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Independents' Day

New online GP service offers £25 video consultations

A new private GP service offering 10-minute video consultations via a video link for £25 has been launched, amid concerns from GPs about how effective it will be.

The new service – called Push Doctor – has a network of over 7,000 GPs who are available from 6am to 10pm for appointments, and works through an app that patients can download.

But GPs warn that such services ignore how essential physical examinations are, while the GPC said that patients will be forced to access these types of services privately until funding issues are resolved.

Under the service, patients can pay an extra £15 if they want to book a longer, 20 minute appointment, while online prescriptions will cost £4.50 and referral letters and Fit for Work notes incur a £12 charge.

Push Doctor Limited said the service is regulated by the CQC and manned by ‘experienced family doctors’ who have been ‘hand-picked and put through a rigorous verification and checking programme’.

It says the scheme will give patients more flexibility and convenience to book appointments outside of working hours, and ‘boasts the longest opening hours of any other service of this kind’.

However, Dr Peter Swinyard, chair of the Family Doctors Association, warned the online service would not be adequate for many consultations because ‘it is an essential part of the consultation to be able to perform a physical examination’.

Dr Swinyard explained: ‘Within limits it will be ok but even for something routine like prescribing contraception, I’d like to see a current blood pressure.’

He added: ‘There may be circumstances in which people will find it convenient – it will be a supplement to general practice but it’s not a replacement for it.’

Dr Beth McCarron-Nash, GPC member and a GP in Truro, said it was a ‘shame’ practices were not given similar levels of funding to provide more access to working age patients for minor illness.

Dr McCarron-Nash said: ‘I think it’s a real shame general practice isn’t funded to the same level – if it was then convenience might be affordable.’

She added: ‘I appreciate traditional general practice perhaps doesn’t offer all the solutions that the young mobile person with limited health issues would like, but if we had more money it would be a completely different board game.

‘This kind of access is the “Martini” form of general practice – “Any time, any place, anywhere”. Unless we address the fundamental workforce, workload and funding issues that are killing general practice in England then I’m afraid this sort of service will only continue to be available privately.’

Readers' comments (33)

  • Wonder what the indemnity cost is. If ok looks like a winner - 150 an hour without leaving your study. This is the future.

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  • Idiot above. If YOU think YOUwill get £150/hr for sitting at home think again. They are quoting £45/hr for the work - which carries considerable medicolegal risk. Its a corporate that will make the money while you get covered when the proverbial hits the fan.

    I also hope that the GPC instruct that ALL PRESCIPTIONS GENERATED BY THIS SERVICE ARE NOT TO BE CONVERTED BY NHS GPs INTO NHS ONES.

    If the population want private medicine, let them feel the full force of the true costs without the NHS picking up the tab.

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  • Anonymous GP partner: could not agree more. £45/hr minus significant indemnity costs (a plea to my current provider: please don't indemnify anyone for this work, as my premiums are already bad enough) is work for the truly desperate and lacking in self-respect. No previous notes and no examination possible - what could go wrong?

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  • This is the way the world ends
    This is the way the world ends
    This is the way the world ends
    Not with a bang but a whimper.

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  • How people have made a mockery of medicine. Hippocrates and Michaelangelo we are sorry for the incompetence of service provision and ££.

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  • What happens after 9.5 minutes when the patient throws in the "while I'm (virtually) here, doc" and brings up something urgent? Is the plug still pulled?

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  • You dinosaurs should hand your heads in shame. New solutions always encounter moronic and thoughtless resistance. It may work or it may not. Give it a fu@king chance.

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  • I think it has it's place for some instances.

    On a more important note- if every GP practice were paid 25 pounds per 10 minute NHS appointment - there would suddenly be no problems with access to appointments.

    Especially if we got an extra 15 pounds for an over-run, 4.50 per prescription and 12 pounds per referral. But even without the extras it would be well funded.

    Surely we should start there.

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  • On their website it states - ''Push Doctor is proud to be an NHS commissioned technology provider''.

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  • Push Doctor – has a network of over 7,000 GPs?
    It looks like there are 10 on the website...

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  • Physician Assistants could do all their consultations in this manner because they are not trained to do clinical examinations.

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  • Anonymous - I'm no dinosaur (GP qualified relatively recently) but believe that prescribing without notes or ability to examine is likely to lead to harm - as, funnily enough, do the MDOs, hence their higher indemnity fees for OOH work.

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  • There is a lot of information we all pick up passively. When someone tells us they are coughing in person we automatically know if they are short of breath, how short of breath, if they are dehydrated, if they are anxious, etc, etc ,etc.

    You just lose that backup if you consult in this way. I expect members of the public to not understand that, but not members of the profession.

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  • Anon@4.17 - sorry you think that highlighting potential problems renders one out-dated. I would have thought that the more issues that are raised pre-emptively, the longer one has to find solutions. Simple risk management. Just think how much could have been saved had attention been paid to legitimate concerns with all the other "bright" ideas attracting investment and diverting money away from basic services in recent years.

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  • This is a very clever way of privatising health care.
    The politicians are the ones who are responsible for making patients lose trust in their doctors and they will resort to third class care and they will have to pay for this third class care!!!

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  • much better working in OOH or locum work. £45 an hour and out of that pay your (guaranteed to be exorbitant) indemnity costs, tax, NI, etc. and you are probably left with about £15 an hour...

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  • 7000 GPs! 6am to 10pm. What GP crisis!

