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At the heart of general practice since 1960

'Uber-style' private GP appointment service primed for national rollout

A new private GP company offering ‘Uber’-style GP appointments is preparing to roll out the service across the whole of England after a successful pilot in two north London boroughs.

The Doctaly service doesn’t employ GPs itself, but is the first reported service to match NHS GPs to patients who are prepared to pay a fee to avoid the usual wait to see their GP.

The GPs will see patients in their own practice and in their spare time, the company says.

But GP leaders warned they are ‘very concerned’ about the service, which they said would destabilise general practice and undermine the NHS, and encourages ‘queue-jumping’ for patients who can afford it.

Doctaly has been running for the past month at 10 practices in the London boroughs of Barnet and Enfield, with around 50 GPs signed up to offer appointments at various times.

The service is not yet available as an app, with patients booking appointments through the Doctaly website.

But the company has been likened to Uber – an app that allows customers to book taxis – because it does not employ the GPs directly, instead providing them with the framework to offer the appointments and then taking a cut of the fee.

Doctaly told Pulse that having proved the concept could work – with both patients and GPs keen to sign up – the service is now being rolled out with the aim of reaching the rest of London by the end of this year and the whole country by 2018.

Company founder Ben Teichman insisted the service is not about queue jumping but ‘quite the opposite’.

He said: ‘Doctaly is essentially a hybrid service between the NHS and existing private practice making private appointments more affordable, thereby opening them up to a wider audience.

‘It is not about queue jumping. Quite the opposite in fact. It should help drive queues down in surgeries and also take traffic away from A&E. An A&E appointment can cost the NHS £150 and if access wasn’t an issue, many of these patients could have been successfully treated by a GP.’

He said that the service was a ‘lucrative and convenient alternative’ for part-time GPs, and even full-time GPs who may ’want to do a few appointments on their admin day if they’ve got time’.

But Dr Jackie Applebee, chair of Tower Hamlets LMC in east London and Doctors in Unite representative on the GPC, said the service was ‘very worrying’ and would ‘further destabilise general practice’.

Dr Applebee added: ‘This is not the answer to the crisis in general practice. I acknowledge that access is a problem, but the fault for this lies at the door of the Government who have disinvested in general practice for years so that we now have an unprecedented workforce crisis.

‘This sort of service is the slippery slope towards privatisation of the NHS. It introduces the principle of topping up NHS services with purchased services if one has the disposable income. If the more affluent begin to do this in significant numbers it is only a small step to an insurance-based health service.’

GPC deputy chair Dr Richard Vautrey said: ‘Patients want and deserve a properly funded NHS GP service, based on the registered list, so they can get appropriate timely access to their local GP and that practices have the resources and capacity to offer this.

‘While patients can access and pay for private GPs or consultants, the risk is a more fragmented service and patients having remote consultations with doctors they don’t know and who won’t have full access to their NHS medical record.’

How ‘Uber GP’ appointments work

Ben Teichman set up Doctaly with the help of a GP friend, Dr Dinesh Silva, after finding he had to wait two weeks for a GP appointment.

Under the model, a senior partner at a practice holds a contract with Doctaly and then any GPs at that practice are free to register a profile on the company’s website and offer appointment slots when they are available.

Doctaly pays the practice a cumulative fee each month based on the number of consultations provided, and the practice then calculates how each GP should be remunerated – salaried GPs may have some of the fee deducted, for example to cover use of the room and reception staff.

Patients use the website to choose a doctor and book a 15-minute appointment slot, paying from £39.99 to £69.99 depending on the time and day of the week. The booking process requires the patient to confirm that they are not registered with the particular GP practice they choose.

Patients are also advised Doctaly does not provide emergency care, and that patients needing care for psychological problems or long-term condition management are better off going to their regular GP who understands their medical history.

After a Doctaly consultation, the GP provides the patient with a printed copy of the consultation notes and the patient is free to decide whether not not they wish to share the information with their NHS GP.

Readers' comments (67)

  • yes there is huge opportunity here for private sector to make a fortune. Surprised private A+Es have not sprung up. I would pay to avoid sitting in misery for hours with drunks etc. I do not like it at all but it looks like NHS is failing so private sector will step in. If this is the case then GP contractors need to have their hands untied so that we can compete on a level playing field.

