Is technology taking over from traditional GPs?

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Doctor who?

Patient 2.0 is turning to futuristic ‘digital doctor’ services for the appointments that traditional GPs are unable to provide.

 

As the NHS prepares for a severe flu outbreak this winter, a GP shortage, recruitment crisis and surgeries closing have resulted in patients not being able to get an appointment with their doctor.

No wonder technology has stepped in, offering frustrated patients another option. ‘Digital doctor’ services such as Push Doctor, ZoomDoc and MedicSpot, where, for a fee, patients are guaranteed to quickly see a real doctor, are on the rise. But what does this mean for patients, the NHS and the future of healthcare?

Dr Zubair Ahmed, Founder and CEO of MedicSpot, says that our expectation of quick and easy access to just about anything we want is partly behind the growing success of digital doctor services: “Latest figures show that 11.3% of patients were unable to get an appointment with their GP when they last tried. Patients who are used to convenience through other non-health services are now also demanding this level of access for their healthcare needs. Digital doctor services fulfil this need pretty well.” Dr Kenny Livingstone, GP and founder of app ZoomDoc, believes that digital doctor services answer the needs of both patients and GPs: “Patients are increasingly frustrated with waiting times at their surgeries and when they are finally able to get through the gatekeepers, such as the admin or online appointment systems, they’re only able to see their GP for about 10 minutes,” he explains. “From the GP point-of-view, more doctors are looking for flexible working times and trying to work in both private and public sectors to support their schedules. This drive towards the private sector has been almost catapulted by NHS workloads.”

London GP Dr Adrian Wayne says that access to ‘digital doctors’ is an inevitable consequence of the increasing difficulty in getting an appointment to see a doctor: “Digital doctor services which enable patients to have a face-to-face GP consultation on their laptop, tablet or mobile, seven days a week, are filling a gap in the market for patients who are prepared to pay to access GP services quickly or at their own convenience.”

 

Waiting room rebellion

As the NHS struggles to keep up with patient demand, the advent of digital doctor services could have positive knock-on effects for speedier diagnosis and treatment: “It’s a chicken-and-egg situation because demand by patients is shaping these services just as these services are simultaneously altering people’s behaviours around health. Apps and technology are regularly reinterpreting our perceptions of luxury,” says Dr Livingstone. “Historically, a person would never think to visit a private GP, but the modern time-poor consumer now understands the value of two to three private visits a year that could potentially expedite referrals and provide access to consultants and medication.”

Traditionalists may be concerned that a health service provided in this way may compromise patient care and safety, but any fears that a ‘digital doctor’ is a poor imitation of a ‘real’ GP are unfounded, says Dr Ahmed: “Our doctors also work for the NHS, but choose to work for MedicSpot on their days off. We know that the average NHS GP works 3.7 days a week and MedicSpot aims to make use of these extra hours to increase capacity in the health system.” 

ZoomDoc’s doctors are all GMC registered, UK-trained GPs. “They mostly work within the NHS, but also within the private sector. All of our doctors are tightly regulated, monitored and fully insured. They all undergo regular appraisal and revalidation,” says Dr Livingstone.

It is this expertise, coupled with convenience, that makes digital doctors so appealing to the 21st Century patient. “Patients are learning the value of paying for a private visit and the access it gives them to quick referrals, much-needed medication and most importantly, a sense of comfort in knowing a doctor can be at their door in an hour, or on video, in fifteen minutes,” says Dr Livingstone.

 

Continuity matters

Dr Wayne says that while digital doctor services have their advantages, in certain situations they also have their limitations: “Telephone helplines and online consultations are fine for dealing with patients who have simple problems; for example, a patient who has clear symptoms of a food allergy. I do think that controlled drugs, sleeping tablets and psychoactive drugs should be prescribed through the patient’s NHS surgery,” he says.

“Telephone triages are, of course, commonplace in NHS GP surgeries, and evidence from our own practice shows that they can reduce the number of face-to-face appointments required. Making diagnoses over the phone or online, however, requires a high-level of competence and digital doctor services are disadvantaged as they do not have access to the patient’s medical notes.”

Dr Ahmed agrees that a more joined-up system needs to be developed to ensure that patients get the care they need: “To take full advantage of digital health, we need a better infrastructure to improve continuity of care between services. There is still a great deal of fragmentation in patient care with online services, but the providers who can tackle this will thrive.”

 

Opportunity knocks

The rise of digital doctor services provides an opportunity for the NHS to collaborate with them to streamline current GP services and benefit the NHS as a whole, according to Dr Wayne: “Provided there is appropriate governance, and prescribing is in accordance with the Care Quality Commission, there is definitely a place for digital doctor services. Furthermore, I believe there is an opportunity for Clinical Commissioning Groups to enter into contracts with these companies to provide telephone consultations, with NHS GPs and out of hours services,” he explains. “These services, which could be accessed more easily than usual NHS services, might be charged back to health insurance companies. If they were signposted, then overseas and non-eligible patients may not present to the NHS directly and, therefore, use fewer NHS resources.”

 

Time travel

If more patients are turning to digital doctors for appointments, could this ultimately relieve pressure on an NHS which is currently buckling under the strain? “Patients are now becoming more aware that these kind of services do exist and can be a viable alternative for their healthcare needs. We will see more conditions being remotely managed efficiently, which will improve capacity in the health system,” says Dr Ahmed. “We are already finding that patients choose to use MedicSpot rather than attending NHS walk-in centres or trying to make an appointment with their own GPs, so early evidence of relieving pressure on the NHS is promising.” Dr Livingstone agrees that the opportunity for patients to get diagnosed earlier can reduce the pressure on acute care services too: “In many ways, these apps are relieving the pressure from the NHS as well as A&Es, where many of the patients in queues don’t actually need emergency assistance.”

The nostalgic idea of ‘our NHS’, which can continue to provide the solutions to our healthcare needs, free, at the point of care, is rapidly fading. Digital doctor services provide an alternative, but is it one that is open to all? “As much as we value the UK’s universal healthcare system and the necessity of having an NHS, we need to understand and accept that there is a significant portion of patients who pay insurance already and would more than happily pay for a doctor to come to their door,” says Dr Livingstone.

The digital-savvy patient, used to having their needs met at a tap, swipe or click, now has a new way to look after their health. The founders of digital doctor services know that, and at the moment it’s a race to the top, which will have inevitable casualties as the market develops. “The market is heavily saturated with different players offering slightly different propositions. I think telemedicine can only grow with the advent of web 2.0, faster broadband and the ever-increasing number of digital consumers; however, the market is a bit saturated and it’s only a matter of time before certain players have to exit,” says Dr Livingstone. “My strong inclination is towards the many video apps out there. While a video consultation is more than enough in many straightforward cases, often a patient needs to see an actual doctor for a proper assessment. There are too many apps competing in this space and only the fittest will survive.”