/ Health

Would you use an online GP app?

New online GP services promise to make access to healthcare easier and quicker. Would you use a digital doctor?

Along with an app where you can book appointments, check your symptoms, and order prescriptions, the NHS has recently been rolling out a new service where you can have an online consultation with a GP.

‘GP at Hand’ promises to revolutionise the way we see a doctor, allowing patients to book near-instant consultations that take place via video chat.

But despite the positives, such as convenience, some have raised drawbacks. In order to use the GP at Hand app, patients have to de-register from their existing practice and instead sign-up as NHS patients to a private healthcare company, Babylon, which has partnered with the health service.

The full story of GP at Hand’s promises and pitfalls was covered in this month’s magazine, but we wanted to get some additional thoughts from some of the Which? staff who have used the app.

We also asked a GP for their opinion, and have included their thoughts below.

Catie Doherty

I am a member of a private medical insurance scheme and noticed that they offer an online GP service.

The website advised that they can make recommendations for treatment and at the time I was suffering with abdominal pains most days.

After a short discussion with the GP they advised me that I potentially had colon, cervical or bowel cancer and would be best to attend a GP in person. They referred me for a colonoscopy, which thankfully came back clear. It turned out I had a simple dairy intolerance.

It was very fast to download an app to my phone and book in an appointment within 24 hours. The consultant was very friendly but didn’t seem all that professional to me and it certainly didn’t feel like a visit to my own GP.

Amelia Wade

I’m a very happy Babylon patient. A few years ago I emigrated from New Zealand and have found the NHS to be excruciatingly frustrating to navigate. I bounced around GPs and clinics to the point that I gave up because my health just didn’t seem worth the stress.

Then I was recommended Babylon. Appointments are easy to book and fit into your schedule, the doctors are patient and helpful and, when you need to see someone in person, that’s something which can easily be arranged.

I like that I get sent a summary of my appointments which makes me feel like I have some control of my own health.

Adam Gillett

I use the Babylon/GP at Hand product somewhat involuntarily – I started the process of switching from my normal GP practice but didn’t complete it, only to find some months later that it had been completed without my consent form and I had been deregistered at my previous practice!

This issue aside, I do appreciate the convenience of it for minor requests and issues. I would worry, however, if I were required to use it for long-term consistent treatment, or needed more major attention. I also feel that the attention you are given as a patient is lessened with GP at Hand, and there is of course no opportunity for the doctor to spot physical signs of an illness that they might in person.

It’s not a replacement for a proper appointment, and Babylon will need to become a lot more transparent for me to have greater confidence, but as a relatively young person with few medical complaints I shall doubtless carry on using it until something more serious comes along.

An anonymous GP

The main concern for me about services like GP At Hand is the real and very serious threat they pose to the financial sustainability of conventional GP practices.

GP at Hand can decline to register patients with complex conditions in a way that conventional services cannot, and at any rate is unlikely to appeal to the frail, elderly and vulnerable.

They will essentially cream off the most straight-forward and ‘cost effective’ patients leaving already extremely overstretched conventional practices unable to remain financially viable. Closure of general practices is a very real and serious problem with many of the neediest patients losing or at risk of losing their local surgery.

GP At Hand may be very convenient for tech-savvy and generally healthy working age people, but it threatens the very fabric of general practice for the patients who need it most.

Have you had an experience with an online GP? Are such digital health services going to help the NHS or damage it?

Join Catie, Amelia and Adam by giving your experiences and thoughts, positive, neutral or negative, in the comments below.

Comments

There’s an article on the subject in the February issue of the magazine.

So far I have had no difficulty in getting an appointment to see a doctor or nurse, though I am disappointed that they don’t do routine blood tests or medication reviews like the practice that I used to use.

I would he interested to give video chat a go but our surgery does not seem to be at the forefront of using technology. I’m not keen on sitting in the waiting room with people who are coughing and sneezing.

DerekP says:
9 February 2019

I echo the concerns raised by your anonymous GP.

Currently, many patients find that it is very difficult to book GP appointments and this development may further aggravate the problem of inadequate resources at surgeries.

I agree Derek.

There are many situations where an in-person appointment is unnecessary. Difficult to think of scenarios at the moment, but there are times you need to go through your GP to access other services when a quick phone/video chat could suffice. Access to the surgery nurse for tests is usually via the GP, some things that might require an X-ray to make a diagnosis, referral to private treatment, etc. A photo of a skin blemish to ask whether it is anything to worry about could be initiated remotely and the patient told to make an appointment in person if necessary.

Our own GP surgeries need to run online services as our health is best served by those who are likely to know our history. Online chats could save surgery time enabling faster appointments in person. Less communicable ailments would be spread around in waiting rooms with a knock-on effect of less people requiring the time of a GP or having to take time off work.

