Lloyds Online Doctor Ireland launched on the 8th of July 2013 and has 15,000 registered patients as of April 2014. Contraception is our most popular area of treatment, representing 76% of all consultations. This is followed by erectile dysfunction (17%) and STI testing (5%). Our patient profile mirrors this trend – over half of all our patients are female and between the ages of 25-35. How does Lloyds Online Doctor work? Patients log in to lloydsonlinedoctor.ie and complete a clinical questionnaire relating to their chosen treatment area. The questionnaires are dynamic and substantial – our contraception questionnaire alone has over 30 fields. Once complete, a clinically designed algorithm categorises patients by risk. For instance, a patient with a BMI over 30 and who is also a smoker will have these details flagged on their record. Once categorised, the patient data is sent to our doctors who decide whether it is suitable to issue a prescription. Often they will contact patients for further information – this is done via an online patient record or via telephone. Over time the patient record becomes a useful source of data, building a holistic picture of each patient’s situation. About this survey The purpose of this survey is to assess our performance against a number of key indicators, including our ability to communicate effectively and the quality of care that we provide. We asked eighteen questions, based on those asked by the NHS. The survey was sent out to 13,524 registered patients on the 14th of March 2014. This sample includes the 8% of patients who have been refused treatment on clinical grounds. As of the 7th of April we have received 894 completed surveys, a response rate of over 6%.

1. Irish Clinical Satisfaction Survey
April 2014
From left: Dr Christina Hennessey, Dr Tatjana Street,
Stephen Bourke, Dr Tom Brett and Dr Gigi Taguri

2. Irish Clinical Satisfaction Survey 2
Medical Director’s Introduction
The term ‘online doctor’ still carries a lot
of baggage in Ireland and patients are
right to be sceptical. It’s an alien concept
that suffers from a negative association
with spam email, illegal online pharmacies
and irresponsible medicine. However, done
right, we believe that technology can have
a transformative effect on healthcare,
improving access, choice and affordability.
But how do we define best practice?
In the UK, the Care Quality Commission (CQC) regulates our practice to
ensure that we meet their rigorous standards for the provision of primary care.
In Northern Ireland the Regulation & Quality Improvement Authority
conducts a similar audit. We embrace this approach as it helps patients to
distinguish between legal and illegal practices, promoting safety. Regular
audits provide us with critical feedback to ensure that we are providing the
best possible service to patients. Progressive legislation enables us to innovate
and find new ways to use technology to solve healthcare problems.
In the Republic of Ireland there is currently no equivalent to the CQC and
the Medical Council of Ireland’s guidelines for telemedicine are limited. This
makes it difficult for Irish patients to know who to trust and stifles healthcare
innovation. In order to address this gap we have developed our own patient
satisfaction survey, based on the guidelines provided by the NHS.
We are very pleased at the overall response rate and feedback. The survey has
also highlighted areas where we need to improve, something that we take very
seriously.
On behalf of myself and the rest of the doctors I want to thank our Irish
patients for their support over the past year and welcome the opportunity
to work with Irish regulators to define best practice.
Dr Tom Brett
Medical Director
LloydsOnlineDoctor
“I just wanted to email you
to thank you and to say
that I think this is the best
idea that I’ve come across
in a long time. I have
suffered with erectile
dysfunction for ten years
and embarrassment has
prevented me from
seeking any sort of help
from my own GP. I have
now received my
prescription with a range of
possible treatments
today so at last I can at
least have a chance to
restart my sex life. For that
I am truly grateful.”
Feedback from a male patient, published with permission

3. Irish Clinical Satisfaction Survey 3
General Manager’s Report
Lloyds Online Doctor Ireland launched on
the 8th of July 2013 and has 15,000
registered patients as of April 2014.
Contraception is our most popular area
of treatment, representing 76% of all
consultations. This is followed by erectile
dysfunction (17%) and STI testing (5%).
Our patient profile mirrors this trend – over
half of all our patients are female and
between the ages of 25-35.
We believe that demand is driven by convenience as much as affordability –
while our consultations are typically cheaper than face to face consultations,
38% of our patients have a Medical Card or GP Card. This means that despite
qualifying for free or subsidised primary care a large minority of patients are
willing to pay a fee for the convenience and discretion of an online service.
How does Lloyds Online Doctor work?
Patients log in to lloydsonlinedoctor.ie and complete a clinical questionnaire
relating to their chosen treatment area. The questionnaires are dynamic and
substantial – our contraception questionnaire alone has over 30 fields. Once
complete, a clinically designed algorithm categorises patients by risk. For
instance, a patient with a BMI over 30 and who is also a smoker will have
these details flagged on their record. Once categorised, the patient data is
sent to our doctors who decide whether it is suitable to issue a prescription.
Often they will contact patients for further information – this is done via an
online patient record or via telephone. Over time the patient record becomes a
useful source of data, building a holistic picture of each patient’s situation.
What is to stop patients lying?
Nothing. We believe that patients should take responsibility for their own
health, whether online or in a face to face consultation. However, our
algorithm enables us to flag inconsistencies which our clinical team can then
decide to challenge. Ultimately the decision to prescribe is up to our doctors,
not the algorithm. A credit card is also required for payment, which helps
prevent identity fraud.
LloydsOnlineDoctor
About this survey
The purpose of this survey is to assess our performance against a number of
key indicators, including our ability to communicate effectively and the quality
of care that we provide. We asked eighteen questions, based on those asked
by the NHS. The survey was sent out to 13,524 registered patients on the 14th
of March 2014. This sample includes the 8% of patients who have been
refused treatment on clinical grounds. As of the 7th of April we have
received 894 completed surveys, a response rate of over 6%.
Summary of results
We are pleased with these results, particularly given that we only launched
nine months ago. Better still are the 159 practical pieces of feedback that we
have received from patients. We have bunched these into themes on page
seven and will work to improve each area over the coming year. Crucially, we
need to improve the way we communicate with pharmacists and with the 8%
of patients that our doctors cannot treat on clinical grounds. We also need to
sort out logistical challenges, such as how we can get time sensitive
prescriptions to patients faster.
Transparency and data protection
The information that we collect from our patients is privileged and survey data
is no different. However, anonymised patient data may be made available to
accredited Irish healthcare professionals for non-commercial purposes and in
accordance with EU data protection laws. Interested parties should contact us
at info@lloydsonlinedoctor.ie for more information.
Stephen Bourke
General Manager
OVERALL
Max score: 5
CARE
Max score: 5
COMMUNICATIONS
Max score: 5
RESPECT
Max score: 100%

