HBI Awards 2017: An online and international GP Service

Doctor Care Anywhere is doctor-founded, patient-focused online international GP service.

Doctor Care Anywhere showed how doctors are consulting with patients in over 70 different countries and provide treatment and advice in all locations. The fast-track referrals to AXA PPP healthcare recommended specialists, seamless referrals to Nuffield Health in-person GPs, a global prescription management service and personalised health tracking and medication reminders, meant that Doctor Care Anywhere stood out from the crowd and was the only telehealth company to make the final shortlist

Full application

1. Briefly describe the organisation giving the number of facilities, staff, revenue numbers.

30 full-time staff, over 35 doctors (Combination of full time employed and sessional contractors) and one office in London and supporting technical team of over 10 in Serbia. Revenue numbers are confidential, however, we serve over 70 corporates, 5 major channel partners including Legal and General, AXA PPP, Aon, Nuffield Health and an International Private Medical Insurer and an International Travel Insurer.

2. Please describe the patient platform. What precisely does it enable the patient to do?

We believe in providing a rounded primary care service to best enable members to take control of their day-to-day healthcare needs and combine that with expert medical advice. We do this through:

GP appointments

Doctor Care Anywhere offers patients simple and efficient access to a GP wherever they are in the world, 24/7, 365 days a year. Members can book 20-minute video and phone GP appointments and once the consultation is underway, Doctor Care Anywhere GPs have sufficient time to speak to their patients, meaning the patient does not leave the consultation with unaddressed concerns.

Private and NHS repeat prescriptions

If required, private prescriptions are delivered or sent to the most convenient pharmacy or medication is delivered, so that home or away in the UK and across the world members can get the medicine they need. Doctor Care Anywhere’s ePrescriptions are accepted at more than 1,000 pharmacies UK wide. Members can now set up their NHS repeat prescription ordering these online via the Doctor Care Anywhere application and no longer have to deal with the hassle of contacting or going to and from their NHS GP.

Referrals and fit notes

If required, members can be provided with specialist referrals and fit notes (medical certificates) as well as being sent to an in-person GP for clinical examination and diagnostic tests in the small number of cases when this is required.

Secure access to patient medical records

All consultation notes and documents are uploaded to a member’s Doctor Care Anywhere medical record shortly after the consultation and available for download and sharing with the patient’s other healthcare providers. This means patients can understand and remind themselves exactly what’s been said and exactly how best to take the necessary steps to treat any ailment or resolve their issue.

Crucially, the platform has been designed with patient empowerment in mind by giving members secure access to their Doctor Care Anywhere medical record, 24/7, with the same high level of security as online banking platforms, encrypting all data.

Health tracking and medication reminders

Using Doctor Care Anywhere’s dedicated health tracking app, members can monitor symptoms linked to over 30 long term medical conditions as well as lifestyle factors. They can also set up medication reminders and we actively encourage members to share these findings with their GP before their consultation enabling their Doctor to provide them with more personalised advice.

Travelling abroad

We offer support and advice to members wherever they are in the world. All members have to do is book an appointment.

3. When was the service first launched?

Month : May

Year : 2014

4. What in your opinion makes the platform unique?

We have grouped our key differentiators in the market into the following 5 categories:

• Customer Experience
• Clinical Quality
• Data Security
• Breadth of integrated services
• Channel partner collaborating working experience

Customer Experience

Doctor Care Anywhere’s (“Doctor Care Anywhere”) vision is to make superb quality primary care easy to access, intuitive and affordable for individuals and their families. Each feature of our service is designed to ensure an outstanding customer experience.

20-minute virtual GP consultations at no additional charge to the patient:

• Our average length of consultation is 13.10 minutes illustrating that our patients appreciate this opportunity to discuss healthcare concerns fully with a GP and receive the appropriate advice and care to address them;
• The feeling that our patients have had the time to talk through their issue, don’t feel rushed and are listened to is the most frequent and positive customer feedback we receive. They have specifically commented on feeling a switch from “is it urgent?” to “is there anything else I can help you with?”;
• Whilst short, seemingly time-saving features and functionalities may seem attractive, often patients have multiple symptoms which need to be linked together. These can be unearthed in a synchronous video or phone appointment with a GP that is not limited by time; computerised symptom sorters are unable to do this and can often either falsely reassure or more commonly, cause concern by escalating the nature of the problem unnecessarily.

Available 365 days per year, from 8am to 10pm with a 24 hour service available on request:

• Our service is available from 8am to 10pm with a 24 hour service available on request, from wherever our patients are in the world; giving them access to UK-qualified GMC and RCGP registered GPs regardless of time or location.
• Providing appointments outside of the typical working day means that patients are able to book appointments and speak to our GPs without the need to take time off work, travel to a GP and wait long periods of time in waiting rooms.
• Increasing this access means that we are encouraging our patients to discuss health niggles that they may have put off due to the inconvenience of seeing their NHS GP.