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  • Peter Swinyard

    To supplement my reported comments above - I do a lot of telephone consulting but the default is to ask the patient to attend for examination - and my call-in rate is 37%, rather lower than my partners' as I know most of the people who call and I have access to the lifelong medical record.
    With PushDoctor - that would mean that I would advise 50% or so of callers to have a physical examination.
    Guess who will be asked to do this.
    Precisely.

    No, I have not applied to be one of the 7000, despite being asked.

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  • This is not new, it is just becoming more mainstream. Lots of medical services are on line and offer efficient medical treatment for everyday ailments and more. What's new is that the cost has reduced so that anyone with a job can afford this rather than wait for an appointment with their local GP - they are willing to pay. The other interesting thing I have found is that people are reporting good treatment from these services. Im not sure what the answer is for the NHS but I see a two tier privatised system gaining strength where people can now choose where they get medical treatment. I think this will mean that the NHS only treats very serious illness and people who cannot afford to pay. The dinosaur comment is sadly correct, and we know that the only thing we can be certain of in the NHS is change!

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  • It's not the NHS - it's private. Presumably developed as a cost saver cf providing face-to-face consultations.

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  • This is accelerating the decline not providing a solution . Good profit margin for the Ltd company though whilst individuals take the risk . Looking at the ten they all seem sensible . Extraordinary if they can't see they'll be dropped like a stone with the first complainant .

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  • This is called a telephone consult ... Not new or innovative. If u want me to see something take time out of twitter or hello mag and come see me.

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  • waiting for the first patient to go to the community pharmacist with their pushDr generated script (presumably it gets e-mailed to the patient??) and the pharmacist explaining that it is rather expensive and they could get it cheaper from their GP...

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  • Some GPs already use Skype to deal with their NHS patients; some hospital doctors use Skype to deal with their patients.

    Some members of the public have their own BP monitor and in my case a pulse oximiter.

    Some patients have access to their GP record on line via for example EMIS.

    I personally have all my hospital records online in a secure cloud storage system - Microsoft Health Vault.

    Some members of the public are savvy enough to know if an in person GP visit is the best option for them.

    Some members of the public would not mind being seen in the first instance by a physicians assistant on a triage basis.

    Telephone consultations with pictures what the problem. Guess it is the same one as the introduction of the telephone consultation years ago.

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  • My thoughts are in line with Dr Sandbach . It is like telephone triage with pictures giving more info . It cannot replace the GP for physical exam and patients are reasonably good at guessing if something needs examining therefore see your own GP . It is probably of most use to commuters who can try the simple things and discuss what to look out for and when to see the gp in person . It is likely to be a step up from cyberchondria . They are likely to e prescribe .

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  • I used to do telemedicine consultations with my patients. The problem I found was that most patients are not used to it and you have to have an agreed time when they are online, which proved difficult.

    I still do telephone consultations with my patients and this, despite the lack of images, Is very much in demand by patients as I can phone them on their mobiles and they don't need to switch on their various mobile video systems. Having done telephone consultations for many years I have found that in excess of 80% of all issues can be safely managed just over the phone. Just like face-to-face consultations one gains more experience with time

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  • I think Peter is the only one who realized this.

    When they need physical exam or safety netting, guess where they'll be directing their patients? Yes, to free at point of Care, no questions asked at booking service called NHS primary care. Wait until your patients come in with *recommendations " from these services

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  • Come on folks - plan for going private.
    This will be used to fill for the GP retirements, and practices falling over, then for OoHs to address staff shortages, and to replace 111. Next it will become common place, and soon you will be competing for a list with these services run nationally, and only getting the most ill and infirm who need constant examination and want a traditional GP.

    Go private, and offer the best service, and let the cowboys in the corporates divide up the rest. Its gone

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  • "secure cloud storage system..."

    whats that?

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  • This is what is needed. GPs should stop overworking and stop doing OOH. make a group and offer paid appointments at a viable cost. thats what the govt wants...do it ...make good money.......and get no abuse.
    a win win situation. Its NOT your job to "save" the NHS.U merely work for it. start this and the monopoly employer problem is solved..

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  • Anonymous | Other healthcare professional | 30 July 2015 12:21pm
    You said patients received 'good treatment' from these services. Define 'good treatment' please.

    1. Correct diagnosis?
    2. Patient satisfaction?
    3. Given a prescription regardless of how (in)appropriate?
    4. Were they advised of the side effects of medications or just given a script?
    5. Falsely reassured and then the 'benign looking mole' turned out to be a melanoma a year later?
    6. Hugely over cautious Dr referring everybody to private consultants?
    7. Being told to see their NHS GP for XYZ without even knowing if the service is available?
    8. Relieved because the 'horrible looking mole' which is actually a Seb K gets diagnosed correctly as benign, but the 'ugly duckling' malignant melanoma sitting near it is completely missed because it wasn't on the screen.

    Sorry but there is just no safety data on these kind of private services so you cannot say that people get a good service. They may think they do, but that is a very different thing all together.

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  • Just watched the video on the Push Doctor website...slightly puzzled as to why the doctors are wearing stethoscopes - checking their monitors are still alive?

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  • Madhurima, the steth is not just an aesthetic tool the ad would have you believe, oh no. Have not heard of the internet of things?! In this brave new world a doctor can place a steth to their screen, and request the patient to place her bare chest upon her screen and voila! You have either got yourself an online heart/chest auscultation or a very imminent court case for gross indecency. Internet chat rooms - God bless'um!!

    Disillusioned GP Partner (3yrs)

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