RESIDENTS OF LONDON, bits of Birmingham and north-west Surrey no longer need to ring up first thing in the morning to nab an appointment with their family doctor. They have access to new digital GP services allowing them to book video consultations with clinicians at short notice. For the moment, video calls represent a tiny fraction of the 307m GP consultations each year. But that is unlikely to remain the case for long. NHS England plans a new GPs’ contract giving all patients the right to online and video consultations by 2021.
If all goes to plan, the shift to digital services will go far beyond video consultations. The basic mechanics of primary care are remarkably similar to when the NHS was created in 1948, with GPs the first destination for the ill and gatekeepers to the rest of the service. NHS officials hope that the introduction of digital services will upend the primary-care system by diverting people who do not need care and, where appropriate, treating patients at home.
There are two existing models. Just over a year ago Babylon, a digital-health company, launched GP at Hand, the first online GP service available on the NHS, in London. Around 40,000 patients have deregistered from their previous GP practice to sign up. The service aims to provide video consultations within two hours, and handles prescriptions, tests and inpatient appointments at five London sites if needed. Other GPs grumble that Babylon is stealing their young and healthy patients, funding for whom has historically subsidised the care of older, infirm folk. The new contract is expected to remove some of the financial perks GP at Hand takes advantage of, such as extra funding for patients who work but do not live in London.
The other model is less disruptive. In January Push Doctor, another digital-health firm, signed a deal to provide online services, including video consultations, to 13 GP practices in Birmingham, covering 88,000 people. Last year Livi, a Swedish company, struck a deal with 40 practices in Surrey. In such cases patients will have access to digital services without having to register with a new provider. Livi, part of Europe’s biggest digital-health firm, is in talks with dozens more providers, says Luke Buhl-Nielsen, who is in charge of its British operations. Other firms work with GPs to provide services like online triaging and symptom checkers.
Providers of both varieties are busy adding new capabilities to their apps, which is where health wonks hope the big gains will be made. GP at Hand already uses artificial intelligence to assess symptoms via a chatbot (though a recent study in the Lancet questioned its effectiveness). The apps can also flag up reminders for the management of long-term conditions and even provide cognitive-behaviour therapy for mental-health conditions, as Livi offers in Sweden. They could provide organisational benefits, too. A shortage of GPs may be eased, since the apps allow doctors to work across the country from one location.
The limited evidence that exists suggests that video consultations are as good as face-to-face meetings for addressing lots of problems, although there is less proof of their ability to reduce workloads, says Harry Evans of the King’s Fund, a think-tank. At the moment the faff of visiting a GP helps to ration services. Some worry that greater convenience may result in doctors spending yet more time dealing with the “worried well”. In health care, improvements in technology have a funny habit of raising costs.