Last reviewed 9 May 2017
The Care Quality Commission (CQC) has reported an increase in the number of providers seeking registration to enable delivery of digital healthcare services in primary care. They have become more aware of individuals and organisations providing such regulated activities without having registered in advance, which is a prerequisite. Concerns have been raised by both patients and healthcare professionals that some of these services may not be clinically safe, potentially putting patients at risk. In this feature article, Deborah Bellamy, Primary Care Business Manager, explains what is meant by digital healthcare services, outlines the CQC guidance for patients choosing online healthcare services and information on how the CQC currently inspects and regulates digital healthcare providers.
Provision of online healthcare services is a rapidly developing sector, enabling patients to access medical and healthcare advice, diagnosis, treatment and obtain prescription medicines.
Digital health encompasses telehealth, telecare, telemonitoring, eMedicine, eHealth and mobile health. The CQC clarifies this as: “Healthcare services that provide a regulated activity by an online means that this involves transmitting information by text, sound, images or other digital forms for the prevention, diagnosis, or treatment of disease and to follow up patients’ treatment.”
Four regulatory bodies incorporating the CQC, the General Medical Council, the General Pharmaceutical Council, and the Medicines and Healthcare products Regulatory Agency (MHRA) issued a joint statement for providers and healthcare professionals highlighting the need to provide safe and effective care, ensuring safeguards are in place for patients whether they attend a physical consultation with their GP or pharmacist or access medical advice and treatment online.
Professor Steve Field, Chief Inspector of General Practice, reiterates this: “As with conventional GP surgeries, online companies and pharmacies are required to provide safe, high-quality and compassionate care and must adhere to exactly the same standards. They must not cut corners.”
To ensure quality standards are complied with, digital healthcare providers must apply to the CQC in advance of supplying such services, to register for the regulated activities they propose to deliver. Providers must assure the CQC that the care and treatment to be delivered will meet the requirements of the Health and Social Care Act 2008 and its associated regulations.
The CQC does not currently hold legal powers to rate digital healthcare providers although it is anticipated that in the future these will be granted. In the interim, the CQC will carry out an assessment of the quality of care provided, leading to a judgment about whether the care is safe, caring, responsive and well-led, based on compliance with current regulations.
Following a review of current online services registered with the CQC, the current inspection programme has been brought forward giving priority to services considered to present significant risk to patients. Information on how the CQC inspects and regulates digital primary care providers: Clarification of Regulatory Methodology: PMS Digital Healthcare Providers was published in March 2017. This document outlines existing primary care guidance and how the CQC proposes to regulate primary care digital healthcare providers and is available on the CQC website.
CQC advice for patients accessing pharmacy services
Advice for patients regarding their safety and tips for ensuring both online pharmacy and doctor services are of an acceptable standard are available on the CQC website.
Guidance for pharmacies in Great Britain stipulates that those providing internet services must be registered with the General Pharmaceutical Council (GPhC) and meet approved standards for registered pharmacies.
The GPhC operates a voluntary internet pharmacy logo scheme to provide reassurance to patients that they are purchasing medicines online from registered pharmacies complying with GPhC standards.
Patients purchasing medicines from an online pharmacy are advised to first check if the pharmacy is legitimately registered. This may be done by:
clicking on the logo which should link to the specific pharmacies entry on GPhC online register
accessing the GPhC website and searching their online register.
Current guidance is that from 1 July 2015, anyone in the UK selling medicines to the public through a website must be registered with the MHRA and be included on the MHRA’s list of UK-registered online retail sellers.
Pharmacies also need to display the new EU common logo on every page of their website offering medicines for sale, even if they are already displaying the GPhC voluntary logo. The registered EU common logo will also be linked to their entry in the MHRA’s list of registered online sellers.
Accessing online doctor services
Prior to accessing online doctor services, patients are advised to check that the doctor is registered with the CQC. This information may be found through a search on the CQC website or by telephoning: 03000 61616.
If the service is registered, the CQC will inspect to verify they are meeting the legal standards for safe, effective, high-quality and compassionate care delivery.
Patients are also advised to verify other details about the online doctor service, prior to accessing services, including checking their address, if based in England, UK or located elsewhere.
Other questions advised include:
how can the doctor be contacted in the event of questions or concerns arising?
how do they keep confidential patient information safe and who might they share it with?
how much will the service charge for the consultations, investigations, treatment or prescriptions?
who is dealing with the patient queries and providing advice?
If based in the UK, the CQC recommends checking if they are on the GMC register. If registered overseas, what are their credentials? Doctors not registered with GMC will not necessarily practise to the same clinical standards.
When patients are having an online consultation, the doctor should:
verify the patient is who they say they are
ask for detailed medical history, including significant past and current health problems
ask about current medication and any known allergies
seek permission to share the consultation outcome with the registered GP; if patients refuse such consent, online services may not be able to issue a prescription.
If patients receive a prescription, they should ensure they have been given information about the medicine, including:
what it is intended for
when and what route to take it
what potential side effects may be
For patients considering having medical tests done online, they are advised to ask:
who will be reviewing their test results?
how will they share findings of the test results?
what follow-up and support will be accessible and if there is an associated cost?
Reports of any inspections undertaken and FAQs are also available on the CQC website as are further details of patient’s advice for online services.