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  • USELESS BMA//GPC cling on to an NHS that exploits all staff. payment for activity excellent idea.

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  • Oh boy, this will slaughter OOH ability to recruit GP willing to work unsocial hours in London.

    Currently our area has many GP Partners topping up their income in hubs/OOH for rouphly £85/h.

    If this can bring in £100-£200/h, then say bye-bye to offering services to HNS.

    Then again, I can't begrudge any GP willing to go an extra mile to top up a miserable remuneration they NEED to support the vocational activity of being a GP partner.

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  • So - I assume that the NHS GP's that are seeing private patients in their NHS tax-payer funded surgeries in their "spare time" will use NHS reception staff, NHS admin staff, NHS clincal systems, the practice's own CQC registration, NHS equipment etc and are effectively being paid twice. Can't really see them paying for using these facilities privately - can you ? Outrageous manipulation of the system, bordering on fraudulent - no wonder the NHS is going bankrupt...

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  • Practice Manager|16 Sep 2016 10:16am

    For some reason, when GP's hand the contract back to NHS England they are liable for the lease of the "NHS premises", they are liable for redundancy payments to "NHS Staff" and are left with hard to sell "NHS equipment" on top of having to deal with personal responsibilities of being registered with CQC (for a very personally funded fee).

    Are you really a practice manager?

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  • Harry Longman

    Exactly how do we know that appointments given in hours for a private fee are not in time taken away from NHS patients? Seems to me this cannot be audited, therefore it will be abused.

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  • Gosh, lots of people get hot under the collar when a service is set up for GPs to provide a service to patients willing to pay for it. Haven't consultants been offering a similar service for years? Hardly controversial stuff especially when the fee is cheaper than the cost of calling out a plumber.

    Shades of Great British Bake Off hysteria.

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  • Remember you are not allowed to see your own patients privately under GMS if it is an NHS core GP service.

    Breach of contract issues here.

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  • Better for patients.stop complaining.patients are important not your salary.

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  • |Harry Longman | Other healthcare professional|16 Sep 2016 10:33am

    As long as in-hours services are staffed to provide NHS services and can demonstrate this, - it's all above board. Rule of thumb would be that the GP seeing the patient is not rostered in to see NHS patients at the same time.

    If NHS wants to issue solid specific advice on what is expected from the GMS contract, then PLEASE PLEASE PLEASE let them. NHS can't have the cake and eat it.

    I understand that this looks like a loophole and probably is one, however this is the stick that has been used to beat the GP's for a decade.

    Good to get on the other end of it for a change.

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  • The Tory Dream - expansion of private services into the NHS. First starve the NHS of funds . Then enable leeches to exploit the situation . These blood suckers don't train staff or provide premises.

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  • GP registrar|16 Sep 2016 10:40am

    read T&C

    https://www.doctaly.com/faq/

    Can I see any GP?

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  • Don't get too excited, indemnity issues will limit the power of this.

    Paid consults will attract a super premium from indemnity MDOs.

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  • At the moment there is no encouragement for NHS GPs to see patients. A good day for a UK GP is a quiet day. In Australia that is a disaster, if no patients then no income at all. So NHS has to consider element of Fee for Service or the private sector will fill that space...adding further encouragement for GPs NOT be rid of waiting lists. Indeed all UK private practice depends on NHS waiting lists, which was why Fundholding was abolished. The hospital consultants could not tolerate loss of private income so lobbied accordingly.

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  • Anonymous | GP registrar16 Sep 2016 10:40am

    Quite right, I can't see how you can ask Pt to pay to be seen in your own surgery (unless on APMS?)

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  • Officially I'm furious. Unofficially I'm just going to have a quick look at the website anyway..

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  • Excellent idea. As GPs, we are experienced and could deal with a huge number of physical and mental conditions at a secondary care level. This training is being wasted because of our ridiculous NHS contract.

    The only problem with this excellent service is that most patients want rapid access to see their own NHS GP. Patients tend to have on going problems and want continuity of care. Similarly most GPs would happily spend more time with their NHS registered patients, IF they were paid for it. Putting aside simple clinical problems (though just dealing with these is probably enough to run a successful business model), a GP needs to have full access to NHS notes. Without this it can be difficult to understand the complexity of a patient's problems.