I would not want to be a Babylon patient, and if signing up to them reduces funding for local GP surgeries, the scheme needs a rethink …….fast.

I suspect Dr anonymous was on the nail when she or he mentioned the cherry picking potential. As long as Babylon (have they looked at the Biblical etymology of that name, I wonder?) is involved and able to force re-registration of potential users, then we move closer again to eventual privatisation of the NHS.

In fact, this is the core issue around which this topic revolves. What is it about some strata in the government that they believe privatisation is the panacea for all problems? I realise we can all see how well it works, on the Railways, for example, or the prison services, with G4S but this seems to be a slightly sinister approach to introducing private health care via a convenient back door.

On the website it states it’s only “available for people living or working within 40 minutes of one of our clinic locations.” which seems to make it a bit limiting and almost certainly not ideal for rural dwellers.

I suppose for me Adam’s sentence:

as a relatively young person with few medical complaints I shall doubtless carry on using it until something more serious comes along.

sums up the potential risks with this. We must always remember that owners of private companies such as Babylon are not philanthropists – whatever their ‘about us’ blurb might suggest. They’re in it to make lots of money and that money is something that the NHS badly needs.

One answer would be for GPs surgeries to combine and produce their own version of the apps, which would then ensure they reaped any benefits. Friends of ours who are GPs wouldn’t – I’m certain – have any time to do it themselves, but they could come together nationally and sort something out. Perhaps they should seek to push their professional associations into acting on their behalf.

My willingness to consider online consultations would be dependent on being seen – albeit online – by my GP and not someone I have never met, sitting in an office in London. The commercial link with Babylon is just another step in privatisation of NHS services.

I have to say, @carneades, your comment resonated with me strongly, and put in tandem with the GP's quotation, is making me consider re-registering with my local bricks-and-mortar GP practice.

Aside from its NHS partnership, the technological aim of Babylon (as a company) appears to be to provide machine-learning diagnosis to reduce the requirement for expert (human) diagnosis, eliminating unnecessary consultations or at least simplifying the first steps. I tried out Babylon years ago, before it integrated NHS services, as something of a novelty and found it to be helpful and interesting for basic things – although it often lacked the intelligence to properly diagnose me or had safeguards that made it push me to visit a GP when it didn't understand what was wrong.

That's the core of the app, and the concept of the business – the 'AI' health professional.

By contrast, the NHS 'GP at Hand' aspects of the app feel quite basic, even tacked-on – messaging your enquiry to GPs who can pick up the query and respond, book consultations with you and then hold them via video. Essentially, things that are not a great deal more sophisticated than a customer service 'ticket' system, plus a calendar and video calling – all things that the NHS could easily license and operate with a suite of readily available technologies that even small firms already offer to help their customers.

Think of tech support lines that will try to answer your question by email – and if they can't, will book a time to call you, or even remotely access your PC and perform the appropriate steps (general note for any new readers – please do be careful with the last step and always be sure it's not a scam!). All of that is done with existing third-party software that could be licensed and implemented directly while costing the NHS essentially peanuts.

Without this small technological gap being plugged directly, the upshot does appear to be a potentially huge loss in funding to general practices under the current financial model, possibly putting at risk in-person services that we would all demand should we require serious examinations and repeat visits. The trouble is, new technology and the NHS have an awful history together, with the latter often rejecting innovations if they could mean a loss or change in the jobs that depend on the current way of doing things, and the former taking the opportunity of a big client to oversell and add on expensive extras.

Purely personally, I hope that the RCGP and other strong voices within the NHS will make a similar case to those aired here, and lobby for a single, internal tech solution that serves both itself and patients, without the same botched tendering processes and reticence about change that have previously dogged such projects. Alternatively, I would like to see a new funding model that can still add up when accounting for private services like Babylon, while protecting the universal obligation to full treatment that we hold somewhat sacred.

Until I've seen one of those things, I may well re-register with my local practice. But maybe GP at Hand will prove to be just the boot that certain parts of the health service need to innovate by themselves.

GP surgeries are private businesses contracted to the NHS. So privatisation is already present in this area. However I think they need encouraging to offer more to their registered patients. They could provide online consultations; we don’t need a third party to do that. They could provide limited A&E facilities to relieve the hospital load and be much more convenient for many. They could provide out of hours services. It may be mergers would be necessary to provide the staff and investment needed but I’d rather support this sort of privatised service than a cherry picker version.

