Would you use an online GP app?

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.

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.

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.

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.

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.

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

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.