Archived: ZoomDoc Base

Updated 25 April 2018

ZoomDoc Ltd provides a private, non NHS service. The service started in March 2017. The service does not employ any staff and all 16 GPs are self-employed. All GPs are UK based, on the General Medical Council (GMC) register, working in the NHS and have an indemnity insurance to cover their work.

ZoomDoc Base is a mobile application (app) based on-demand GP visiting service which offers medical advice and treatment within patients’ own homes, office or hotel. The app has been downloaded over 4800 times and the service has carried out 555 consultations. There are 2,970 patients registered with the service. To be eligible to register for a ZoomDoc account the patient must be 18 years of age or older. Parents or legal guardians may add children below the age of 18 years of age to their primary ZoomDoc account as patients after initial registration.

Patients are able to book appointments at a time to suit them and with a doctor of their choice via an online app. Patients are able to book a 10 minute telephone or 25 minute face-to-face consultation with a GP 24 hours a day and seven days a week. Telephone consultation is offered nationwide and face-to-face consultation is offered in and around London area. GPs, working remotely, conduct consultations with patients and, where appropriate, issue prescriptions (only after face to face consultations) or make referrals to specialists; consultation notes are available for patients to access. Patients must pay for an individual consultation by credit or debit card only via the ZoomDoc app.

A registered manager is in place. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service is registered with the Care Quality Commission for the regulated activities of Treatment of disease, disorder or injury and Transport services, triage and medical advice provided remotely.

Updated 25 April 2018

We carried out an announced comprehensive inspection at ZoomDoc Base on 28 February 2018 as part of our inspection programme.

ZoomDoc Base is a mobile application (app) based private GP visiting service which provides telephone and face-to-face GP consultations at the patient’s home, office or hotel. Patients are able to book a 10 minute telephone or 25 minute face-to-face consultation with a GP 24 hours a day and seven days a week.

We found this service provided responsive, caring and well-led services in accordance with the relevant regulations. However, service was not providing safe and effective services in some areas in accordance with the relevant regulations.

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

Are services safe? - We found the service was not providing a safe service in some areas in accordance with the relevant regulations.

• The provider did not ensure proper and safe management of medicines including the doctors’ bag.
• The protocol for prescribing did not include the clear guidance for visiting GPs regarding the safe prescribing of off-licence medicines and some other medicines.
• Infection control audits had not been carried out. 
• Arrangements were in place to check evidence of parental responsibility where an adult was consenting to treatment on behalf of a child, but this was not documented in the child notes after consultations.
• Arrangements were in place to safeguard people, including arrangements to check patient identity during face-to-face consultations.
• There were enough GPs to meet the demands on the service.

Are services effective? - We found the service was not providing an effective service in some areas in accordance with the relevant regulations.

• There was some evidence of quality improvement activity.
• The provider had not provided clear clinical evidence based guidance to prescribe longer prescriptions of benzodiazepines, the oral contraceptive pill and hormone replacement therapy which could lead to large quantities being prescribed without further investigation.
• All GPs had attended role-specific training in safeguarding of vulnerable adults, safeguarding children level three and basic life support. However, the provider was unable to provide evidence that all GPs had received formal training in infection control, health and safety, information governance and the Mental Capacity Act.
• Following patient consultations information was appropriately shared with a patient’s own GP in line with GMC guidance.

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

• 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.
• Patients had access to information about GPs working at the service.

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

• Information about how to access the service was clear and the service was available 24 hours a day and 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 the service was providing a well-led service in accordance with the relevant regulations.

• The service had clear leadership, a business strategy and plans to grow and expand the service.
• There was a clear ethos of patient centred care.
• There were clinical governance systems and processes in place to monitor and improve the quality and performance of the service. However, the provider did not have a monitoring procedure in place to ensure the safety and effectiveness of the doctors bag.
• Service specific policies were available with the exception of a whistleblowing policy.
• The service encouraged and acted on feedback from both patients and staff.
• Systems were in place to protect personal information about patients. The company was registered with the Information Commissioner’s Office.

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

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Ensure that where a consultation is held with a child, GPs document that they have seen evidence of parental responsibility in the notes.
• Implement the recruitment policy in place to ensure two staff references are always collected.
• Implement quality improvement initiatives which may include completed clinical and prescribing audits.
• Ensure all staff receives the appropriate training necessary to enable them to carry out their duties.
• Consider arranging a translation service and review the information available for patients who do not speak English.
• Develop a whistleblowing policy.

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