The GP “private business” model was devised for NHS use to allow GPs and their staff to exert greater control over the finance being issued to them by the NHS. It’s not a “private business” in the traditional way. There are major differences between a GPs’ surgery and Tesco, for example, and it’s those differences which make any suggestion that it’s privatisation rather silly.

But the model does allow for pooling of arrangements, say – for the purposes of devising apps which would be standardised across the UK. This is really what’s needed, not a private company wanting to make lots of cash at the expense of the NHS.

The basis on which the above “silly” comment was made was this, to distinguish a service model that is run independently and not by the NHS.

https://www.bma.org.uk/advice/employment/gp-practices/service-provision/prescribing/advice-for-dispensing-gps/the-gp-practice/running-a-general-practice

Running a general practice
Roles within general practice
Most GPs are independent contractors, either running the business on their own or in partnership with others. As with all other independent NHS contractors, GPs are responsible for running the business affairs of the practice, providing adequate premises and infrastructure to provide safe patient services and employ and train practice staff.

Over recent years there has been a steady increase in the number of large partnerships resulting in the consolidation and growth of a number of GP patient lists. In turn, the traditional staff roles have expanded and developed to meet the needs of the practice.

GP partners (contractors)
Self-employed independent contractors. The partners are essentially shareholders or owners of the practice and take an active role in the strategic development of the practice as an independent business.

Approximately 75% of GPs are partners (this figure does not include locums).

Salaried GPs
Salaried by the practice (not by the NHS).

My comment was that it is ‘silly’ to suggest that it’s a form of creeping privatisation; it isn’t. There are substantial – fundamental – differences between the model used for GPs and private business.

At the most fundamental level, the GPs cannot ‘sell’ their services to patients. They are also required to be part of a commissioning group, yet another major and fundamental difference between the model used and Private business.

They’re in trouble, too, as this report from the Kings Fund illustrates (pdf). “General practice is in crisis. Workload has increased substantially in recent years and has not been matched by growth in either funding or in workforce. A lack of nationally available, real-time data means that this crisis has been until recently largely invisible to commissioners and policy-makers.

The report makes it glaringly obvious that the model used is not a private company and has none of the advantages of a private company, other than placing the day-to-day management of the practice in the hands of the already overworked GPs.

Put simply, the model used for the GP surgery management vested CEO-type control over employees and activities, whilst simultaneously enforcing strict requirements of service.

I saw no suggestion of “creeping”. However, I think some will see the point.

I’m sure many will see the point.

The introduction and user comments give a full set of reasons why this service is of doubtful value. The financial degradation of the traditional GP service, the need to deregister elsewhere, the fee that is charged, the lack of physical contact and medical tests that can happen in a surgery, the need to be close to a Babylon clinic, the inability to see the same doctor or doctors, the difficulty with home visits and the need to have a reliable on line connection at any time that an appointment takes place all mitigate against it. It is also more difficult for the doctor to make judgements on a television screen where appearance and body language are less obvious. For me, a doctor’s appointment should be a personal consultation with the doctor in the surgery where conversations can take place without interruption or the limitations of distance communication. I am capable of using the internet to read up on symptoms. The problem with being unable to get a doctor’s appointment needs to be solved. Babylon is not the solution as its aim is to be a business first and a surgery second.

How long before we are introduced to robotic practitioners and there will no longer be a need for a human GP?

If it were not for the traditional GP I may not be alive today. For example, a year ago at a routine blood check appointment the doctor asked if she could help in any other way (an acceptable way of ending the 10 minute slot allocated). I happen to mention I had been experiencing a lot of headaches lately.. “Let’s check your blood pressure” she said. After the third time and the opinion of an associate practitioner she announced I was to be admitted straight away to the A&E “as a matter of urgency” as I was in danger of having a major stroke.

That doctor probably saved my life. My old wrist BP monitor had been malfunctioning and giving an inaccurate reading. I have since invested in a new one similar to those used at the practice and keep a regular BP check and take the prescribed medication on a daily basis.

I had a very similar experience a couple of times. Not least when I was pregnant and went in to my GP about something non pregnancy related but he still did the BP checks.

Some really interesting thoughts here.

I’d be keen to see this sort of service properly integrated into existing services at my GP’s surgery although to be honest I would categorise it as a nice to have rather than essential. I’d be more keen to see GP’s given more capacity and flexibility. Every story of amazing GPs I have heard is them going above and beyond. It shows the dedication of GPs but often without the structural support.

I would encourage anyone who has difficulty in booking an appointment or dissatisfied with their GP for another reason to consider trying another GP if they have the opportunity. Local GP surgeries can be found via this page: https://www.nhs.uk/Service-Search/GP/LocationSearch/4 Neighbours and others may be able to offer recommendations and there may be useful reviews on the above website. The GP practice may have useful information on their own website. Although GPs are expected to be able to cope with all sorts of ailments, some may declare their own special interests on the website.