    Of course what really needs to happen is to change the GP contract so that we get paid according to what we do, like everywhere else in the world. Alternatively NHSE needs to define exactly what a GP is supposed to do for £110 per year.

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  • It seems to be using practice premises and resources which are largely NHS resourced. We are going down a slope quite quickly here with big implications. If co-payment is going to be a thing (which I think it is), it needs to be properly debated and understood by all NHS users.

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  • Peter Swinyard

    1. The premises issue. AS an owner occupier the NHS pays me a rental for use of my premises within contracted hours. I am at liberty to see as many private patients as I like in those times but if the private income exceeds 10% of practice income, the rent is abated. I pay the staff. The NHS does not. There is money in the Global Sum intended to pay the staff in contracted hours. Any money I spend on staff cones from my pocket.
    2. The elephant in the system. Prescriptions. See à patient privately and they must have private scripts. Fine for Wondercillin. But what if they need a Prostap injection at £285? Or if you are trying to give best choice treatment for hypertension? I would not be amused if my patients rock up (or ring up) demanding that I change their private script to an NHS one as it's their right... Actually this, and the restriction of trade which prevents my patients choosing to pay to see me on a Saturday when I am not contracted to care for them on the NHS, is what stands in the way of a mixed NHS/Private economy

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  • Practices have been offering private services to their own patients, like minor surgery, for several years and NHSE doesn't take any action... so a message is being sent out...

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  • Cherry picking patients for £40 to £60 a pop? No mental health or long term conditions. No visits. No QOF or ES targets. It's too attractive to be resisted. Our already shrunken NHS workforce will diminish further.

    All part of the grand privatisation plan of this corrupt government.

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  • like nhs 111, pharmicists, walk in center, ooh there will be additional work force whic will tell patien "IF YOU ARE ILL YOU SHOULD SEE OWN GP" gp consultation is not like visiting hair saloon. private gp need to prescribe privately, if investigations needed then they should be done privately. 39 pound will be only for one consutation. no matter how much you tell patients they will have to see emergency and they will be told to go to a and e or see gp.
    i was asked by some patients in 1980's to register them as private patients . i refused for above reason.

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  • Vinci Ho

    The 'trend' is much stronger than men. As we said in Chinese.
    There is nothing wrong if patients are willing to pay . Maybe there is argument whether patients still have to go back to their own GPs for the same complaint(s).
    My argument about any weekend routine GP appointments should be charged with a fee is not far away from this ideology .
    Yes, sooner or later , even A/E in private hospital for a fee.....
    The Tories are so happy......

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  • Its a great idea. Of course psychological and LTC related issues play no part in how, when and why a person presents with an acute problem... Good luck....

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  • It is so tiresome to read the same privatisation knee jerk response which offers no solution other thsn send me more money and then leave me alone - the clinician who comments on the Australian system raises a key fundamental issue which so many refuse to contemplate ; it is time to overhaul the health and social care system and challenge the entrenched attitudes which the BMA are so keen on extolling

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  • Private Health service can reduce NHS workload .If a patient can afford ,I encourage them to use their insurance /money & do referral to private specialist service .
    Of course this can cause certain ethical dilemmas when patient expects NHS prescription eg pregabalin

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  • I can't wait to get me snout in the trough. Yum Yum .

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  • I can't see how this can be very profitable for an individual seeing a limited number without encroaching on/disadvantaging use of nhs equipment. I would be very put out if I found , for example ,that the practice ecg machine/ physio was being used by a colleague for a private patient in the week when I might have wanted it quickly for an nhs patient, - or dressings/consumables/needles/syringes etc for that matter.- and the issue of being asked for a nhs prescription based a recent consult with someone else is as always-- usually appropriate, but what if it's not /not in the local formulary/not suitable? Also can I ask if any gp now doing this is willing to share roughly how much extra their medical defence provider is charging for the higher risk work of seeing pts without access to their notes on a private basis?
    In short a gp consultation is not just a chunk of gp time,,its the intro to all the other 'stuff'/people needed to respond to the presenting problem,and I don't think people should be led to expect to queue jump all the other stuff only for the consultation fee

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  • @1040 and 1108

    You, as an individual cannot charge patients directly for care that can/ should be given under the contract you hold.

