Any reference to “skindoc”, “SkindocUK”, “our”, “us” and “Company” are references to SKINDOCUK LTD, a limited company registered in England and Wales (company number 12639692), the registered address being 85 Great Portland Street, First Floor, London, W1W 7LT. SKINDOCUK LTD own and manage this/these website(s) and the skindoc platform (“platform”) and/or its services.
Any service provided to you by skindoc will henceforth be referred to as “skindoc service(s)” or simply “services”. Dedicated clinical services shall be referred to as “Clinical Services” but the term “services” still acts as an umbrella term.
Please read these Terms carefully as they set out the basis on which we provide services to you. They cover all the services we provide to you through our website (http://www.skindoc.uk) and apply to you whether you are an NHS or private (“self-payer” or “self-funded”) patient (including those granted access via a private medical insurer (PMI) or Business with whom we are subcontracted) and should be read in conjunction with the additional Terms listed below. If you are unhappy with, or do not agree with, these Terms then you should exit the skindoc platform and cancel any appointments or submissions.
By using the skindoc platform and/or its services, you are agreeing to these Terms, along with the following additional Terms, which also apply and shall be incorporated into our contract with you:
The additional Terms and Conditions of Service apply for NHS or private patients, depending on how you are accessing skindoc services. If you are a private patient, please also see our costs and charging information.
Any reference to 'these Terms' shall include all of these Terms (as applicable).
When you use our Clinical Services, our healthcare practitioners will serve you from the United Kingdom (UK).
These Terms include details on our complaints procedure and what is required from you to provide the services. You will be asked to accept these Terms as part of your account registration. We may update the Terms from time to time, and if your rights change, we will always notify you of this. If you do not agree to, or cannot comply with, these Terms as amended, you should not use our website. You will be deemed to have accepted these Terms as amended if you continue to use the website(s), the skindoc platform and/or its services after any amendments are made.
1. ABOUT US AND HOW TO CONTACT US
skindoc exists to bring rapid, high-quality, and convenient online Dermatology right to your door. We pride ourselves on aiming to provide the highest legal, ethical and security standards. We also value your opinion and want to hear from you so if you have any questions or thoughts, or if you need to provide notice to us, please do not hesitate to get in touch via [email protected].
We provide online clinical Dermatology services via our photo upload service or live consultation video service with our Dermatologists (Clinical Services).
Our Clinical Services are provided using NHS-trained, Dermatology professionals (“Dermatologists” or “Clinicians”, collectively referred to as “Practitioners”) based exclusively in the UK. All “Dermatologists” are Consultant-grade and are on the medical and specialty register as supervised by the General Medical Council (GMC). “Clinicians” may refer to a General Practioner with Extended Roles (GPwER) who have specialist qualifications in Dermatology and are too registered and supervised by the General Medical Council (GMC). “Clinicians” may also refer to Clinical Nurse Specialists (CNS) who have specialist training in Dermatology and are register and supervised by the Nursing & Midwifery Medical Council (NMC). Before any service is offered it will be made clear who is providing it. At present, 100% of services are provided by Dermatology Consultant Doctors.
skindoc is also regulated by the Care Quality Commission ('CQC') (Provider ID 1-9882997633). The CQC is the independent regulator of all health and social care in England. The CQC monitors, inspects, and regulates all healthcare facilities including online medical services.
To contact us, please email [email protected]. We may contact you by email via the email address provided in your account, by telephone via the telephone number provided in your account or by written communication via the postal address provided in your account.
*PLEASE NOTE THAT skindoc IS NOT TO BE USED IN AN EMERGENCY SITUATION. IF YOU BELIEVE THAT YOU OR THE PERSON YOU ARE ASSISTING IS IN AN URGENT OR EMERGENCY SITUATION YOU SHOULD DIAL 999 IMMEDIATELY*
YOU SHOULD CALL 999 IMMEDIATELY in a critical or life-threatening situation, such as if someone has:
- difficulty breathing;
- severe bleeding and it can't be stopped;
- severe chest pain;
- a severe allergic reaction;
- severe burns or scalds;
- loss of consciousness;
- major trauma such as the result of a serious road traffic accident, a stabbing, a shooting, a fall from height or a serious head injury; or
- acute confused states and fits which are not stopping,
- or if you believe someone is having a heart attack or stroke.
3. OUR SERVICES
We provide our services using interlinked websites, a patient portal (“skindoc platform” or “platform”) and communication methods such as email.
Our services include:
- an asynchronous photo upload Clinical Service (using ‘store-and-forward’ or ‘SAF’ technology) whereby carefully crafted questionnaires are completed by the patient and accompanied with patient-provided photographs and/or videos to create a bundle ready for review by our Practitioners;
- a synchronous remote live online video consultation Clinical Service (using ‘live conferencing’ or LC’ technology) with our Practitioners. This service also utilises questionnaires completed by the patient and patient-provided photographs and/or videos. It is possible to book and amend appointments;
- a bespoke acne pathway specificlly for the highly regulated medication, isotretinoin (also know as Roaccutane or Accutane). This service functions similarly to our snchronous remote live online video consultation Clinical Service except has additional steps including an enhanced consent process, pregnancy monitoring and enhanced support.
- where appropriate through use of our Clinical Services, our Practitioners may prescribe medicines (see sections 3.7 & 9);
- access to healthcare records we hold; and
- access to other digital healthcare links that provide health and lifestyle information.
3.1 Photo upload Clinical Service
The photo upload Clinical Service is open twenty-four (24) hours a day, three hundred and sixty-five (365) days a year including bank holidays. Cases can be submitted under several headers and we aim to address each case within forty-eight (48) hours. Although your case will be assessed by a Consultant Dermatologist you do not get a choice of who. Instead, it will be the next available Practioner who will review and accept your case unless deemed inappropriate for the photo upload Clinical Service. A Practioner may decide to reject your case or discuss with the administrative team about possibly ‘upgrading’ the case to a live online video consultation instead. For self-payers, additional fees would be required for such an ‘upgrade’, but charges will not be made without you, your insurance company and/or the payers’ explicit permission. In the event of cases originating from the NHS, PMI or other Business subcontract, a discussion will be had with the relevant NHS providers who would need to provide authorisation.
