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GPs go forth

GPs should refer patients to Skype outpatient appointments, says NHS England

GPs could soon be referring patients to outpatient appointments taking place via Skype, following calls from NHS England's medical director.

Professor Stephen Powis said the 'the time has come' to use technology to reduce some of the 118m outpatient appointments every year, 'many of which' NHS England claimed are 'unnecessary'.

Aside from using 'Skype, apps and online tools' to treat outpatients, another alternative route to make better use of patients time would be by having them seen 'by specialists at the GP surgery', said Professor Powis.

According to NHS England, this would mean 'thousands' of patients being 'spared hospital visits, time off work and school while also saving the NHS millions'.

Professor Powis further suggested these new measures would form part of the NHS long-term plan, which is expected to be published later this month.

He said: 'The outpatient system is older than the NHS and the time has come to grasp the nettle and use tech and other innovations to improve patients’ experience and care. 

'As part of the long-term plan for the NHS, it’s right we look at ways to cut unnecessary appointments, save thousands of journeys, reduce traffic and pollution and make the NHS more efficient.'

But Family Doctor Association chair Dr Peter Swinyard said: 'There are few specialities in which a contemporaneous examination of the patient is not a useful part of the consultation.

'There is a risk that this could just transfer secondary care work inappropriately to overstretched GPs – we want a consultant opinion and sometimes supervision of care where it is clearly the right place for care.'

Highlighting a number of NHS 'case studies' related to cutting outpatient appointments, NHS England mentioned a virtual renal e-clinic in Tower Hamlets in east London, via which GP can send questions on kidney patients direct to specialist consultants for a quick reply.

It also mentioned the telephone ‘hotline’ for GPs to get fast advice from neurology consultants in Cheshire and Merseyside, which NHS England recently claimed has saved £100,000 a year.

Professor Powis made his comments in the foreword of a new report by the Royal College of Physicians, published today.

Among the report's key recommendations, the RCP suggests it is time hospitals were paid based on 'clinical value, not units of physical interaction or activity'.

The report also noted that a reduction in referrals to outpatients by GPs has been 'negated' because of a rise in referrals from other consultants.

Taking a swipe at CCG measures to reduce referrals from primary care, as highlighted by Pulse's 'cash-for-cuts' investigation, the report said: 'Interventions to reduce new patient demand should be targeted at all referral sources.

'They must not deter necessary referrals or damage professional working relationships.'

Readers' comments (16)

  • Bornjovial

    Used carefully this can be an useful tool in select patients in selected circumstances.
    However To a man with a hammer, everything looks like a nail - should not apply it indiscriminately.

    I offered to pilot Skype/ Conference consultations between patient, GP and lipid clinic consultant who almost never needed to examine a patient more than a GP can.
    The hospital was not interested as they don't get paid HRG tariff!!!

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  • For about a century now there has been the option of telephone consulting. For better or for worse, primary care has embraced it; secondary care has generally not. Before getting excited over technologies that are only a few years old, we need to understand why hospitals are not using the established technologies familiar to almost every UK resident.

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  • I was pushing for this 18 years ago and even managed to speak to one of the labour health ministers, but to no avail.

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  • National Hopeless Service

    What has this got to do with primary care? Given that most hospital desk top computers are ten years old I doubt they could cope with Skype.

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  • Saving journeys yes. Clinician time, no. It can make it worse with IT problems. Other risks include voice or colour representation and clearity/misinterpretation and being unable to judge non verbal communication/body language. Just remember one source of complaint or litigation is not examining the patient and providing best care. If the patient dies Gross Negligence Manslaughter is round the corner for you. The bureaucrats are very good at asking us to take risks but are extremely poor in taking the risk and seeing the patients themselves, helping with the GMC or supporting our MDU fees. Sorry I am NOT doing it as I am providing best care face to face as is dictated by the GMC.

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  • Bet it will be as safe as robot operations eh looking at the headlines this morning!

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  • My wife is under secondary care and while they are quite good at using email, they wouldn't ever communicate by phone (except for one particularly caring consultant). I am sure this is because they don't get paid for this and want to fill their clinics instead. And why not- its us who are the mugs adding dozens of phone consults on every day.

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  • Vinci Ho

    It is coming whether we like it or not .
    The interest question is , what will doctor-patient relationship become (both primary and secondary care) in the foreseeable future?

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  • Think there is some merit in it but care needed as Consultants will love to get GPs to do their admin work etc. please just pop and see your GP and get pee dipped or your BP checked or quickly look in the back of your eyes etc.and forward the results on to my secretary. Will be fully costed from the secondary care point of view but of course not from primary care.

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  • Vinci Ho

    Ha ha ha
    We are currently having enough ‘fun’ from hospital colleagues (not just consultants) already giving plenty of follow up workload (can you kindly do .....).
    Imagine sitting on the screen talking to patients from a remote site . ‘I have a few video calls waiting, you can talk to your GP if you have any further questions.’
    Temptation 😬😎😜🤨

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