Online GP Services Compromising Safety of Patients

Online pharmacies and delivery services have become more common as the public look for the easiest ways to obtain relatively simple and repeat medication.

However, a recent inspection by the Care Quality Commission (CQC) has resulted in the publication of a damning report of its investigations in to Doctor Matt Ltd, an online GP provider.

The company (also known as The Online Surgery) allowed patients to register and pay around £20-30 for an online consultation and production of a prescription that could then be delivered to them.

The CQC inspected the company in January 2017 and found that the service was not providing safe, well-led or effective care in accordance with the relevant regulations. The report details that the clinician concerned had received relevant safeguarding training but non-clinical staff had not and that new Disclosure and Barring Service (DBS) checks had not been completed on all staff, instead carrying over certificates from previous employers. Worryingly, although the clinician was able to produce indemnity evidence, it did not cover the role within Doctor Matt Ltd and there were no appropriate systems in place to ensure that consent and capacity were adequately assessed or that patients were aged 18 years or over.

In addition to this, the CQC highlighted instances of unsafe care where national and local guidelines regarding the prescription of antibiotics were not followed, allowing the patient to choose the antibiotic, the dose and the duration of the treatment as well as prescriptions for long term conditions such as diabetes, heart disease or asthma based only upon presentation of proof from the client that they had received this medication previously. There was no mechanism for regular monitoring of these patients or physical examination. However, the CQC did highlight that Doctor Matt Ltd had refused prescriptions for thyroid medication where blood test results indicating low thyroid activity could not be produced.6,700 prescriptions were provided by the service in the 12 months prior to the investigation. 25 of these were produced following assessment of online questionnaires lasting less than one minute and one questionnaire was analysed in just 17 seconds.

A spokesperson for Doctor Matt Ltd commented: “Interactions may last only a few seconds, for example, when a known customer is requesting a repeat prescription – as is the case in many normal GP consultations”.

The CQC has suspended the registration of Doctor Matt Ltd for a period of six months in order to protect patients as well as issuing areas in which the company must make improvements in order to operate.

A member of the specialist clinical negligence team at Ashtons Legal, says: “In theory, I think that the idea of an online GP service would serve to meet the demand of consumerism in the 21st century. Attending a local surgery during office hours, with children or when you are a shift worker can be time consuming and inconvenient particularly if you require private prescriptions. Numerous steps have therefore been taken in recent years to alleviate pressure placed on GP surgeries, including the introduction of asthma clinics which allow patients to bypass their GP and buy inhalers following assessment from trained pharmacy staff.

“Although it appears that Doctor Matt Ltd was working towards patient convenience and accessibility, they have failed to keep central the key role of a clinician – to ensure that prescribing is necessary, appropriate and absolutely safe by following relevant guidelines and monitoring patients. The CQC has made the right decision to suspend the service so that the relevant personnel can review their practice and amend their approach. Medication is not to be taken lightly and physical examinations will always be safer and strict limitations should be made, as they are with GP surgeries, as to which medication can be prescribed without a physical assessment.”