When I moved to the area I discovered that my new neighbours work for the NHS and recommended the surgery I now use, warning that they were very good with technology. That has certainly proved to be the weak point, but online prescription requests and they stopped apologising for problems with the phone system, though that has never caused me a problem. I doubt that the surgery will offer online consultations any time soon but now that the elderly senior partner retired we might see some changes.

It’s worth checking the CQC website for ratings of GP surgeries and maybe looking elsewhere if there is one or more ‘Requires improvement’. Sometimes the inspections are not recent and staff and management may have changed. CQC rates the practice as a whole rather than individual GPs.

Our local GP practice will always give you an urgent appointment with their duty doctor. A problem with changing GPs may be the distance you have to travel to a new one.

There is, I believe, a move to join practices together to make best use of the different specialities their various GPs offer. Seems sensible.

With larger practices and more patients, the chance of seeing your preferred GP is smaller.

There is only one GP at my local practice I refuse to see and I always point this out when making an appointment. The response has always been an amused chuckle at reception but so far no-one has questioned the reason why!

You are not alone, Beryl. Years ago my GP retired and was replaced with new one I was very unhappy with, so I booked appointments with the other partner and moved practice when he set up his own surgery nearby.

There is a GP at my surgery I refuse to see. Reception always seem to say him first for an appointment, but don’t question why I don’t want to see him. I blame him for ruining several years of my life because he only gave me a few days of antibiotics and when I felt I needed more he refused to give them to me. On reflection, I should have insisted on seeing another doctor, but when you feel so ill, have struggled to get to the doctor in the first place and he treated me like I was wasting his time with a cold………..

In past times many GPs tended to have an avuncular approach, one which strongly implied they knew what was in your best interests far better then you. Part of this was as a consequence of Medical training, which tended to emphasis the intellectual superiority of a Doctor over that of their patients. I admit to taking some pleasure in pointing out to one such GP that their title was honorary, whereas those of us with one or more PhDs had earned them.

I think that’s changed to a large degree, now, partly as a consequence of the greater levels of information now available to everyone, partly as a consequence of the increasing tendency to seek legal redress by wronged parties but for whatever reason it’s welcome.

Sadly, the weak point is always the GP, since they act as the gatekeeper, and if they remain obstinately wedded to the old school dynamic there’s not a lot that can be done. And there are still many of that disposition around.

It ought not to be necessary to establish your intellectual or educational credentials when you first visit a GP but sometimes it can be an uphill battle to penetrate the aura of self-assuredness that some still project.

I’d rather not risk alienating a GP, though I have been tempted. 🙂 My preferred approach is to try to develop a rapport, so on my occasional visit to my GP I have asked how his son is getting on studying medicine at Manchester. Studying the body language should make it clear if they have time to chat or want you out of the room because they are running late. At my next visit I will ask if there are any plans to offer online appointments.

I agree about not alienating the GP, for obvious reasons (!) but things are slightly different round here, as surgeries are losing their senior practitioners and partners rather quickly. Thus we have the situation where we see mostly locum staff, who don’t know us.

What you describe seems to be a growing problem and not just in rural areas. Although I’m not a regular visitor to GP surgeries and never have been, I can see the value of patients being able to see the same GP where possible. Having had friends and family working as GPs I have some idea of the pressures involved and it does not surprise me when GPs train to become consultants, find another role or retire early.

J STEPHENSON says:
14 February 2019

I see an out of hours go occassionally but it isnt the same as seeing you’re own go who knows you and you’re medical history and diagnosis but it’s better to me seeing a locum in person than on line – lots of Drs when taking medical histories are examining patients at the same time observing patients colour can take their temperature and can interact better and speak clearer if the patient is hard of hearing – so much can be missed I think by seeing a Dr on line – if it’s a time issue / weather issue and a GP is unable to do a home visit I think it might be better seeing the patient on line and maybe confirming the patient needs to go into hospital instead of not going to visit the patient and just sending the patient into hospital.
But in the great scheme of things I think seeing a go on line is not a good idea!

I worked in an acute admissions unit in a hospital and Drs always said theyd much rather see and examine the patient than eg being asked over the phone about patients eg this is part of a registrars role and the reg always gives advice if they can but always goes to see the patient!

Wakhani says:
14 February 2019

Just like the scheme introduced a while back dial 111, which is useless, this also will prove to have many problems, who thinks these thing up?, I can only presume it’s another idiot who will not have to use the programme but assumes we are to blind to notice the idiotic notions that we have to pay twice for useless information, once in our pay check and another for a consultation,