Archived: Index Medical Limited

Updated 4 June 2019

Index Medical Limited is based in Bristol. Index Medical Limited set up an online service in 2010 which includes a remote consultation with a GP. We did not inspect the provider’s affiliated pharmacy which is regulated by the General Pharmaceutical Council. We inspected both online services known as Dr Fox online doctor and pharmacy and Fast Doctor at the following address where the provider is registered to provide services from:

60, City Road, St Pauls, Bristol, BS2 8TX

Index Limited does not see or treat patients in person at its premises. All consultations are provided remotely via a secure online portal and assessed by a team of GPs. Patients can complete an online questionnaire which is assessed by the GPs and a prescription issued if appropriate. Dr Fox and Fast Doctor had approximately 366,000 patients registered at the time of the inspection. The service can be accessed through their websites, www.doctorfox.co.uk and www.fastdr.com where patients can place orders for medicines.

The service is not intended to be used in an emergency and patients under the age of 18 are not treated. On the website patients complete a consultation questionnaire to assess their eligibility before selecting the required medicine. Patients do not have to pay to register with the service to do this. Patients pay for their medicines when making their on-line application. If approved by the prescriber, medicines via the Dr Fox website are dispensed, packed and delivered by a third party tracked and secure courier service. Medicines prescribed via the Fast Doctor website are collected from an affiliated pharmacy chosen by the patient at the time of ordering. If GPs reject a prescription request, refunds are made to the patient at this point. The service is available for patients in the UK only. Patients can access the service by phone from 9am to 5pm, Monday to Friday.

At the time of the inspection there were two directors of the service supported by three contracted GPs. They also employed a head of governance and two administrators.

How we inspected this service

Before the inspection we gathered and reviewed information from the provider. During this inspection we spoke to the Registered Manager and members of the management and administration team and one of the four GP’s who carried out consultations.

To get to the heart of patients’ experiences of care and treatment, we ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 4 June 2019

Letter from the Chief Inspector of General Practice

We rated this service as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Index Medical Limited on 16 April 2019 as part of our inspection programme.

Index Medical Limited provides an online primary care consultation service and medicines

ordering service. Patients register for the service on the provider’s website.

At this inspection we found:

• There were comprehensive systems in place to check patient identity for safe prescribing.
• There were systems in place to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• The service had risk assessed conditions that could be treated by the service and information was shared with the patients’ own GP appropriately.
• There were checks and alerts in place to prevent misuse of the service and appropriate prescribing by GPs.
• The service routinely reviewed the effectiveness and appropriateness of the care provided by conducting regular consultation audits. It ensured that care and treatment was delivered according to evidence- based guidelines and appropriate medical records were kept.
• All patient data was encrypted and securely stored.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients could access care and treatment from the service within an appropriate timescale for their needs.
• There was evidence of continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

• The provider had coordinated and collaborated with other providers to develop a risk-based identification verification standard, for all digital services. These standards were being fully implemented by Index Medical Limited and also included photographic identification for all patients under the age of 20.

The areas where the provider should make improvements are:

• Continue to develop consultation questionnaires in order that GPs have sight of information that may be necessary to support rationale for prescribing, specifically relating to contraception and travel health.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care