3.2 Live online video consultation Clinical Service (including Acne only - Isotretinoin (Accutane/Roaccutane))
Remote live online video consultation appointments are subject to availability. Appointment times are subject to change and are only made available to you at our sole discretion. In the event that:
- you require medical advice and you are unable to access skindoc services for whatever reason;
- there are no appointments available to suit your requirements;
- you miss an appointment for whatever reason;
- you lose connection to the skindoc platform during an appointment; or
- your appointment is cancelled, including as a result of a Practitioner being unavailable,
it is your sole responsibility to either book an alternative appointment with us or seek appropriate alternative medical advice from alternative service providers (e.g. your NHS GP practice if you are registered with one). If the issues stem or originate from our side we will endeavour to assist you where we feel appropriate. See our Did Not Attend (DNA) policy in Appendix 1.
3.3 Practitioners and choice (Live Consultations only)
You will have a choice of Practioner from those available however we do not make any guarantee whatsoever as to the availability of any single Practitioner at any time. There may be occasions when only one Practioner is available on a given day. There may also be occasions when there are no Practioners available on a given day.
As required by the CQC and UK law, we make appropriate checks to ensure that each Practitioner has a current and valid registration with the GMC/NMC and has a right to practice in the UK. Dermatologists must also be on the GMC’s specialist register.
If you think that our services have not met this standard, please contact us as soon as possible. We will fix or re-perform, without charge, any services we agree do not meet this standard.
3.4 Your appointment length
A live online video consultation appointment is a thirty-minute block of time, during which you can have a consultation with a Practitioner via the skindoc platform. At time of writing that applies to both private and NHS patients but is subject to change.
3.5 Booking an appointment in advance
You can choose to book several appointments in advance. There is no maximum number of consecutive appointments that you can book in advance at any time. You can request an appointment on your chosen date and time (subject to availability) via the skindoc platform.
3.6 Confirmation of appointments
After you have requested an appointment via the skindoc platform you will be sent written confirmation of the appointment in the form of an email. If you do not receive such confirmation within twenty-four (24) hours of requesting your appointment, please contact us (see Section 1) to check we have received your booking request. Please remember to check your ‘Junk Mail’ folder.
3.7 Your right to amend an appointment once booked
If you wish to make a change to the date or time of your appointment you should do this by contacting us as soon as possible. You can only change your appointment a minimum of twenty-four (24) hours before it is scheduled to occur. If it is possible, we will confirm via email, any changes to the date or time of your appointment or anything else which would be necessary as a result of your request. If we cannot make the change or the consequences of making the change are unacceptable to you, you may want to cancel your appointment. Cancellations can be made a minimum of twenty-four (24) hours before your appointment is due.
3.8 Our duty if we make changes to a booked appointment
We will advise you by email or telephone as soon as possible if we must amend, change, or cancel any appointment that you have booked.
3.9 Prescription services
Prescriptions will only be issued by Practitioners where it is appropriate, legal, and responsible in the circumstances and as the result of discussion and mutual agreement between you and the Practitioner. We are partnered with the online Pharmacy company Phlo® (https://wearephlo.com/) who can safely and securely arrange delivery of medicines anywhere in the UK. You are under no obligation to utilise their services but if you would like to, we will help facilitate this. Alternatively, paper prescriptions can be provided to you or your GP and a nominated Pharmacy can be utilised to dispense medicines. In this event it would be your responsibility to be aware of and adhere to the nominated Pharmacy’s guidelines on dispensing medicines.
Practitioners will not prescribe medicines unless it is, in their judgement, in the patient's best interests.
3.10 Our services are for Dermatological complaints only
Some conditions are not suitable for the SAF service and likewise some are not suitable for live online video consultations via our Clinical Services. You should always seek advice from a medical practitioner in person if you are unsure about whether you have been able to explain or communicate your medical needs through our Clinical Services, or if you have any concerns about the advice you receive from us or if it is different from other advice you have received. All services are currently only provided in English.
3.11 Physical Examination
You should not use our Clinical Services if you have a condition that you know will require an in-person physical examination.
3.12 Your GP
If you are a self-payer or private patient (including those granted access via PMI or another Business subcontract), we strongly encourage you to discuss any information that you receive from us with your GP or usual medical practitioner. We also strongly encourage you to permit us allowance to send relevant clinic outcomes onward for storing in your NHS, GP-held medical file.
3.13 Follow-up appointments
A 'follow-up' appointment is one that follows on from a previous one. skindoc aims to reduce the price of follow-up appointments but there is a time limit of three months between appointments before the timeframe is no longer valid and a new appointment must be made. In special circumstances your doctor may decide to waive this condition.
4. WHAT WE NEED FROM YOU IN ORDER TO PROVIDE SERVICES
We are unable to provide our services without certain information from you. We can only provide the services in accordance with these Terms if you provide us with the information we need in order to help you. You must be careful that:
- you provide full and accurate information about your medical history and current symptoms (to the Practitioner during an appointment and by uploading relevant information to the skindoc platform, as applicable). Failure to provide full information may impact on our ability to provide services and the ability of the Practitioner to make a full assessment of your health and care needs;
- any information you give to us or a Practitioner, must be in English;
- you seek further medical advice if you have any concerns about the information we provide you or any information in the websites;
- you follow any instructions you are given by Practitioners;
- you follow any instructions regarding the use of any medicines or healthcare products we recommend or prescribe (including in respect of use-by dates);
- you seek immediate medical assistance if you suffer adverse or unexpected effects of any treatment, medicine or healthcare product recommended to you on the skindoc platform and/or by a Practitioner. Please see Emergencies (see Section 1).
- you report any adverse or unexpected effects of treatments we recommend to us;
- you keep any medicines we give you securely and do not allow others (especially children) to use them;
- you tell us if any of our information about you is or becomes inaccurate or incomplete; and
- you use our services only for yourself, unless you are helping a child or caring for a dependant adult, further to section 7.
- you not use our services for any inappropriate purposes (including, without limitation, to obtain clinically inappropriate prescriptions);
- you comply with our Fair Usage Policy (see Appendix 2, below) at all times;
We rely on an accurate record of your use of services to do this. Please do not therefore register more than once for our services.
To register with us you are required to provide accurate and complete information, including your first and last name, date of birth, sex, email address, postal address, UK mobile telephone number (you are not permitted to use landline numbers in place of a mobile telephone number) and any other information that we specifically request. You must always keep your account details up to date.
