UK web-based primary care services are being suspended by the national regulator

The Care Quality Commission (CQC) in the UK has recently suspended and warned a number of healthcare service providers after discovering that the providers were endangering patients with sub-par service. The primary issues involved failures to confirm patient identities before prescribing medications, not connecting with patients’ usual GPs, among other things. One provider did not spend sufficient time assessing patients before making a diagnosis, with some patient questionnaires taking only 17 seconds to review.

What does the CQC do?

The CQC is the regulator for health and social care providers, and makes sure that providers are meeting a certain level of safe and effective care. When they analyse the performance of providers, the CQC examines five areas of behaviour: safety; effectiveness; care; responsiveness; and leadership.

Are online healthcare services held to the same standards as regular doctors and pharmacies?

Like traditional doctors and pharmacies, online healthcare providers must still provide effective, safe patient care. In the past few months the CQC has performed numerous inspections of these types of providers and found that many were not meeting this crucial standard of care.

In April 2017, four healthcare providers were assessed, with major regulatory compliance issues uncovered by the CQC. One of them was found to have had no system in place for confirming patients’ medical history or previous prescriptions. Furthermore, they were not seeking consent to care and treatment “in line with the Mental Capacity Act 2005”, which meant that patients were not necessarily providing adequate consent to healthcare decisions being made. Another provider was more-or-less in compliance with regulatory requirements, but needed a more robust patient identity system and record-keeping practices. Due to the higher level of compliance, they were issued with requirement notices rather than warnings or suspensions.

Other issues were discovered earlier in the year, in March 2017:

• Some providers had no methods in place to determine patient capacity to consent to treatment or understand the advice they had been given

• Some providers had no mechanisms for contacting patients’ normal GPs. This was crucial for treatment plans that involved medication needing follow-ups or monitoring.

• Services failed to take into account clinical conditions of patients when making prescribing decisions, and often only one diagnosis was considered before making a decision.

• Some providers did not provide sufficient evidence that their professionals were appropriately qualified.

A solicitor from Patient Claim Line, a medical negligence law firm, is emphatic that online healthcare providers must always follow “best practice guidelines and regulations. They must also ensure that they validate patient identity, examine medical and prescription history of patients, and link up with the patient’s own GP to pass on information about decisions that have been made.”

One of the chief inspectors at the CQC, Professor Steve Field also made clear that despite services being provided online and allowing access for numerous potentially hard-to-reach patients, the “same standards of quality and safety” as traditional GP practices still need to be met.

How do we determine which online services are safe?

Most online medical services follow guidelines to the letter and provide safe and effective care, and the CQC is clearly doing a good job of finding those providers who are not up to par. GOV.UK provides a system where health service consumers can look up websites to see if they are able to legally provide health services or medicines online.

The CQC also provides assistance and information for how consumers can make decisions about selecting an online healthcare service. The factors they suggest that consumers consider are:

• Look to see whether the service is registered with the CQC

• Check where the service is based and make sure they have working contact information

• Make sure they use a clear and reasonable pricing structure

• Confirm the details of exactly what is included in the service

• Check whether staff such as Doctors based in the UK are listed on the General Medical Council register

• Look at whether the staff member confirms your identity during your consultation

• Make sure the service checks your medical history and asks for permission to share the consultation with your GP

• Look at whether the service provider gives clear instructions about medication (e.g. how to take it) as well as potential side effects

• If the provider is a testing service, look at how the results are reviewed, who does the testing, and what follow-up services are provided

The recent number of CQC cases is a signal to consumers to carefully scrutinise providers that they are considering, and look up that service’s inspections online. Take steps suggested by the CQC to ensure the safety and effectiveness of the healthcare service that you are considering. CQC reports against healthcare providers will continue to come out as they take a stance against these services that are putting people at risk.