Archived: Livi UK

Letter from the Chief Inspector of General Practice

We rated this service as Outstanding overall. We have not previously inspected this service.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Livi UK on 5 May 2021 as part of our inspection programme.

Digital Medical Supply UK Limited (The Provider) (trading as “Livi UK”) was a wholly owned subsidiary of Digital Medical Supply Sweden AB, which itself was a wholly owned subsidiary of Kry International AB, a healthcare company, which provided healthcare services across a range of European countries. Livi UK (the service)provided access for patients within England (and other UK Home Nations) to healthcare for patients within three separate categories:

• Patients of NHS GP practices with whom Livi UK had entered into contracts;
• Self-funded patients (Pay as you go appointments),
• Clients of an international life and health Insurance company.

Patients signed up to access the service via an app or through Livi Connect. They could book appointments either on the same day or up to seven days ahead. GPs were able to advise on a range of medical issues, so long as no physical examination was required, and provide prescriptions or referrals to specialist services. Prescriptions were, for most patients, sent to a pharmacy of their choice; for other patient’s prescriptions were sent according to the rules set by their NHS GP. The service was free to use for most patients, however self-funded patients paid one inclusive fee which included any necessary prescription and/or sick note.

At this inspection we found:

• The service had good systems 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 routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• 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 a strong focus on continuous learning and improvement at all levels of the organisation.

We saw the following areas of outstanding practice:

• On 7 March 2020, at the outset of the Covid-19 pandemic, NHS England asked the service to develop a system for home monitoring of early cases of patients with Covid-19. Within 30 hours of being asked, the service developed and adapted their systems, including expansion of its operational hours to 24 hours a day seven days a week to establish the NHS National Covid Home Monitoring Service (CHMS). CHMS enabled patients to receive access to care without risking potential exposure of others to the virus. In total the service supported 791 patients during the first month of the pandemic. All surviving patients were discharged back to their NHS GP’s on 31 March 2020.
• In March 2020 the service launched Livi Connect (“Connect”), a free web-based platform enabling healthcare professionals (including those with no connection to the service) to conduct secure remote video consultations with their patients. Connect was launched in response to the spread of Covid-19 to make it easy for healthcare professionals to continue with their work remotely, and as a best way of replicating face-to-face contact. Connect was free to use for all doctors and other healthcare professionals and was available in 10 languages: English; French; German; Italian; Spanish; Swedish; Norwegian; Danish; Dutch; and Polish. The provider had launched Connect in other European countries. Since launching Connect, it had enabled 26,473 patients in the UK, and 190,000 across Europe to benefit from video consultations with their healthcare professional.
• The service had implemented a comprehensive range of wellness benefits for staff it employed to ensure their physical and mental wellbeing. The impact of the benefits was demonstrated by the findings of the 2021 staff survey, including: 86% of GPs said the service took positive action on health and wellbeing.

The areas where the provider should make improvements are:

• Review the system for recording GPs NHS appraisals and ensure GP records of these are kept up to date.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care