We reserve the right to terminate any account which (at any time) does not include a valid email address and UK mobile telephone number (not a landline) on file as part of that individual's account. Both the email address and mobile telephone number must be stored in the profile of your account. Please note this does not affect our conformity with all relevant UK laws regarding the keeping, maintenance and protection of medical/patient records.
You should not register multiple accounts; if you do, this will mean that records of your care may be inaccurate, and you may put the safety and quality of your future care at risk.
Where you submit to us any personal health information to for upload to the skindoc platform which you have obtained from a third-party health service provider, you warrant that such information is provided lawfully and has not been tampered with.
You should keep your log-in details confidential. If you choose, or you are provided with, a user identification code, password, or any other piece of information as part of our security procedures, you must treat this as confidential. You must not disclose it to any third party. If you know or suspect that anyone other than you knows your user identification code or password, you must promptly contact us (see Section 1). We also strongly advise you turn two factor authentication (2FA) on as soon as you log in for the first time.
You are solely responsible for all activity that occurs on your account and you must notify us immediately if you become aware of any unauthorised use of your account or if your login details are lost or stolen. We shall not be liable for any losses that you incur as a result of any unauthorised use of your account.
We reserve the right to monitor your use of the skindoc platform and/or its services and to disable any user identification code or password, whether chosen by you or allocated by us, at any time, if in our reasonable opinion you have failed to comply with any of the provisions of these Terms or if we suspect any unauthorised use or misuse of the skindoc platform and/or its services.
4.3 Identity (ID) checks
Before any skin care can be provided to you, we must verify your identity. Checking your ID is necessary so we can ensure that a safe, secure and effective service is delivered. It also makes sure that we are helping the right individual and not an impersonator. For children beneath 18 years old or cared-for individuals you will need to provide either their birth certificate, passport or an order of guardianship/confirmation of parental/carer responsibility.
We aim to complete the verification process within 24 hours. We recommend that you upload the documents as soon as possible to avoid any delays. Simply navigate to your skindoc account where you will be prompted to upload a selfie/photo as well as the necessary identity documents.
Upon submission, you can continue using the skindoc website, submit and book appointments. We will update your account with the outcome once verification is complete.
Please note, if you have been referred to us, for example from an NHS GP, your ID will have already been verified. If not, please contact us by clicking here.
Before any skin care can be provided to you, we must verify your identity. We accept the following forms of ID:
- Driving Licence (UK, Isle of Man, Channel Islands and EU)
- Biometric Residence Permit (UK)
- Birth Certificate (UK, Isle of Man and Channel Islands) - issued within 12 months of birth)
- Adoption certificate
- National ID*
*Please be aware that not all National ID’s are accepted. If you submit an ID that is not recognised, we will contact you.
In addition to our dedicated ID checking process, we may contact you by telephone or email to verify identity or other account information and may request further information from you, which you agree to provide, in order to ensure you have not fraudulently created your account. If you do not provide this information in the manner requested within seven (7) working days of the request, we reserve the right to suspend, discontinue or deny you access to and use of the skindoc platform and/or its services until the information is provided to our reasonable satisfaction.
4.4 Stable Internet Connection
Since live consultation services are provided by video connection we require you to have a stable and strong internet connection to deliver continuous and affective services. Ideally, we would suggest a patient enables a direct 'hardwired' connection to their router/LAN although a good wi-fi connection is usually sufficient. If a patients internet connection is unstable and/or the connection 'drops out' during your consultation skindoc cannot be held accountable for any delays or if the doctor needs to terminate the consultation after your allocated time has elapsed (usually 30 minutes) as another patients appointment may be due. In the event of a significantly affected consultation a refund cannot be provided as the doctor needs to be paid for their booked time/services and they do not have control over the patients internet connectivity. As such, another appointment may need to be arranged and the costs of this will be the patients responsibility.
4.5 What we do with your information
5. TECHNICAL INFORMATION FOR USING THE WEBSITE AND PLATFORM
We recommend that if you are using a wireless network to access the website, you avoid use of public wi-fi facilities in favour of a personal wi-fi connection, and that the wireless network is secured with WPA-2 or WPA-3 security. We recommend that the device from which you access the website is password protected, set to lock after a short period of inactivity, and protected with suitable anti-virus and anti-malware software.
Our services are accessed remotely using the internet, data networks and devices which can access the internet (“Infrastructure”) and operate the websites. We make the websites available for access using Infrastructure but are not responsible for Infrastructure ourselves. If you wish to use the services, you should ensure you have an internet-enabled device and a sufficient internet connection available.
Technical or security threats or issues affecting the Infrastructure may require us to suspend our services in order to ensure they are secure and/or operating optimally. We will minimise these suspensions, but are not responsible to refund charges or compensate you if they occur, unless they exceed 30 days in aggregate in any 12 month period, in which event you may cancel your agreement with us.
When you use the skindoc platform and/or its services or send e-mails to us, you are communicating with us electronically. We will communicate with you by e-mail or by posting other information on your medical profile as is necessary to deliver the services to you.
We operate anti-virus and malicious software prevention measures on the websites but we cannot guarantee that our services will always be virus-free. You should ensure that your devices used to access services are protected against viruses and malicious software. You must not use or expose the websites to virus or malicious software contamination.
You must not attempt to gain unauthorised access to the services or websites.
6. ACCESSING OF OUR SERVICES
Our services are available to adults, and to children in the UK in accordance with section 7.
Any persons using our service outside of England must understand that this business is registered in England and is fashioned around the English healthcare system. As such, we are regulated by the Care Quality Commission (CQC) and abide by structures and systems put in place to serve the people of England. However, due to significant similarities to the healthcare system within the UK, skindoc will strive to provide an equal clinical and administrative service to the entire UK population. This includes, but is not limited to, access to pharmacists and communication with allocated GPs.
If you are accessing our services from outside the UK, you can expect us to provide an equal clinical service to that of the UK population albeit with clinical decisions made in the context of UK-healthcare culture and training. A limited service however, must be expected in regard to accessing your homeland healthcare systems, with which we are not familiar or affiliated. You must also expect a lesser administrative service. Finally, you should check whether it is lawful to access our services in the territory where you are. We provide our services in compliance with UK law and regulation and cannot take responsibility for any differences between those rules and any different rules applying to healthcare services anywhere else.
