the service on their website, to enable patients to make an informed choice about the GP they saw.

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.
• 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 the service was 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 and improve the quality and performance of the service.
• Patient information was held securely.

The areas where the provider should make improvements are:

• Arrange for all GPs working for the service to complete Mental Capacity Act training, as identified in the service’s training action plan.
• Publishing Patient feedback on their website.
• Provide information about GPs working for the service on their website, to enable patients to make an informed choice about which GP they choose to consult with.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice