Improvements to online primary care services still needed

The quality of virtual GP services has improved over the last year but nearly half of providers are still failing to provide safe care, the Care Quality Commission (CQC) has said.

In its long-awaited report on independent online primary care services, the regulator found that safety had improved dramatically. Just 14% of providers fully met the required standard for the provision of safe care when they were first inspected. But by February 2018, the figure had risen to 57%.

However, despite the improvements, the CCQ said this still meant 47% of providers failed to meet the necessary safety standards and that improvements were needed to ensure online services are as safe as general practice in physical premises.

One of the CQC’s main safety concerns was the inappropriate prescribing of certain drugs. It said the inability to perform a physical examination had, in some cases, led to the overuse of antibiotics as thresholds were lowered and that ‘high volumes’ of opioid-based medicines were being prescribed without consulting patients’ GPs.

The regulator also identified safety issues around the prescription of medication for long-term conditions, such as failures to monitor the volume of asthma inhalers being prescribed to individuals when their condition should be regularly checked.

In addition, it raised concerns over the collection and sharing of information with NHS GPs and ‘unsatisfactory approaches’ to safeguarding children and vulnerable adults.

Professor Steve Field, chief inspector of general practice at the CQC said: ‘New methods of service delivery that increase access to care and give patients more control over how and when they see a GP have huge potential not only for patients but for the wider health system.

‘However, while innovation should be encouraged, it must never come at the expense of quality.’

The regulator is calling for measures to be taken to ensure the ‘better flow’ of information between online independent healthcare providers and patients’ GPs. Access to NHS patient medical records, underpinned by appropriate safeguards, has the potential to improve the information available to clinics that work outside of the NHS and will ease the sharing of information back into the wider healthcare system, the regulator said.

The CQC will continue to hold online healthcare providers in need of improvements to account, and says it will share the ‘good practice’ it does find to encourage progress.

Despite concerns over safety, the regulator said its inspections revealed a high proportion of online primary care services meeting its standards in other areas, with 97% meeting regulations around being ‘caring’ and 90%  ‘responsive’ to people’s needs.

The CQC said it was engaging with the Department of Health and Social Care (DHSC) on ways to better regulate online services and is committed to ‘aligning approaches’ for remotely delivered services with regulatory partners in the UK.

In January, the DHSC granted the CQC additional powers to rate independent online primary care services from ‘inadequate’ to ‘outstanding’. The extended powers are expected to come into effect once a consultation has taken place.

‘ This way of delivering primary care has an important place in the future of health provision – but it are still evolving. We must all work together – providers by using our inspection findings to learn and improve, and oversight bodies by working together and continuing to have a positive dialogue with providers – to ensure that this model fulfils its promise of accessible, responsive care while ensuring that the care delivered is always safe and high quality’, said Field.

Responding to the report, a spokesperson from babylon, now one of the leading app-based GP services in the UK, said: ‘babylon welcomes the CQC publicly restating its commitment to learning alongside providers who offer new care models or use new technology to encourage innovation.’