7. CHILDREN, DEPENDANT ADULTS AND OUR SERVICES
Adults can use our services on behalf of children, but children should not use our services themselves, alone.
According to the standard based upon Gillick v West Norfolk and Wisbech Area Health Authority (1985) persons below the age of sixteen can consent if he or she fully understood the medical treatment that is proposed and as such as a matter of Law the parental right to determine whether or not their minor/child below the age of sixteen will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed.
It is therefore up to the discretion of the treating Practioner to decide whether a minor is indeed ‘Gillick Competent’ and thus able to consent to a suggested medical treatment. Since Gillick competence cannot be assessed by us prior to registration or submission we have taken the decision to deny under-16s the ability to self-register. Instead their parents, carer or legal guardian must always register in their place and supervise the child’s use of our services.
For photo upload cases, Gillick competence cannot be assessed and thus consent for treatment can occur only after the age of 16 unless the treating Practioner contacts the patient to assess them which is not standard practice.
Young people between 16 and 18 may use our services and open their own account with us, but only if entitled to by an adult who has agreed to use of their credit or debit card for the payment of charges. This will need to be provided to us and verified by said adult.
We may suspend services or terminate user accounts if we reasonably suspect that they are being used in breach of the restrictions in this section.
When a child matures into adulthood, they can request sole ownership of an account via our administrative team. They will be required to re-verify their ID to do so.
7.2 Dependant adults
Carers or adults responsible for a patient (e.g. for those with cognitive impairment, language impairment etc.) can open an account with us and use our services on behalf of the cared-for individual. They may use our services and open an account with us, but for our self-paying service, only if done so with the strict permission of the dependant adults registered lasting power of attorney ( LPA ) or responsible financial officer who has the legal power to use their credit or debit card for the payment of charges.
8. CLINICAL LETTERS, CORRESPONDENCE AND DOCUMENTATION
All forms of documentation will remain available to you for download from your secure and personalised medical file on the skindoc platform. This includes but is not limited to your clinical letter, prescription, invoice, and patient information leaflets. We believe keeping your documents on the skindoc platform is more secure than emailing them as emails are liable to interception.
In the unlikely event documents are sent to you via email you understand and accept that documents are deemed to have been sent to you once the skindoc platform marks the email containing the document as 'correct' and 'sent', including time and date stamping for our records. You understand and accept such records shall be accepted by you as proof that we have sent the document and fulfilled our obligation to provide the same.
You understand and accept that we are not responsible for the spam, junk or mail receipt prevention tactics of your email service provider/host, which may for whatever reason outside of our control filter emails from us away from your inbox. In such instances you understand and accept that you must take such issues up with your email provider and not us.
In the UK, Practioners and prescribing Pharmacists are permitted to prescribe medicines without meeting the patient face to face.
All Practioners who have signed up to provide Clinical Services via skindoc have undertaken to comply with the General Medical Council Guidelines on remote prescribing, essential standards of quality and safety as enforced by the Care Quality Commission. Copies of these can be found at http://www.gmc-uk.org and http://www.cqc.org.uk.
We do not provide prescriptions for controlled drugs (as defined by the misuse of drugs act 1971).
You should understand and accept that each Practitioner, at their sole discretion, creates prescriptions via the skindoc platform based on their own professional judgement and legal obligations. You understand and accept that that the content of such items is individual, based on information you provide to the Practitioner and your submission or presentation at the time of your consultation. As such, the contents of any prescription may vary; the precise nature of the content shall be at the sole discretion of the Practitioner and you agree to hold harmless skindoc, its employees, officers, directors, agents and affiliates from any claim that may arise as a result of the contents of such items. You must not tamper with the content of any such prescriptions (to do this would be a criminal offence). You understand and accept that there is no guarantee that such prescriptions will contain the content you desired, hoped for, expected, were informed of, understood, or believed they would contain.
Prescriptions can be provided to both Non-NHS and NHS patients but please note the prescription is a private prescription and as such prices of medications are at your chosen Pharmacist’s discretion. We have no influence over their prices nor are we remunerated in any way. NHS patients who want their prescription processed by their nominated Pharmacy linked to their GP surgery must request the medications via their GP. With your permission we will send your GP a copy of your prescription to help facilitate this, but it is your responsibility to ask your GP to translate it into an NHS prescription. You should expect a delay if requesting this option and one based on your GP surgeries organisational structure. We cannot ‘speed up’ this process.
Non-NHS patients can request their prescription be sent to their GP for translation into an NHS prescription. It is at your own GPs discretion if they want to honour your request and we are under no obligation to help sway their decision.
If you are happy to pay for a private prescription, we will send it to our online Pharmacy partners Phlo® (see section 3.9) who will contact you and can arrange nationwide delivery. If you would prefer not to use Phlo® we can instead provide you with a paper prescription which can be given to the Pharmacy of your choice. You are under no obligation to purchase prescribed medicine from any particular Pharmacy.
We have no control over or responsibility for any individual Pharmacy, their policies in relation to acceptance or otherwise of prescriptions, opening hours, cost or availability of medicines prescribed. You should check with your chosen Pharmacy if they accept private paper prescriptions before using them.
You should refer to Phlo’s website (https://wearephlo.com/) or your chosen Pharmacy’s website for further information on delivery times as well as their Terms and Conditions. For context, Phlo® can provide real-time, same-day prescription delivery across London and next day delivery across England.
We or our partner Pharmacy may refuse to fulfil an order where it considers the order not to be in the best interests of the person for whom it is intended or who has ordered it or may be illegal or contrary to any regulation or guideline.
If no one is available to take delivery of the order when delivery is first attempted, there may be a delay in delivery, and/or the recipient may have to follow the procedures of the relevant despatch company in order to collect the order, including picking it up from a depot.
Our partner Pharmacy are not part of our organisation and, to the extent permitted by law, we disclaim responsibility for their acts and omissions.
10. TESTING SERVICES
We currently do not offer 'in house' private testing services but if we feel that you warrant further investigation we will make a reasonable attempt to request this via your GP unless the investigation requires a secondary care facility, for which we would request onward referral. We can however help arrange for home blood test kits to be sent to you for a minimal price (price includes cost of purchasing the kit, administrative fees, laboratory fees and reporting by a doctor).