Choice of doctor upon booking:

• We enable our members to build a relationship with our GPs by being able to opt to see the same GP each time; this allows our patients to feel comfortable speaking to the specific doctor that they want to talk to.
• Patients are able to select their GP by name, gender or area of specialist interest

Available on any device and platform:

• Through our iOS and Android apps, web app and telephone options, our service can be used on any smartphone, tablet, computer or phone;
• This versatility allows the patient to interact in a way that they feel comfortable and is most suitable to the time and place of their appointment;
• All video consultations are HD quality.

Global access and use – we are the only provider to offer this:

• Members can access the service no matter where they are in the world. To date Doctor Care Anywhere GPs have conducted consultations with patients in 77 different countries;
• Private prescriptions at home and abroad. Our global prescription management service means we can we can provide patients with prescription medication whilst overseas, whether that’s through pick up at a local pharmacy, delivery or over-the-counter advice. This depends on availability of drugs and local regulations;
• With more than 60 million visits abroad annually, Doctor Care Anywhere wants to make sure that UK residents have access to first class care even when they are abroad.

Dedicated customer service line open from 8am- 10 days per week, with a 24 hour service that is available on request:

• Open from 8am- 10pm, 7 days a week, with a 24 hour service that is available on request, 365 days a year;
• Members have a line into one of our customer service team for any questions regarding their appointment, their membership or our service in general.

Centralised Doctor Care Anywhere medical record:

• Our members have access to their Doctor Care Anywhere medical record 24/7;
• Patients can easily read their consultation notes to help them to adhere to medical advice as well as download referrals or prescriptions as required;
• All additional interactions with Doctor Care Anywhere are stored in the same, secure location in the member’s account. This includes: consultation notes; referrals; prescriptions; fit notes; test results; scans; and anything the patient uploads – photos, wellness reports, diagnostic reports, NHS summary care record;
• We are also in the process of integrating with NHS records and should be in a position to do so during 2017.

Quality of care:

Feedback taken after every interaction and follow up, any score below 4 out of 5 on any indicator is followed up by either the clinical or customer services team

Clinical Quality

Consistent and excellent clinical quality should sit at the heart of any healthcare provider, regardless of the type of service or modality of care they specialise in. To deliver this, we have set first-class standards for our doctor recruitment, clinical processes and governance board.

Specifically, we deliver this by ensuring that we recruit, train and retain best quality doctors.

All Doctor Care Anywhere GPs are:

• Are exclusive to Doctor Care Anywhere in the virtual GP market;
• Are UK trained and fully accredited with the General Medical Council (GMC) and Royal College of General Practitioners (RCGP) registered;
• Have a minimum of 5 years’ post qualification experience and have up-to-date validation. However, in reality, they have an average of ~10 years’ post qualification experience. Doctor Care Anywhere is registered with CQC as a registered provider, meeting all the requirements of the UK Health and Social Care Act 2008;
• Receive bespoke training in online consultation skills, specially designed by Royal College of GP’s eminent consultation skills’ trainer and former Royal College of General Practitioners’ president RCGP 2003-2006, Dr Roger Neighbour, OBE, MA, MB, BChir, DObstRCOG, FRCGP;
• Are proud to be part of a doctor-led organisation where they know quality will never be compromised.
• We have received feedback from our GPs that they feel our service delivers the level of care and quality of service that inspired them to pursue their profession.
• Are provided with full third party medical indemnity cover, with a limit of at least £10 million for claims arising from a single event, or series of related events, in a single calendar year. Doctor Care Anywhere is the only digital healthcare company that provides this.

Rigorous recruitment, onboarding, ongoing review processes:

• All Doctor Care Anywhere doctors have to meet our minimum requirements in terms of experience and qualifications and have to provide proof of qualifications, GP register checks, DBS and child safeguarding certifications and references;
• Our clinical leadership and doctor panel management team conduct a series of interviews during an in-person induction day.
• Doctor Care Anywhere assess the candidate’s appearance, manner and the consulting environment, in addition to their rapport-building and clinical reasoning.
• When Doctor Care Anywhere are satisfied that the candidate is suitable and ready to accept patients, they will be registered on the platform and assigned patients. Their performance is closely monitored and patient feedback and mystery shopping results feed into this continuous review.

Strict audit, significant event and complaints’ management processes:

• Once enrolled on the panel, GPs are subject to exacting standards of clinical governance.
• In addition to ongoing monitoring external appraisal and relevant training, Doctor Care Anywhere track metrics for consultation length, prescribing and referral issuing, patient feedback and clinical audit scores.
• The Clinical Team will intervene to performance-manage the GP panel and, where necessary, will suspend any GPs not meeting our performance criteria. There is also an annual internal appraisal of the GPs’ performance.

Delivery regular clinical & performance appraisals:

• We have prescribing guidelines that are developed with a specific focus on remote consultation, meeting General Medical Council (GMC) guidelines. We have further enhanced these guidelines to ensure the highest level of patient safety.
• We conduct monthly prescribing audits and significant event reviews in our six-weekly clinical governance board meetings.
• Act on patient feedback We ask each patient to rate the advice from their GP after every consultation. Any consultation that receives less than 4 out of 5 for advice is clinically investigated and repeated scores of under 4 out of 5 result in the GP being removed from our platform.

