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Lack of evidence for GP video consultations, finds study

There is limited evidence that GP video consultations are safe, effective or improve patient access to primary care, a new study from Imperial College has revealed.

Researchers, from Imperial College London, found that the services may also increase GP workload and could result in a rise in antibiotic prescribing. 

The study, published in The Journal of the Royal Society of Medicine, aimed to assess the impact of online video consultation in private practices through analysis of the provider websites and current literature. 

It found that the safety and clinical efficacy remain ‘largely untested’, and although they are promoted as a way of improving patient access to primary care and reducing GP workload, the evidence for this is 'limited'.

The paper stated: ‘Evidence suggests they do not reduce general practitioners’ workload and may even increase it, with potential for patients ‘gaming’ the system in order to obtain prompt face-to-face appointments’.

Lead author on the paper, Dr Benedict Hayhoe, commented: ‘Despite limited evidence for improving access to primary care, and potential for increased workload through supply induced demand, greater use of digital technology remains a key government priority.

‘While availability of affordable online consultations may reduce pressure on NHS primary care, it may conversely increase pressure through supply induced demand, or through defensive practices.'

The team used the CQC online register to identify seven private companies that offer video consultations with GPs.

The researchers reported that ‘safety concerns’ had been raised regarding such services, with a recent CQC inspection criticising one of the providers for providing ‘neither safe nor effective care’.

They also highlighted the potential impact on antibiotic prescribing, and found that four of the seven services specified that they would prescribe antibiotics, although none mentioned using them appropriately.

When searching terms like ‘get antibiotics’, ‘antibiotic prescription’ and ‘buy antibiotics’ on the internet, they spotted that all searches had a top result advertising a GP video consultation service, which promised antibiotic prescriptions ‘in minutes’.

The paper said: ‘Provision of antibiotics is known to be associated with increased patient satisfaction, and in a competitive online environment, private companies will be particularly reliant on positive patient feedback.'

But the results come as North West London CCGs announced that their residents are benefitting from ‘faster access to health services’ due to online GP services, which saw over 80,000 appointments booked between July and December 2017.

They reported that their practices had saved 1,460 days in administration, due to the services allowing patients to book and cancel appointments, order repeat prescriptions and view their GP records without calling their surgery.

Digital innovation lead for the CCGs, Kwesi Afful, said that their next step is to introduce ‘other ways to engage with and access GP services’.

Earlier this week, Public Health England announced that it hopes to reduce antibiotic prescribing by 10% in the next two years, after research found that between 8% and 23% of all antibiotic prescriptions in primary care were inappropriate.

Readers' comments (9)

  • I have had a couple of patients come to the emergency surgery after being "e-mailed antibiotics" because of flu illness. The patients were very pleased. Of course the ABs were totally unneeded. Asked how the doctor examined the patient I was told "he told me to feel my own pulse".

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  • Jmd

    Baffling how any telephone or online consultant ion can be sage...how can one diagnose sepsis without examination of the vital signs?
    Personally, I think for a good safe on line or phone consultation needs 10 mts or so, this is how long it takes for F2F....a much safer and patient orientatedservice

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  • AlanAlmond

    I’m glad this has been formally recognised in a study. The findings are blindingly obvious. Anyone who works for these cowboys needs to be aware they are responsible for the care they are providing and be willing to accept the personal and wider societal risk they are taking on. It won’t be long before the insurance industry cottons on to the inherent risks of this model of care. I won’t be crying any tears for nieve on line ‘Drs’ who find themselves on the wrong end of a negligence claim. You take the money, you live with the consequences. It often takes a few years before they come out of the woodwork, but don’t delude yourself - cases will be forthcoming and this studies like this will be used as evidence against you.

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  • Very danger video consultations, like to see how they would assess pile or vaginal discharge though maybe a camera app!The only way to medico-legally safely assess an ill patient is face to face history examine and diagnose.The rest can be left to Dr Google it.

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  • Hayhoe or Hey-ho
    (latter in Collins dictionary: an exclamation of weariness, disappointment, surprise, or happiness)
    Take your pick!

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  • Video consults increase antibiotic prescribing a bit, CCGs push to decrease it, decreases it a bit.

    Status quo. Everyones happy......

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  • I just would feel as nervous as a small nun at a penguin shoot about making legally binding decisions on the evidence of a video consultation. Risk of litigation must be higher for the problems that slip through the net but they could always just go and queue up in the local A & E Department for a second opinion!

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  • I have received some consultation summaries which are 9 pages long and end with an antibiotic script. The presenting complaint? Sore throat/cough.

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