Results of investigations obtained externally and independent to skindoc can be sent to us and interpreted free of charge as long as it relates to an ongoing case with us. The results will be forwarded to your treating Practioner and advice relayed to you if appropriate.
When sending us your results we will assume you provide us consent to upload to your skindoc medical file for secure storage. This way these results can be used to inform any further developments in your case or future consultations.
11. CHANGES TO THESE TERMS
We may need to change these Terms sometimes, for example, when the rules regulating our services change, in order to ensure that our services are secure and your information is safe, or when we update or modify our services or our charges. If we make a change to these Terms that affects your rights or obligations, we will notify you.
12. CHANGES TO THE PLATFORM AND/OR ITS SERVICES
We may update and/or make changes to the skindoc platform and/or its services from time to time, for example, to reflect changes in your needs and/or our business priorities, security updates or any legal or regulatory changes. We will try to give you reasonable notice of any major changes in advance. If you are not happy with the proposed changes, then you may contact us (see Section 1) to terminate your account with us.
We do not guarantee that the skindoc platform, or any content on it, will always be available or be uninterrupted. We may suspend or withdraw or restrict the availability of all or any part of the skindoc platform for business and operational reasons, including (without limitation) for technical or security reasons. We will try to give you reasonable notice of any suspension or withdrawal.
If we need to suspend access to the skindoc platform at any time prior to any appointment that you have already booked, we will notify you in advance (unless the suspension is due to unforeseen circumstances such as emergency maintenance) and arrange a new appointment for you as soon as possible.
We reserve the right to suspend or terminate your access to the skindoc platform and its services at any time, without notice and without us bearing any liability to you, if we reasonably believe you have breached any of these Terms. In such circumstances, any appointments that you have already booked will be cancelled.
13. CONSULTATION RECORDINGS
We do not record consultations. Only in exceptional cases may we request to record the online consultation if the Practioner feels threatened or abused. If you feel that you are victim of abuse you may also request the Practioner record the consultation for you.
14. DISCLAIMERS & LIMITATIONS TO OUR SERVICE (in addition to those previously stated)
Practitioners may hold different clinical opinions on the same medical condition or symptoms and, provided these opinions are reasonably held, the fact that two or more Practitioners give different opinions in the course of service provision does not necessarily indicate that our services are defective.
We do not tolerate abuse or offensive behaviour towards Practitioners.
Our services are designed to be accessed remotely by any of our customers and are not designed for non-English speakers.
We may need to ask you for certain personal information in order to provide our services. If you do not provide this information when requested, we may be unable to provide our services.
We may suspend your access to services or terminate your account with us if your use of services breaches any of these Terms.
We shall not be responsible if the supply of the services is delayed or prevented by circumstances outside our reasonable control. If this happens we will contact you as soon as possible to let you know and we will take steps to minimise the effect of the delay or failure. Where the delay means that we cannot supply the services in respect of an appointment that you have already booked, we will try to offer you an alternative appointment. If there is a risk of substantial delay, you may contact us (see Section a) to cancel your account and/or cancel any appointments.
Although substantial effort is made provide secure, professional, reliable and quality services we make no warranty that the platform and/or its services will meet your requirements or that the services will be uninterrupted, 100% secure or error-free, or that defects, if any, will be corrected. We are not responsible for transmission errors or any corruption or compromise of data carried over local or interchange telecommunication carriers. You are responsible for configuring your devices in order to access the platform. You should use your own virus protection software.
We will take all reasonable precautions to protect against failure of our equipment and software and are ensured that regular back-ups of all data stored is performed by our third-party provider of cloud storage. You acknowledge and accept that in the event that restoration of data from backup is necessary, it may take several days to complete such restoration of data and resume operation of the platform and/or its services, in which circumstances any booked appointments shall be deemed a disrupted appointment.
We do not endorse the promotions, products or services of any third-parties, nor do we warrant or validate the accuracy of any third-party advertisements, promotions, communications or other materials. We do not assume any responsibility or liability for the accuracy of information contained on any third-party web sites.
Any information on our platform or in any communications from us (other than advice provided by a Practitioner following a photo upload case or during an appointment) is for general educational and informational purposes only and is not intended to amount to advice on which you should rely. Such information should not be relied upon as a substitute for seeking appropriate individual medical advice or services.
Although we make reasonable efforts to update the information on the platform, we make no representations, warranties or guarantees, whether express or implied, that the content on the platform is accurate, complete or up to date. We accept no responsibility for any consequences relating directly or indirectly to any action or inaction you take based upon such information.
You should always seek the advice of a doctor or other qualified healthcare provider regarding any medical concerns (and before starting, stopping or modifying any treatment or medication) even if you have already obtained medical advice via or read relevant material on the skindoc platform.
skindoc does not guarantee that a photo upload case or live online video consultation is the best course of accessing advice or indeed the appropriate course of treatment for your particular healthcare concern or medical issue. You agree to contact your GP immediately should your condition change or your symptoms worsen (if you are not registered with a UK doctor you agree to contact your local walk-in centre or hospital for advice). In an emergency, you should contact your nearest emergency services centre immediately.
14.4 Dermatology Specific
14.4.1 Image Quality
Diagnostic accuracy is only as good as the information provided. The quality of the photographs and/or videos supplied is therefore of paramount importance. Furthermore, remote dermatology (known as teledermatology) is known to be slightly less accurate than in-person assessment. skindoc denies responsibility for mis-diagnosis and associated mis-management based on poor quality images. skindoc does however employ a manual process of quality control to ensure cases are only accepted based on images that can be used to accurately manage a patient’s case. This process keeps the quality of service high and helps protect patients from inaccurate management. If the photographs and/or video are considered of too poor quality you will be contacted to consider re-submitting better images unless there exists an additional issue in which your case may be fully rejected and alternative medical assistance suggested.
14.4.2 Hair-bearing skin & mucosal lesions
The scalp and other areas with a significant amount of hair may need to have hair physically displaced or removed, otherwise the hair can obstruct the camera from taking sufficiently useful photographs. Mucosal lesions and orifices, including genitalia, often require special attention to lighting and exposure in order to allow photography. These regions are also difficult to photograph without assistance and thus it is reasonable to assume some patients would struggle to. Given the challenges of capturing photographs under these conditions, image quality is like to suffer and as such so is diagnostic accuracy as explained in section 14.4.1.