4. Irish Clinical Satisfaction Survey 4LloydsOnlineDoctor
Excellent
Good
Average
Poor
Very Poor
0
10%
20%
30%
40%
50%
60%
I don't want to
talk about my
treatment
with my GP
I don't currently
have a regular GP
Lloyds Online
Doctor is
cheaper than
seeing my GP
Lloyds Online
Doctor is more
convenient than
seeing my GP
I was unable
to get to an
appointment
with my GP
Why did you decide to use Lloyds Online Doctor?
(Please tick all that apply)
n=850
How would you rate the quality of care that
you received when using our service?
Very happy
Quite happy
Neither happy nor unhappy
Not happy
How happy are you with the overall
service provided by Lloyds?
Average score: 4.63 out of 5
n=850
Average score: 3.71 out of 4
n=850
Overall Service

5. No
Yes
No
Yes
No
Yes
Very easy
Quite easy
Quite difficult
Very difficult
Irish Clinical Satisfaction Survey 5LloydsOnlineDoctor
How easy did you find it to get the information you
needed about your treatment and the medication
prescribed by our doctors?
Were you aware that our doctors sent you information about
your treatment after you ordered (via your patient record)?
Average score: 3.64 out of 4
n=838
Did you feel confident enough to ask the doctor a
question through your patient record if you had any
concerns or questions about your treatment?
If you messaged our doctors via your patient record were
their questions and responses clear and understandable?
Yes: 66.7%
n=838
Yes: 90%
n=320
Yes: 93%
n=210
Communication

6. Don't know
No
Yes
Don't know
No
Yes
Don't know
No
Yes
Irish Clinical Satisfaction Survey 6LloydsOnlineDoctor
Overall, how would you rate the communications you
have received from Lloyds Online Doctor?
Did you feel your privacy was respected when using
Lloyds Online Doctor?
Average score: 4.59 out of 5
n=827
Did you feel that you were treated with respect when
using Lloyds Online Doctor?
Are you confident that your data is being held and managed
securely by Lloyds Online Doctor?
Yes: 91.2%
n=748
Yes: 94.5%
n=785
Yes: 76.9%
n=817
Excellent
Good
Average
Poor
Very poor
Respect

7. Irish Clinical Satisfaction Survey 7LloydsOnlineDoctor
Areas for Improvement
1. Communication with pharmacists
What our patients say: “[I experienced] raised eyebrows and questions
from the pharmacist followed by a backroom consultation among staff
when I presented the prescription!”
Some pharmacists have queried the validity of scripts issued by our doctors,
particularly with regards to our English practice address. We will address
this issue by launching a communication campaign in the pharmacy trade
press.
2. Delivery options and timings
What our patients say: “I placed my order for my prescription on the third
of March. Was told it would have arrived within five days. I am still waiting.”
As electronic prescriptions are not currently legal in Ireland we have to send
out our prescriptions by post. Sometimes scripts get lost – in this instance
we issue a second script and send it via registered post at no additional
charge. We will investigate courier options and how we can work with a
patient’s nominated pharmacy in order to find a more reliable solution.
3. Communication when treatment is refused on clinical grounds
What our patients say: “I was refused weight loss medication, which I ac-
cept, but I was not given a reason why.”
Our doctors may find that it is not medically appropriate to provide a
prescription for treatment – this occurs on average 8% of the time. We are
currently reviewing our patient messages to ensure that we provide clearer
reasons when treatment is refused.
4. Providing holistic healthcare solutions
What our patients say: “Getting my blood pressure is a bit of a nuisance...
but I can understand why you need it. If there was some way of making
that easier it would be good.”
We will investigate ways in which we can work with other healthcare
providers (such as chemists, medical device suppliers and nurses) to
improve access.
5. Linking payments to existing healthcare infrastructure
What our patients say: “I got no receipt provided, so I am unable to get a
partial refund through my insurance.”
We will work with insurers to understand if our consultations can be
covered by traditional plans and provide patients with itemised receipts in
the first instance. Please note that receipts are available on request.
6. Improving our patient record
What our patients say: “The doctor needed additional information but I
did not realise they would be contacting me through the Lloyds portal
rather than email or text.”
Data protection restrictions mean that we cannot communicate personal
information via email or text. However, we are currently upgrading our
content management system which will improve visibility of messages. We
will also look to simplify the messages going out, in order to make clinical
communication as clear and concise as possible.
We asked patients “What can we do to improve our service?”

8. Emily and Bobby, the stars of our
STI testing campaign. See the
video at bit.ly/1jnznBD
For more information please
contact Rebecca Matthews at
info@lloydsonlinedoctor.ie
Lloyds Online Doctor
50-54 Wigmore Street
London W1U 2AU