Our clinical governance board:

We have a robust clinical governance framework that is reviewed and maintained by our Clinical Governance Board, on which comprises the following medical professionals:

• Dr James Kingsland OBE, Clinical Governance Board Co-Chair
• Professor David Colin-Thomé OBE, Senior Medical Advisor
• Hemant Patel, FRPharmS, DipPharmacol, M.I.Mg, Pharmacy & Prescribing Advisor
• Dr Farzad Entikabi, MSc, MRCSE (Eng) MRCGP, Co-founder & Medical Director
• Dr. Shad Mimeh BA, MA, MBBS, MRCGP, Clinical Director

Data Security

This should be the highest priority for any digital healthcare provider. Our data promise is that we treat your information the way we wish our own to be treated, with the utmost care and confidentiality.

ISO 27001 certified:

• As an organization, we are certified with the internationally recognized information security controls defined in the ISO/IEC 27001 and are working towards HIPAA compliance;
• ISO27001 is the international standard that describes best practice for an information security management system (ISMS). We are also ISO 9001 certified.

Data stored securely in the cloud:

• Our data is hosted in the Microsoft Azure Cloud, accredited to the UK Government G Cloud framework to Level 6.
• Patient records are encrypted in transit using SSL and at rest using SQL encryption.
• The Azure data centres also have ISO 27017 (information security in the cloud), ISO 27018 (privacy protection in the cloud), ISO 22301(business continuity).

Data transfer fully encrypted:

• All communication between you and our Platform (both website and apps) is encrypted, using industry-standard ‘HTTPS’ connection. This applies to all text, video and audio traffic.

Regular breach testing:

• We operate best-in-class security and attack protection methods, including hardware and software firewalls and a unified threat management system.

Breadth of Integrated Services

Our vision is to deliver what we call “Proper Primary Care” where the virtual GP service supported by digital diagnostic and support tools is seamlessly integrated with traditional in-person GP services, health assessments and diagnostics.

These are all delivered according to patient need, and centred around and recorded in a single, secure and accessible medical record.

Virtual GP consultations:

20 minute virtual GP consultations at a time and place that suits the patient, 8am to 10pm, 7 days a week, 365 days a year, with diagnosis, self-management advice, signposting advice and guidance, prescription, referral and fit notes as appropriate.

Global prescription management service and NHS repeat prescription fulfilment in the UK:

We offer a private prescription fulfilment and delivery service where medication can be delivered directly to an address of your choice, UK and worldwide (except the US). It will be delivered within 4 hours in London, the next working day for the rest of the UK and from 24 hours internationally. We can also ensure prescription medication pick-up at any local pharmacy across the UK and in all EEA countries and where regulation permits across the rest of the world.

Through the application, patients can also request fulfilment of their NHS repeat prescription medication enabling them to manage all their healthcare needs in one accessible, convenient and secure place.

Integrated healthcare tracking:

Condition-led symptom tracking and medication reminder functionality which improves both compliance and adherence to medication and increased engagement with self-management, improved information for consultation diagnosis and improved patient experience. This results in keeping our members more engaged in their own healthcare, increases their satisfaction with the overall service and keeps them well for longer.

The Doctor Care Anywhere Health Tracking is currently available on iOS only.

Referral to in-person GP:

Whilst currently less than 10% of all our virtual consultations result in the need for referral back to an in-person GP for examination or diagnostics, if required, patients can be referred to an in-person GP at a UK location convenient for the patient, for further diagnostics and investigations. This means the patient doesn’t have to wait to see a first-class quality GP and there is continuous care where the customer journey is not broken.

Digital health assessments:

Our service will also include, by end of Q2 2017, the ability to carry out full health assessments including in-person biometric and blood and pathology tests, digital questionnaires, assessment and symptom checkers, online results assessment and reports, follow up online GP and specialist consultations, and prescriptions, as required. These will result in our members taking a proactive and ongoing positive approach to their health management and sets the foundations for efficient data-driven consults from then on.

5. What impact has the platform had on your business?

How many users have signed up for the service?

We currently have over 120,000 end users on our platform from all over the world. Our latest figures show that our GPs have conducted consultations with patients based in 77 different countries. Around 90% of our end users register for the service as part of an employee benefits scheme. We currently have 70 corporate clients who provide the service to their employees as part of their benefits programme and a 100% corporate renewal rate.

How many have subsequently become active users?

For B2C customers there is no free version, so we do not have inactive signups for that cohort.

Have you a net promoter score for the service from active users? If so, what is it?

Feedback is incredibly important to us. At the end of every consultation we ask our patients to rate us on their satisfaction of our service, the advice given by our doctor and how likely they are to recommend our service to others. Our NPS score is currently +83.

Has it led to any incremental increase in revenue? If so, how can you best quantify this?

We have a 100% corporate client retention rate. One client reported that they had an 18% decrease in absenteeism for medical appointments as a result of rolling out the Doctor Care Anywhere service. As a result of the confidence level in our service from both end users, corporate clients and channel partners, we are expecting a 5 fold increase in revenue increase from 2016 to 2017.

We would welcome your thoughts on this story. Email your views to Daisy Hotopf or call 0207 183 3779.