Archived: MD Direct Ltd

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at MD Direct on 13 December 2016. MD Direct is an online service that allows patients to obtain a prescription and purchase medicines.

Our key findings across all the areas we inspected were as follows:

• There were no effective systems in place for recording, reporting and learning from significant events or safety alerts.
• Risks to patients were not appropriately assessed or managed. For example, we found patients being prescribed large quantities of inhalers but there was a lack of monitoring or follow up for these patients whose condition could put them at serious risk of harm.
• Some non-clinical staff with no formal training assessed patients’ needs. Staff training was ineffective and training of clinical staff had not been assessed or monitored by the provider.
• Information about services was available on the provider’s website. Information on how to complain was located within the terms and conditions section of the website. The provider told us that they did not document complaints.
• There was little understanding of continuous improvement.
• The clinician was working outside of her scope of practice, and told us they were not competent to carry out the role. The service had some policies which staff were not aware of and were ineffective.
• During the inspection the provider of the service failed to demonstrate they had the experience, capacity and capability to run the service and ensure high quality care.
• The service did not proactively seek feedback from staff or patients.
• The service did not have vision or values that were shared with staff.
• The provider was aware of the requirements of the duty of candour.

After the inspection we wrote to the provider outlining the seriousness of our concerns and our intention to take enforcement action. The provider responded saying they would voluntarily cancel their registration and stop providing services to patients immediately.

Had the provider remained registered we would have required them to take the following actions:

• Ensure there is a system to ensure recording, assessing and managing significant events.
• Ensure prescribing decisions are made appropriately and in line with clinical best practice and that appropriate safety advice is provided with each prescription.
• Ensure systems are in place to deal with emergency situations.
• Ensure systems are in place to assess capacity and obtain consent.
• Ensure systems are in place to action patient safety and MHRA alerts.
• Ensure systems are in place to confirm a patient’s identity.
• Ensure feedback from patients and staff is gathered to improve services.
• Ensure there is effective governance in place and that staff have received the training needed to perform their role and that they have access to policies and procedures.
• Ensure there is a policy in place for data security, safeguarding, and that the practice has an effective business continuity plan.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice