Archived: Doctor Matt Ltd

Updated 6 April 2017

Background

Doctor Matt ltd is an online service that allows patients to request prescriptions through a website which can be dispensed by the affiliated registered pharmacy. Patients are able to register with the website www.doctormatt.co.uk or www.theonlinesurgery.co.uk, select a condition they would like treatment for and complete a health questionnaire which is then analysed by a clinician and a prescription is issued. In the last 12 months approximately 6700 prescriptions had been issued.

Alternatively, patients can request what the provider called a ‘bespoke’ prescription which could be for any medicine. The prescriber could use a webchat facility to request any further information they needed in order to decide whether to prescribe. Once the prescription has been issued, the medicine is dispensed by an affiliated pharmacy which is part of the same organisation and posted out to the patient by a third party courier service. Doctor Matt ltd can also offer home kit blood testing for certain conditions such as diabetes and anaemia.

Dr Matt ltd is owned by DMC Medical which is a Clinical Service Holding Company. Dr Matt only provides services to patients based in the UK.

Doctor Matt ltd employs a GMC registered GP who works remotely in analysing patient information forms when they apply online for prescriptions. The service also employs a customer service administrator and an IT systems manager. The service can be accessed 24 hours a day, seven days a week through a website but patient information forms are processed Monday to Friday from 9am to 5pm. This is not an emergency service.

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).

We conducted our inspection on 10 January 2017 when we visited Doctor Matt’s registered location in Daisy Business Park, London. We spoke with the registered manager who was also the lead clinician, the IT systems manager and the customer service administrator.

Our inspection team was led by a CQC Lead Inspector. The team included a GP specialist adviser, a second CQC inspector, a member of the CQC medicines team, and a further specialist advisor.

Before visiting, we reviewed a range of information we hold about the service and asked other organisations to share what they knew.

During our visits we:

• Spoke with a range of staff
• Reviewed organisational documents.
• Reviewed a random sample of patient records.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 6 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Doctor Matt Ltd on 10 January 2017. Dr Matt is an online service providing patients with prescriptions for medicines that they can obtain from the affiliated registered pharmacy

We found this service did not provide safe, effective, responsive and well led services in accordance with the relevant regulations.

Our key findings were:

• Practice policies were available but staff had no awareness of the policies. For example, the adult safeguarding policy.
• Risks to patients were not appropriately assessed or managed. For example, we found patients being prescribed large quantities of inhalers for the treatment of respiratory disease but there was a lack of monitoring or follow up for these patients whose condition could put them at serious risk of harm.
• There service did not follow current evidence based guidelines and standards.
• There was no formal programme in place for quality improvement, for example clinical audits, to assess the service provision including organisational learning from significant events.
• The service did not have a business continuity plan in place to deal with disruption to the service or staff absence.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• We found that the service was not following their own recruitment policy which stated that all new employees would receive a Disclosure and Barring Service (DBS) check, but we found that some DBS checks were carried over from previous employment.
• We found that there was no system in place to monitor training, and some staff had not completed training relevant to their role.
• Some patients were not treated in line with best practice guidance.
• Information about services and how to complain was available.
• 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 must make improvements are:

• Ensure there are robust governance arrangements in place that includes a programme of quality improvement and that practice policies, such as the recruitment policy, are followed.
• Ensure that questionnaires completed by the patient are fully assessed.
• Ensure there is a system in place for receiving and acting upon medical and patient safety alerts.
• Ensure that patient records are complete and accurate and that care and treatment is delivered in accordance with evidence based guidelines.
• Ensure consent and capacity is adequately assessed, and the identity of a patient is confirmed to ensure the people receiving the medicines are over the age of 18.
• Ensure medical indemnity is in place for clinicians working for the service.
• The service must have a system in place to manage medical emergencies should they arise while a patient is accessing the service.
• Ensure all staff have completed safeguarding training.

The areas where the provider should make improvements are:

• Consider documenting team meetings to ensure learning is disseminated.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available

We have suspended the registration of this provider for six month until 29 June 2017 in order to protect patients.