Should NHS GPs do private online consulting?
Dr Lynnette Peterson says GPs must consider their work-life balance and that concerns about private online providers have been overblown, but Dr Nick Mann argues this work is risky for GPs and is already undermining the NHS
Yes. It is safe and gives us work-life balance
In the current political environment where the value of the GMS contract is being strangled, and GP partners are unable to respond to free market forces in the same way that any other business can, attempts by private GP providers to use whatever levers they can to expand their services are inevitable.
The ‘Babylon concept’ realised also opens GPs’ minds to other opportunities beyond GMS – important in an age where LMCs have voted to explore the possibility of handing back contracts. Telehealth may well be the saviour, not the enemy.
I believe in the NHS and healthcare that is free at the point of contact. But the reckless underfunding has left a service that is unable to meet demand; the number of contacts in a standard GP day, and the intensity of those contacts, leaves us exposed, demoralised and feeling abused.
So, is it little wonder that half of newly qualifying GPs in my local area choose locum work or telehealth?
In my experience this attracts complex and often very challenging patients
Could the private ‘digital disrupters’ be the answer what GPs want? The pay itself, from my experience of working for Babylon’s ‘GP at Hand’ service, is approximately equivalent to a salaried GP, but the benefits are greater.
For example, there is limit on the number of contacts you see, real-time adjustment on the number of contacts should one patient take longer than the 10-minute slot (though this appears to be something Babylon are cutting down on), substantially less paperwork and the ability to work from home.
As for concerns over safety, it is true many calls take place as video calls – offered for all contacts if they choose with the option to arrange a face-to-face if required. Although face-to-face appointments are limited this is not unusual, even in the GMS sector.
Due to such high patient demand, many GP surgeries are now offering telephone consultations on first point of contact, without the benefit of visual input. As such, the ‘Babylon-style’ model is equivalent or safer.
Does this system cherry-pick all the healthy patients? Yes and no. Many are healthy patients, the vast majority are young and by that very definition, yes. However, in my experience it also attracts complex and often very challenging patients who for example, have personality disorders, or are in the process of trying to sue their NHS GPs, or are bedbound and find it very difficult to get GPs to come out but need a GP for medical advice, or are so complex they have moved to telemedicine because they feel their NHS GP has given up on them.
Patients can quickly and easily make several appointments to address each one of their needs and are much more easily satisfied, though it is telling that some patients are so demanding that Babylon has had to limit the number of appointments to three daily. So there are actually a lot of ‘challenging’ patients encountered doing telemedicine – and rather than cherry-picking, this is creaming off many of the difficult patients.
As such I think there is no evidence so far our engagement with these providers will undermine the NHS.
And if the government provides more money for each patient to its core services, or a payment by contact basis, each GP practice may even be able to afford to offer such progressive services themselves and offer fair and competitive services.
Dr Lynnette Peterson is a locum GP in Oxfordshire
No. It is risky and undermines NHS general practice
At first glance, what’s not to like about working for a private ‘digital GP’ service provider? Hours to suit, working from home, extra cash. In today’s NHS, when workload pressures on general practice are at times frightening, many GPs are seeking to reduce their commitment and looking to diversify.
Private online GP work may seem tempting in this regard. However, an ex-GP registrar at our practice tried this while locuming. She quit after a short period, however, reporting that terms and conditions were not as advertised, training was extremely basic and clinical support non-existent.
Few would argue that online consulting has some benefits for patients, mainly for low acuity consultations where accession to convenience does not pose a significant risk to patients. However, while it is portrayed as ‘low risk’ consulting, it is the atypical cases which could lead to problems for both patients and their GPs. Clinicians are individually responsible for mistakes, even if the online model itself is flawed. The lack of access to patient records, continuity and the patients themselves, may turn an ostensibly simple consultation for headache or abdominal pain into a GMC fitness-to-practice investigation.
Online consulting should have been developed as an extra to existing services, not as an alternative – within NHS general practice, not as its competitor. As we have seen with Babylon’s ‘GP at Hand’ service, an alternative to NHS GP services in London and soon, potentially, across the whole country, this may involve excluding higher risk groups of patients and conditions. This seriously fragments and undermines the risk-pooled funding model that is essential to the NHS. Poorer terms and conditions for GPs, both in the NHS and under private providers, will likely follow.
An ostensibly simple consultation may turn into a GMC fitness-to-practice investigation
Private online services have also used advertising slogans such as ‘if you can’t get antibiotics from your GP, call us’ – complete with a full-spread image of a packet of amoxicillin, which demonstrates the risks of a parallel GP service driven by unscrupulous market forces.
And, as we have seen with NHS 111 triaging, in order to protect themselves private online providers must engage a low threshold of risk for referring patients onwards, either to their GP or to A&E. NHS urgent activity is likely to increase as a result.
If GP at Hand represents the vanguard of Hancock’s tech ‘revolution’, we can look forward to more private companies like Babylon catapulted into the NHS patient-doctor interface without proven safety, quality and oversight standards being met.
And what is to stop a private online service being wholly provided by, or seeking sponsorship from, a pharmaceutical company or pharmacy chain, thus perverting the integrity of the clinical process and decision-making?
Private providers do not educate or train their doctors, so it is taxpayers who are funding this exodus from public to private sector. With today’s potentially catastrophic workforce crisis, luring more doctors away is something that NHS patients cannot afford.
Sadly, Matt Hancock and his ‘disruptive innovator’ friends view healthcare as a business opportunity, not as a public service. I would urge conscientious NHS GPs not to follow likewise.
Dr Nick Mann is a salaried GP in Hackney