14.4.2 Cameras & Dermoscopy
Service users should ideally have a smartphone or at the very least a digital camera. These devices are required to provide photographs or video clips and without them you would not be able to engage with our Clinical Services. The skindoc platform is also designed to accommodate both smartphones and laptops/personal computers (PC) but the former provides a better overall user experience as smartphones tend to have both internet browser and photographic capabilities.
Although the skindoc platform can accommodate an array of dermatological ailments, if users are seeking help with skin lesions (e.g. moles) then it is often necessary a smartphone be used as dermatoscopic attachments (devices that attach to smartphones and magnify images) are often critical to providing adequate images to accurately process a patients case. Lesional cases submitted to skindoc will be rejected if dermatoscopic images are required.
14.4.3 Suspected skin cancer
skindoc offers a lesion checking service as part of its usual Clinical Services. The vast majority of lesions reviewed in Dermatological settings are benign but a significant number do subsequently result in a diagnosis of skin cancer. If you feel that your lesion(s) represent a possible skin cancer you should discuss with your GP about onward referral to a community or secondary care setting for review and a view to a biopsy of these lesions. We do not have any established links with surgical clinics nor do we perform surgery via established skindoc clinics. In summary, you should only submit images that you think are benign.
14.4.4 Wrongly Identified Lesions
A study produced by Ke et al. (2009) demonstrated that 29% of patients incorrectly identified the wrong lesion when referred for biopsy. With this is mind, it is extremely important that any patient using skindoc’s Clinical Services double or even triple check that the photographs uploaded for lesional analysis directly correlate with the body map location that they are submitting. Not only will this aid in managing your case, but it is also essential for lesion surveillance and allows us to accurately inform you that a lesion has or has not changed at your next review with us.
This disclaimer applies to all service users. The responsibility of any error in the provision of information and/or associated poor or reduced prognosis lies wholly with the submitting individual. That being said, if a discrepancy is noticed by a skindoc Practioner it is assumed that they should raise that query with the patient or carer and request repeat submission of data if appropriate.
14.4.5 Full body examination
A full body skin examination using the photo upload Clinical Service or the live online video consultation is feasible, but it may not show all skin lesions and surfaces with sufficient detail. Enhanced lighting, multiple imaging and several angles may be helpful but this a major limitation to online Dermatology services. Likewise, we limited the number of images a user can upload to six (6) to reduce the burden of storage requirements. We feel six (6) is a generous amount and sufficient for the vast majority of cases.
14.4.6 Darker skin types
Darker skin phototypes (Fitzpatrick 4, 5 or 6 - https://dermnetnz.org/topics/skin-phototype) may impede diagnostic accuracy as, when photographed skin rashes or skin lesions are subtler. Photographs may not demonstrate the true appearance, compared to a face to face examination, as regularly as individuals with lighter skin phototypes do.
15. PRICE, PAYMENT & REFUND
You can pay for Clinical Services using a credit or debit card. Skindoc uses the third party provider, Stripe, to take, freeze, capture and authorise all payments provided via the skindoc platform. Skindoc and Stripe comply with PCI standards and ensure the use of HTTPS and othere security best practices which are are not susectible to card testing. Skindoc and Stripe ensure that all customer payment information is handled safely.
If you meet the NHS eligibility criteria and are referred to us then the skindoc platform and/or its services will be provided at no charge to you so long as you remain registered with your GP. Not all features of the service will be funded by the NHS. Where this is the case, this is explicitly stated to you.
If you are a self-payer the price of our Clinical Services will be set out on the website at the time of our commitment to provide services. Our prices may change at any time, but price changes will not affect any Clinical Service that you have already ordered.
You are responsible for paying the price for our Clinical Services (“Charges”). Charges include VAT, where applicable, unless otherwise stated.
We will usually charge or invoice you for Clinical Services at the time you order them. Any amounts charged or invoiced are due and payable upon our invoice being issued unless otherwise specified. Payment may be held first, before finalised charge, to ensure your case is appropriate for skindoc If it is felt otherwise, your payment will be released back to you rather than taken and refunded.
Refunds can also be issued if both the patient and the doctor feel the service provided was not optimal and/or the service was deleterious to a patients health. Refunds remain under the discretion of skindoc and are not guaranteed.
Skindoc is not responsible for refunds requested in regard to medication dispensed by utilised pharmacies or investigations requested from laboratories.
16. OUR LIABILITY TO YOU
Because these Terms are part of a binding legal agreement, we must compensate you for loss you suffer if our service doesn't comply with these Terms. However, we don't compensate you for all losses. This section is important as it explains those things.
- If we break any of these Terms and you suffer loss or damage, we are responsible for compensating you for that loss or damage if it was a foreseeable result of our breaking of these Terms.
- We are not responsible for compensating you for loss or damage that is not a foreseeable result of breaking these Terms. Nor will we be liable for indirect, incidental, special or consequential damages.
- Other than our Clinical Services, our software and other services are provided on an ‘as is’ basis without a warranty of any kind being provided by us.
- We are responsible for compensating you for personal injury or death caused by our negligence or that of our Practitioners or employees, and for defective products where we are legally responsible for their supply. Subject to doing this, and subject to applicable law, we will not be liable to you for an amount greater than the fees paid to us by you. Whilst the Practitioners are independent contractors and not employees of skindoc we ensure that each of the Practitioners holds appropriate medical indemnity insurance to cover them in respect of claims arising from the provision of medical advice by them via the skindoc platform.
- If we provide digital content that is defective and damages a device or other digital content belonging to you, and we have not used our reasonable skill and care, we will compensate you or repair the device or content (at our election).
- We will not be liable for any loss or damage resulting from defective digital content where you have failed to follow our usage instructions or advice in these Terms.
- We supply the services for private personal use and we are not responsible for any losses you suffer arising out of the use of the services which are business losses.
- We design our services and the websites to keep your personal health data secure and it is important that you follow the usage instructions and advice in these Terms in order to keep your data safe. We are not liable for loss or unauthorised access to your data where it results from you not following these instructions and advice.
- We are not liable for business losses. We only supply the services for domestic and private use. If you use the services for any commercial, business or re-sale purpose we will have no liability to you for any loss of profit, loss of business, business interruption, or loss of business opportunity.
