Are online GP services too good to be true?
Visiting a GP could become a thing of the past, replaced by a “virtual” consultation. But is this good news for patients? Lucy Trevallion investigates.
If you want a GP appointment today, there’s an app for that. In the last few years there has been a surge of online GP services that you can access from your smartphone or computer. They claim to offer fast and accessible GP appointments, but is it too good to be true?
Video consultations aren’t a foreign concept to the NHS – GPs have been doing these for several years in some areas, and NHS England would like this to be rolled out widely.
GPs have been doing video consultations for several years in some areas and NHS England would like this to be rolled out widely
Meanwhile, you can pay for an online consultation with any one of at least 35 providers offering this service on a commercial basis.
In London, GP At Hand is a NHS GP service that you use via a free app. It’s run in partnership with Babylon Healthcare service, which was inspected by the national regulator, the Care Quality Commission (CQC) in 2017.
The report found that most services were good, but did raise some concerns about its digital services, including that prescribing decisions were not always made appropriately, and information was not always shared properly. Babylon took legal action to stop the report, which it said contained 'inaccuracies', being published, but the High Court ruled against them and Babylon later agreed to pay the CQC’s legal costs.
In March 2018, a CQC report covering 35 online GP services, found that the quality has improved over the last year and could improve access and convenience for some patients, but further action is needed to make these as safe as normal GPs. They found 43 per cent of them were not providing ‘safe’ care.
The benefits of speed and convenience
Dr Prudence Knight, a GP at Push Doctor, which charges from £20 for an online appointment, said: “The main difference is the speed and ease with which a patient can access a GP assessment and usually a definitive treatment. Seeing patients sooner means offering treatment at an earlier, often less serious, point in their illness.”
Most online services offer video or text-based appointments within two hours. An at-home “virtual” appointment may also be more convenient. Push Doctor said that 9 out of 10 patients got the help they needed through Push Doctor, without needing to see a doctor in person .
Services like GP At Hand are not recommended for people with ‘complex physical needs’, dementia, and for frail older people
Dr Richard Vautrey, head of the GPs Committee at the British Medical Association said: “There is widespread concern among GPs.” He explains that this is because services like GP At Hand are not recommended for, amongst others, people with ‘complex physical needs’, dementia, and for frail older people.
NHS figures show that 79 per cent of GP at Hand patients are aged 20-39. The concern is that traditional GPs will have older, more complex patients who are more expensive to look after, and this could cause funding problems and possible practice closures, Dr Vautrey said.
A spokesman for GP At Hand said: “As a disruptive technology, there are GPs who see this service as threatening. There are a considerable number of GPs who are very impressed by the service.” He said that the NHS will not pay more than for regular GP registrations, and the service could ease pressure by helping reduce A&E visits, out of hours GP visits and missed appointments.
Dr Vautrey said another concern is that private providers often need to please those paying for a service, so “the risk is of giving patients what they ask for, rather than what they need.”
It may be too early to judge the strengths and weaknesses of this service. In autumn 2017 NHS England issued a formal objection to plans to roll out GP At Hand, saying more evaluation was needed. In response, GP At Hand scaled back from nine planned new locations, which would have included Manchester and Birmingham, to five in London.
An interim review found it “had the potential to benefit patients and the wider healthcare system” but raised several concerns, including whether up to 45 minutes travel time is too much for patients who do need a face to face consultation, and possible “unintended effects on both patient care and the wider system.” A full evaluation is being carried out.
John Kell, Head of Policy at the Patient’s Association, said: “These apps offer more flexibility to patients… but it’s still very unclear how these services are going.”
How do GP services compare?
GP At Hand
- A free NHS service
- Becomes your sole GP
- Launched November 2017 and now has around 26,000 registered patients and 200 GPs .
- Currently only available for people who live or work in zones 1-3 in London.
- If your problem can’t be dealt with by a video call, in-person appointments are available six days a week in five London clinics. Virtual GP consultations are 24/7.
- Once you’ve registered, it has access to your full medical records.
Private online GP services
- Available for anyone in the UK; you will still be registered with your regular GP.
- No in-person appointments. Video (or text-based) appointments are usually available 24/7.
- Costs vary, but are usually around £20-£40 for a 10-minute appointment.
- They won't have access to your medical records – so you might want to tell them which other medications you’re taking, to help them with safe prescribing.
- In some cases prescriptions can be delivered to your home or work.
Your normal GP
- A free NHS service available for anyone who lives in the local area.
- Some offer evening or weekend appointments, but out of hours you’ll usually be directed to an out-of-hours service.
- They’ll have full access to your medical records.
- Your prescriptions can be collected at a convenient pharmacy.