    Company A can charge patients whatever they like for providing a service. You could work for company A. That would not be a breach of your contract.

    You may have to register company A with the CQC - not certain about that one.

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  • The Government will be only too glad of this. That is why they are making the job of an NHS GP and soon all Doctors, nurses... completely untenable. So eventually most of us will be doing private work. There will be a few NHS staff left, but God help them. The Government will not be 'actively' privatising the NHS, but they will be driving it through making the NHS job completely impossible. Then of course we will all get the blame from the public.

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  • Dear anon practice manager,

    Before you reject the idea of an NHS, did you realise the GP share of the NHS budget is now 5.9%?

    I will only reject it once we are back up to 12% and patient demand has been tackled.

    Until then, don't fall for the grand plan of bleeding us dry so we feel we have no choice.

    We need to fight for our share of the cake and put pressure on the GPC to make this one of the conditions of a trade dispute.

    If we don't, then we are all losers.

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  • If I am a gp partner and want to offer private appointments, why would I use doctaly as the middle man? Wouldn't it make more sense for me to just offer private appointments and keep more of the profits for myself and my practice?

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  • My experience of working in private general practice is not good. Tends to attract hypochondriacs and self-limiting illnesses such as URTIs but because patient has paid expectations are very high and would expect to walk away with antibiotics. Anything that needs investigations even simple blood tests would end up needing referral to a specialist. Not many people prepared to pay for blood tests, radiology etc. when you could just refer to a specialist and these would then be covered by insurance. Also no safety net of follow-up appointment etc.

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  • i think it is an excellent idea, we should give choice to the patient, if they do not want to wait, this is the way forward, anything given free is never appreciated, all the consultation should be charged - at-least 5 pound/day.
    home visit should be charged too- we get loads of abuse.

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  • i think it is matter of choice, why should anyone should have a problem, NHS consultant has been doing private practice for so many years, if GP wants to do whats wrong in that??

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  • "GP's doing a few appointments on their admin day" Do they get paid by the NHS for their admin hours? IF so wouldn't this be fraud?

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  • Agree with 'GP partner' at 4.41pm.

    The patients will expect a diagnosis and script (which will be private, expect a fuss) in the consultation. They won't be expecting to pay for any investigations that are necessary. Sounds like more hassle than it's worth to me.

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  • @9.48
    I don't think you have quite grasped GPs' pay structure. Practices are paid a set fee to cover as much work as comes through the door (or telephones or emails or calls for a visit). The admin has to be done around the immediate clinical stuff - the working day just extends until work is finished, frequently 10-11 hours during the week +/- weekend catch-up work.You want us to be paid by the hour and be accountable to "management"? Can the NHS afford that?

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  • Now then, all getting their nickers in a twist!!
    Please get off your Nhs horse and face reality..

    The whole system is slowly being eroded and it is time we have few innovative companies try to take us out of this mess. There is no funding coming from the government, we will all have to pay for our health.
    What is wrong if I pay for my medical advice? Other day I had a chap look at my washer, upfront charge was 95 quid. My son works as a junior doctor and his hourly rate is 14.50 ! My gardner charges 15.00 an hour.

    We need to have a system where young doctors feel valued so that we attract more of them in the profession. Earning more for half your lifetime spent training is not a swear word. Bring it on, I say.......

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  • Dear All,
    I say again, we are here because of a sustained campaign by HMG to destroy universal easy access to NHS GPs. It is now working adn we are at a tipping point. Unless Mr Hunt comes up with shed loads of money (he won't because he doesn't intend to) then primary care NHS as we know it will disappear.
    This is a solution for patients and doctors problems arisen from desperation - if patients had access they wouldn't need it, if GPs had reasonable working conditions they wouldn't want it.
    Good luck to them.
    Regards
    Paul C

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  • I have been very naughty. I just did a HGV medical in my 'NHS' premises and I charged a private fee. And then I did an adoption medical and charged a private fee. And then I did a diving medical and charged a private fee. Will I be told off by the NHS police.....

