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Primary care

Online primary care improving but there is still work to do, says CQC

In an inspection by the Care Quality Commission, 43% of online primary care providers were not providing safe care in February 2018, compared with 86% of providers before July 2017.

The quality of online primary care services has improved over the past year, according to a report from the Care Quality Commission (CQC). But continued action from both the providers themselves and their oversight bodies is needed to ensure online services are as safe as the service offered in physical premises, the report warns.

The CQC’s report is based on findings from 55 inspections carried out between November 2016 and February 2018. A total of 35 of these were carried out before July 2017 as part of an initial programme of visits by the CQC. Between July 2017 and February 2018, 16 of the previously inspected 35 online providers were re-inspected at least once.

During the initial round of inspections, 86% of providers were found not to be providing ‘safe’ care. According to the report, by 28 February 2018 this figure had decreased to 43%. Examples of improvement measures taken included a provider deciding to no longer prescribe certain medicines, and implementation of systems through which an opioid prescription triggered an automatic letter to the patient’s GP.

“Where we initially found concerns, our re-inspections have shown a willingness among providers to improve and adapt,” the report stated. However, safety issues are still a problem with some providers. “One of the main barriers we found to providing safe, high-quality care is a lack of coordinated two-way sharing of information between providers – particularly in the safe management of long-term conditions, including asthma.”

The report also highlighted concerns around the prescribing of antibiotics. Some services inspected were found to be lowering the threshold at which antibiotics were prescribed. This, the report says, is because the prescriber was unable to carry out face-to-face examination of a patient’s chest, ears or throat.

Safe care was one of five ‘key areas’ assessed by the CQC, the other four were whether the service was caring, effective, responsive to people’s needs, and well-led. As of 28 February 2018, 97% of providers inspected met standards to be considered ‘caring’ and 90% met ‘responsive’ standards. Regulations related to being ‘well-led’ were met by 63% of providers, and 54% met regulations around being ‘effective’.

The CQC recognised the advantages that online primary care can offer, especially to patients with a physical or sensory impairment, and those who live in rural areas and have poor transport links. But it warned that advances in technology had outpaced regulations.

Helen Stokes-Lampard, chair of the Royal College of GPs, said it was “very concerning to see that even now, 43% of online consultation providers have been deemed unsafe in some respect”.

“New services will inevitably experience some teething problems but when our patients’ health is at risk, urgent, swift action must be taken to comprehensively address these before the service is rolled out further,” she said. “It is now essential that lessons are learnt from this report to ensure patients are not put at risk and that they receive the high-quality care they need and deserve.”

The CQC plans to rate online primary care providers from April 2019.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204588

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