17. INTELLECTUAL PROPERTY
We (SKINDOCUK LTD) are the owner or the licensee of all intellectual property rights on the skindoc platform and in the material published on it. These works are protected by copyright laws and treaties around the world. All such rights are reserved. The trademark ‘skindocUK™’ can be searched using TM No. UK00003507545.
You are permitted to use the skindoc platform in order to receive our services, store it on your device and print copies of it for your personal use. You may communicate material containing skindoc branding to your GP or another medical practitioner. You are not permitted to copy, distribute or make any business use of the skindoc platform. You must not remove or obscure any notices regarding SKINDOCUK LTD intellectual property.
You may print off one copy, and may download extracts, of any page(s) from our platform for your personal (non-commercial) use. You must not modify the paper or digital copies of any materials you have printed off or downloaded in any way, and you must not use any illustrations, photographs, video or audio sequences or any graphics separately from any accompanying text. Our status (and that of any identified contributors) as the authors of content on our platform must always be acknowledged.
If you print off, copy or download any part of our platform in breach of these Terms or otherwise breach our intellectual property rights, your right to use our platform will cease immediately and you must, at our option, return or destroy any copies of the materials you have made.
You may not use any logo or other proprietary graphic or trademark of ours, our Partners or affiliates without our express written permission.
18. LICENCE AND WEBSITE(S)/PLATFORM USE
You are allowed to use the websites but not copy it or distribute it.
We grant you a limited licence to access and make personal use of the skindoc platform and not to modify it, or any portion of it, except with our express written consent. This licence does not include any resale or commercial use of the platform or its contents; any derivative use of the platform or its contents; or any use of data mining, robots, or similar data gathering and extraction tools.
The platform or any portion of the platform may not be reproduced, duplicated, copied, sold, resold, visited, or otherwise exploited for any commercial purpose without our express written consent. Any unauthorised use terminates the permission or licence granted by us.
The platform and/or any services may contain links to other independent third-party websites (“third party sites”). Third party Sites are not under our control, and we are not responsible for and do not endorse their content. You will need to make your own independent judgement regarding your interaction with any third-party sites, including the purchase and use of any products or services accessible through them.
If any open-source software is included in the platform, the Terms of an open-source licence may override some of the Terms set out in this section.
You acknowledge and agree that skindoc’s provision of the necessary platform infrastructure and end user data storage for the services will be through Digital Ocean. Notwithstanding anything to the contrary in these Terms, to the extent that the services include services provided by Digital Ocean, skindoc shall pass-through the commitments from Digital Ocean with respect to using their products for the services, and skindoc’s sole obligation with respect to the use of Digital Ocean with the relevant services is to enforce its rights against Digital Ocean on behalf of itself and you. skindoc is not liable to you if skindoc is unable to obtain remedies from Digital Ocean.
19. CANCELLATION/TERMINATION OF OUR AGREEMENT WITH YOU AND CONSEQUENCES
1. You may de-register from skindoc and sign up with a new online dermatology service at any time in the usual way.
2. You may end your agreement with us:
- if the services are unavailable for reasons outside our control as set out in section 14
- if you do not agree with a material change we propose to make to these Terms under section 11; or
- if we have failed to fix or re-perform services not provided to the standards set out in section 3.
3. If you end your agreement with us, you will be given two weeks to download any clinical information in relation to previous or current cases before your account will be permanently closed and all documentation erased.
4. If you want to cancel your agreement under this section, you must give us notice by calling us on 02078710074 or email us at [email protected].
5. We may end our agreement with you, subject to applicable regulation:
- if the services are unavailable for reasons outside our control as set out in section 14;
- you do not, within a reasonable time of us asking for it, provide us with information that is necessary for us to provide the services, for example valid contact details;
- if you do not comply with the conditions on use of services set out in sections 4, 7, 17 and 18;
- you seriously (as determined by us) or repeatedly breach any of these Terms or our Fair Usage Policy (see Appendix 2, below).
- if you break any other term of this agreement and do not make good that break within 7 days of when we ask you; or
- for the self-payers, if you do not pay us any Charges owed.
We will advise you of any termination or suspension via the contact email held as part of your Account.
20. COMPLAINTS AND DISPUTES
You can always give us feedback on our services by calling or emailing us via the details provided in the ‘Contact us’ section above (see section 1).
If you have a complaint about our services, we would like to resolve it as soon as possible. Please tell us about your complaint as soon as you can so that we can do this.
If you wish to make a formal complaint about our services, you should do so as soon as possible by calling or emailing us via the details provided in the ‘About us and how to contact us’ section above (see section 1). We may ask you for certain details about you and your complaint in order to address it. Please provide these as soon as you can so that we can resolve your complaint quickly.
Our Practitioners are registered healthcare professionals, and we will handle your complaint in an appropriate way, as required to do so by the professional rules that apply to our Practitioners and to our services and following our complaints procedure.
We will tell you the outcome of our investigation into your complaint and give you the chance to discuss it with us. If we have done something wrong, we will apologise to you.
If any disagreement between you and us arises in connection with these Terms, we will attempt to resolve it by discussing it with you.
If we have not resolved a disagreement about these Terms, or a complaint about our services, either of us can refer the dispute to mediation in accordance with the Centre for Effective Dispute Resolution's independent mediation scheme for patients (see https://www.cedr.com/consumer-disputes/healthcare/mediation/introduction).
You may also submit a disagreement with us for online resolution to the European Online Dispute Resolution platform at https://webgate.ec.europa.eu/odr (or search "odr Europe").
These Terms are governed by English law and the English courts shall have exclusive jurisdiction to hear any claim arising out of or in connection with these Terms or the use of our products and services.
21. OTHER IMPORTANT TERMS
Other provisions explaining how we may exercise our rights under these Terms
- If there is any proposed transfer of our rights and obligations under these Terms, we will always notify you in writing and this will not affect your rights under these Terms.
- As our services are personalised, you may only transfer your rights or your obligations under these Terms to another person if we agree.
- The agreement for our services is between you and us, and no-one else. Only you can enforce that agreement (although a parent or guardian may enforce their agreement on behalf of a person under 18 whose use of our services is allowed under section 7).
- We may transfer our rights and obligations to someone else. We may transfer our rights and obligations under these Terms to another organisation. We will always tell you in writing if this happens and we will ensure that the transfer will not affect your rights under the contract you have with us.
- You need our consent to transfer your rights to someone else. You may only transfer your rights or your obligations under these Terms to another person if we agree to this in writing.
