The doctor will see you now – on Skype?

All patients will have the right to see GPs online within the next five years, NHS England chief executive Simon Stevens pledged yesterday (January 7) as he unveiled the new NHS Long-Term Plan.

The pledge is part of an overall ‘digital first’ strategy for the NHS, which will enable patients, Stevens said, to make use of technology such as video calls on smartphones that are already part of their daily lives.

With such technology, he said “patients can easily see a GP over the internet and even get expert help from consultants without the need for an inconvenient hospital visit.

“This will mean that we can make one in three outpatient appointments unnecessary, sparing patients around 30 million trips and freeing up doctors, nurses and other staff for other duties such as our drive to increase early cancer diagnosis to save lives,” he added.

As part of the Long-Term Plan, for those patients who cannot access their current GPs online through programmes such as Skype, they will be able to do so through the option of “new digital GP providers”.

GP at Hand controversy 

The pledge comes on the heels of a controversy last year surrounding GP at Hand, an app owned by the company Babylon, which provides online GP services to patients living in certain areas of London.

GP at Hand has been roundly criticised by doctors who point out that it requires patients to de-register from their current GP in order to sign up. More than 30,000 people are now signed up to GP at Hand.

This loss of tens of thousands of patients from GP surgeries – the vast majority of whom are between 20 and 39 years old and so tend to be healthy – has sparked fears of a substantial loss in registration fees, since it is younger, healthier patients who in effect subsidise the older and less healthy population.

The app is inherently exclusionary because Babylon specifically advises people with a wide variety of more serious health conditions to not sign up, Doctors in Unite (DiU) has noted. It also excludes people whose first language is not English or those who are computer illiterate. What’s more, there are serious safety concerns surrounding the app – NHS England has blocked GP at Hand’s expansion outside London as it conducts a safety evaluation.

The Long-Term Plan touched upon these concerns over online GP providers by noting that it would ensure “new ‘digital first’ practices are safe” and would also work to “ensure fair funding without inequitably favouring one type of GP provider over another”.

A system that works for everyone

But Doctors in Unite chair Jackie Applebee said that it’s not enough to simply pay lip service to the very serious apprehensions doctors and patients have over online GP services.

“It’s all very well and good to promise online GP services but we are struggling with access already,” she said. “This may be convenient but convenience can increase demand and bring people to us that might not have come.

“I don’t advocate access being difficult,” Applebee added. “In a properly resourced system everyone who perceives that they need access should be able to get it, but as we all know the system is not properly resourced. We need to be careful that this policy does not just add to an already intolerable workload and divert care from those who need it most to those who are best able to access it.”

Applebee emphasised the need to build a system that works for everyone, which she said in this case seemed doubtful considering the inadequate funding increase now on the table.

“For this to work for everyone the system needs to be properly resourced,” she said. “The 3.4 per cent increase to NHS funding doesn’t take us back to where we were pre-austerity — so it doesn’t even help us to stand still let alone innovate.”

It was hinted in the Long-Term Plan that NHS England would tackle the funding inequities presented by services such as GP at Hand by “reviewing current out-of-area arrangements and adjusting the GP payment formulae to ensure fair funding without inequitably favouring one type of GP provider over another”.

Applebee said she would welcome this move if it meant scrapping the out-of-area clause in GP contracts because there is “growing evidence that continuity of care improves health outcomes, so holistic, geographically based general practice, based on local GP lists has been shown to be the best form of care”.

But she added that “anything less than total abolition won’t solve the problem – a fudge I would not welcome.”