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CQC inspections backed to weed out 'rogue' providers of online care

Targeted inspections carried out by the Care Quality Commission (CQC) in England into the provision of online care services can help improve quality, security and reliability of online primary care providers and help to keep out or shut down "rogue" providers in the market, an expert in the regulation of health care said.27 Mar 2018

Louise Fullwood of Pinsent Masons, the law firm behind Out-Law.com, was commenting after the CQC published a report into the state of care in independent online primary health services (39-page / 890KB PDF).

The CQC carried out what it said were "35 comprehensive inspections of online primary health care providers" between November 2016 and July 2017. By February this year, it had re-inspected and reported the findings concerning 16 providers. Through those inspections the CQC assessed whether the services provided were safe, effective, caring, responsive and well-led.

The regulator said the findings raised a number of concerns, particularly on patient safety, including around the monitoring of long-term conditions, clinical oversight, identity verification and acting on patient and medicines safety alerts. It also said there was "limited information sharing with patients’ GPs", and flagged further concerns in relation to the way in which some 'off-label' drugs are prescribed online and on the assessment of patients' mental capacity.

"It is fair to say that there have been some providers of online primary care services who have not appeared to be running a service which is in the best interests of all of their patients," Fullwood said. "In general, online primary care services can be a great tool to provide convenient ways for people to access advice, treatment and medication. However, certain practices may be putting patients at risk, and the CQC correctly identified particular concerns that risks to patients may not always be appropriately assessed or managed."

Fullwood said that the CQC's inspections exercise was principally focused initially on online consultations or forms for prescriptions and other medication, such as Viagra or weight loss agents, but that the scope of its enquiries, and of the final report itself, was "consistently broader".

"This targeted and specific inspection system as outlined in the report will help keep out the rogues and increase trust and credibility in the provision of online primary care," Fullwood said. "This will benefit the legitimate players and help ensure patient safety."

Fullwood said that the CQC has been clear with its inspection programme that the online provision of care must adhere to the same standards that GP surgeries are held to. The rigorous approach has had results, she said.

"The CQC gave certain providers a highly critical inspection report, suspended registration of one and led to others closing altogether or restructuring operations," Fullwood said. "The CQC ran a formal inspection of all such providers during 2017 and clarified the terms on which they inspect and assess. It was remarkable to see this focussed exercise taking place and being completed within a matter of months by an organisation which has a very high workload and limited resources – this demonstrates the level of concerns and perceived risk."

"We noted in particular a strong emphasis on data protection, security and privacy which was very good to see. We also noted with interest the flagged need for online providers to not act in a silo, but, for example, to provide relevant information to patient’s GPs. It was also interesting to see direct criticism of prescribing out of line with evidence based/best practice guidance, such as prescribing strong painkillers which were not in line with consultation policy," she said.

Fullwood said that there is a perception that online services are open to abuse from 'patients' who are seeking a specific prescription which their own GP will not give them.

"The guidance in the report has a number of factors which would act to shut down this tendency for online consultations to be 'giving patients what they want' rather than what is in their best interests," Fullwood said.