Following a comprehensive inspection carried out on 1 March 2017, the Care Quality Commission (CQC) has reported that Push Doctor Limited, an online GP service, was not providing safe care in accordance with current regulations.
The CQC found that in some cases GPs working for the service had prescribed high-risk medicines, such as blood thinners, without checking whether the patient had received the correct monitoring and blood tests. Doctors were also found to be prescribing ‘off label’ medicines without recording the rationale behind their decisions.
In one case study, a 29-year-old was prescribed modafinil to keep them awake at work, despite the fact that the narcolepsy drug is not licensed for this use and an electrocardiogram is required before initiation.
Push Doctor is an online service whereby patients can access a GP via video calling seven days a week, from 7am to 10pm. According to the CQC report, each appointment lasts 10 minutes and costs £20. If required, a prescription costs £7 and can be taken to a pharmacy of the patient’s choice. The service, which carries out around 10,000 consultations a month, can be used for any health issue.
In its report, published on 22 June 2017, the CQC outlines a number of improvements to be made to the service, including following protocols to ensure the health and safety of service users; assessing the risk to the health and safety of service users and doing everything possible to mitigate any risk; maintaining an accurate and complete record of each service user; and ensuring that all prescribing decisions are based on best clinical practice and General Medical Council (GMC) guidelines.
The CQC also took urgent action to prevent Push Doctor from treating children without all the appropriate checks being made by imposing a condition on their registration. In response, the service introduced new systems and protocols to mitigate risk to all patients.
“We remain concerned about the quality and safety of remote and online services as highlighted in recent CQC reports,” says the Royal Pharmaceutical Society.
“Our view is that an online consultation can never replace a face-to-face interaction with a health professional and this should be what we strive to achieve.
“Although improving access through the provision of online services can seem advantageous, when this is done without putting in place safeguards that protect patients and the public from harm, we would expect regulators to take action,” it adds.
A spokesperson from the GMC, the regulator for individual doctors, says: “We are in receipt of the Care Quality Commission’s report about Push Doctor and we will act upon any concerns that relate to the fitness to practise of any individual doctors.”
The CQC inspection team comprised a lead inspector, one GP specialist adviser, a clinical adviser, second inspector and a pharmacist specialist.