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  • 1. Ideally there would be no private medicine it is queue jumping and it doesn't exist in Alberta Canada where I work for that reason. Doctors are paid better here of course and no beurocrasy.

    2. If youre going to do it this system seems a pain in the arse. The odd patient for 40 quid. surely youwould want at least 10 together to make it worth while or charge more.

    3. who cares about having all their notes for most things. As said for long term conditions might need it. Again here in Canada people go to random clinics a lot not just their own doc if they even have one and it works ok. This service is more for urtis m.skel, STIs, new symptoms and worried well and if not reassured may well be advised to keep the appointment with their own GP which was 2 weeks away. so what?

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  • Canadian GP.....keep up! there's a whole lot of stink going re introduction of private practice in Canada.see THEBMJ this week

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  • I am a full time NHS GP. I created Doctaly in an attempt to redress the balance. For too long there has been a total disconnect in what our monopolised NHS contracts offer us, for perceived versus actual activity. I have found that supply will never meet demand because it is free. GPs and more recently junior doctors have been the easiest targets for cost cutting despite repeated calls from the profession that funding is required. I know great doctors who have been totally demoralised and turned into faceless cogs worthy of culling at the drop of a hat. I want to bring value and appreciation of general practice and champion excelling GPs be that salaried or principals.
    Private care already exists so why can't the ones doing all the complex NHS work be the ones who benefit from what dissenters call "cherry picking". Hospitals have been doing this for years to balance their books whilst also being paid on activity. The same can be seen in dentistry.
    I fundamentally believe that by creating extra affordable appointments which are fair to the GP, pressures will invariably be taken away from NHS services creating a level of order. The patient who pays would have gone on to use an NHS services be that A&E or a GP appointment. Ultimately I hope to bring an appreciation of a GP appointment and in turn, force proper funding of primary care by bringing a little bit of power back to the GP.

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  • Private services are going to gain momentum and this is just the normal transformation and consequence of the collapse of NHs. If Doctally wishes to expand and take over or contract sites where these services can be provided, many would gladly join and ditch NHS. The questions remaining to be clarified would be your indemnity premiums which may spiral and eventually the premises costs - would one earn enough to mange those. Subletting consultation rooms to other GPs or Specialist Consultants and/or taking a percentage of payments made for each visit would need to be worked out to ensure liquidity of business. Most of the private clinics work that way.

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  • Dinesh, how does it affect your indemnity premiums and rent reimbursements if you see 2-4 private patients a day? Please give us an idea.

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  • John Glasspool

    Surely, the (TOory) government will love it? I mean, it is a market in action!

    I don't blame any GP for taking part given they way they have been treated for about, er, ten years now.

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  • John Glasspool

    Surely, the (Tory) government will love it? I mean, it is a market in action!

    I don't blame any GP for taking part given they way they have been treated for about, er, ten years now.

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  • Finally! An opportunity to take matters into our own hands rather than just watch as our profession is ground into the dust. I have done a lot of thinking about this, and am struggling to see it as anything other than a complete win/win. Every Doctaly patient is one less appointment for the NHS to pay for. The model as I understand it just sweats existing assets that belong to the practice. And as GP's, we get a chance to supplement our gradually declining income. I spoke to my insurance provider, stressing that I would potentially be seeing people without their notes, and they were relaxed - no different to a home visit for example. Difference in premium was negligible.

    Time for a quick chat with the partner methinks....

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  • Sanjeev, the work is classed in a similar vein to OOH in that we are not furnished with the notes. There are differences in all the defence unions in how they indemnify partners and salaried GPs. I am with the MPS and I am covered for a session of OOH as a partner. There is no change to anyone's indemnity for creating availability and if I were to see 4 extra patients a week as I do currently there is unlikely to be any change to my insurance. Once you start to see a significant volume of patients the insurance will change, but if I very crudely say indemnity costs as a principal are approx £1-1.5k/session (4 hrs20mins) would equate to maybe 800-1000 patients a year. The practice income generated for that extra "private" session clearly makes the increase in indemnity fees almost academic. In our GP FAQs we state that each doctor must ask their provider how the insurance changes according to the number of patients they see because unfortunately there is no uniform answer.

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