- Nobody else has any rights under these Terms. No other person shall have any rights to enforce any of these Terms
- If a court finds part of these Terms illegal, the rest will continue in force. Each of the paragraphs of these Terms operates separately. If any court or relevant authority decides that any of them are unlawful, the remaining paragraphs will remain in full force and effect.
- Even if we delay in enforcing these Terms, we can still enforce them later. If we do not insist immediately that you do anything you are required to do under these Terms, or if we delay in taking steps against you in respect of your breaching these Term, that will not mean that you do not have to do those things and it will not prevent us taking steps against you at a later date.
- Which laws apply to these Terms and where you may bring legal proceedings. These Terms are governed by English law and you can bring legal proceedings in respect of the Platform and/or the services in the English courts. If you live in Scotland you may alternatively bring legal proceedings in Scotland. If you live in Northern Ireland you may alternatively bring legal proceedings in Northern Ireland.
APPENDIX 1 – ‘DID NOT ATTEND’ (DNA) POLICY
Live online video consultation Clinical Service
If a self-paying/private patient (including those funded by their PMI or services provided on behalf of a business with whom we are subcontracted) fails to attend a pre-booked appointment on 1 occasion the patient will be contacted, their case archived, and payment retained by skindoc If they re-contact skindoc their case can be re-instated, but they will have to pay again for another appointment. Their case will be archived for 28 days. Certain circumstances may be taken into account and a decision to offer a free re-booking considered. This will be made on a case by case basis.
If an NHS patient fails to attend a pre-booked appointment on 1 occasion the patient will be contacted and offered the opportunity to re-book. However, if a patient fails to attend a pre-booked appointment on 2 occasions this is considered unreasonable, they will be discharged and they will have their case archived. If they re-contact skindoc they will be asked to seek re-referral by their NHS referrer. Their case will be archived for 28 days.
If there was a technical error which led to patient missing their appointment with the Practioner then the patient will have a new appointment scheduled free of charge. If the patient declines another appointment they will be refunded in full.
Photo upload Clinical Service
This is not applicable for self-paying patients as they pay upon submission. This is applicable to patients referred from the NHS or private healthcare/insurance companies/businesses with whom we are subcontracted who fail to use their unique login details. These details will expire after 28 days after which the referrer is notified of the DNA. The referrer will not be charged and the administrative costs will be absorbed by skindoc. The administrative duties involved include registration, notification, de-commissioning of unused patient account and notification of DNA to referrer (to ensure effective tracking).
APPENDIX 2 – FAIR USAGE POLICY
Our Fair Usage Policy is designed to prevent fraud, abuse of Memberships and to ensure that everyone who wishes to use our services is able to access a UK doctor as fast and safely as possible.
Unlawful, prohibited or unusual activities (this list is not exhaustive)
You are not permitted to (or permit anyone else to):
- use the skindoc platform or its services in any unlawful or fraudulent way and/or for any unlawful, fraudulent or inappropriate purpose;
- use the skindoc platform or its services for the purpose of harming or attempting to harm minors in any way;
- post or transmit a message (written, verbal or via video) under a false name or use our network resources to impersonate another person or misrepresent authorisation to act on behalf of others (including but not limited to Practitioners) or skindoc. All messages transmitted via skindoc platform should correctly identify the sender and you may not attempt to alter the origin of email messages or postings;
- allow another person or entity to use your account, username or password (unless a permitted minor) ;
- use our service for multiple people under one person’s profile or medical records. This is a criminal offense as this is considered fraud and impersonation under section 2 of the Fraud Act (2006).
- market, promote or solicit the services except as expressly permitted by these Terms;
- distribute chain letters or unsolicited bulk electronic mail ("spamming") via the platform, to skindoc, or to any third party allegedly on behalf of skindoc.;
- attempt to undermine the security or integrity of computing systems or networks of skindoc., the skindoc platform or any sites or platforms accessed through or via the skindoc platform, and you must not attempt to gain unauthorised access;
- harvest or collect data about any other individual who uses the skindoc platform or its services;
- post or transmit any data, materials, content or information which is threatening, false, misleading, abusive, defamatory, derogatory, pornographic or profane, or that contains or promotes any virus, worm, Trojan horse, time bomb or other computer programming or code that is designed or intended to damage, destroy, intercept, download, interfere, manipulate or otherwise interrupt or expropriate the skindoc platform and/or its services;
- tamper, hack, spoof, copy, modify or otherwise corrupt or attempt to gain unauthorised access to the administration, security or proper function of the skindoc platform and/or its services, or the server on which the skindoc platform or related materials are stored or any server, computer or database connected to the skindoc platform. You will not use robots or scripts with the skindoc platform;
- attempt to reverse engineer, reverse assemble, reverse compile, decompile, disassemble, translate or otherwise alter, defraud or create false results from any executable code or information on or received by this skindoc platform. You agree to have anti-virus and/or anti-spyware software running that is set to override the Internet browser's cookie setting;
- upload or provide any information to the skindoc platform or any Practitioner in breach of any third party's intellectual property rights and/or any obligation of confidentiality or contractual duty owed to any third party; or
- reproduce, duplicate, copy or sell any part of the skindoc platform in contravention of the provisions of our Terms.
Breach of this Fair Usage Policy
When we consider that a breach of this Fair Usage Policy has occurred, we may take such action as we deem appropriate.
- Failure to comply with this Fair Usage Policy constitutes a material breach of our Terms upon which you are permitted to use our Platform, and may result in our taking all or any of the following actions (at our sole discretion):
- Deletion of any information provided by you that we deem in our sole discretion to be fraudulent, abusive, defamatory, obscene or in violation of any third-party intellectual property right.
- Suspension or termination of your contract for services. Where we consider it reasonable and at out complete discretion, we may provide you with a notice of improper behaviour before suspending, terminating or offering alternative services, as we deem appropriate.
- Issue of a warning to you;
- Legal proceedings against you for reimbursement of all costs on an indemnity basis (including, but not limited to, reasonable administrative and legal costs) resulting from the breach.
- Further legal action against you.
- Disclosure of such information to law enforcement authorities as we reasonably feel is necessary or as required by law.
We exclude our liability for all action we may take in response to breaches of this Fair Usage Policy. The actions we may take are not limited to those described above, and we may take any other action we reasonably deem appropriate.