Are online GPs the future of healthcare?

The recently unveiled NHS 10-year plan has promised that every patient in England will be able to access online GP consultations within five years. But are you ready for a digital doctor, and is the NHS?

Soon you could be able to chat to your GP with just a few swipes of your smartphone. The NHS is undergoing a huge drive to expand its digital offerings. It's just launched an NHS app, through which you can do things such as book appointments, check your symptoms, and order prescriptions, And, it has been rolling out a new online GP service - GP at Hand.

In principle, these developments are a positive step, expanding your options for accessing medical help when you need it, and allowing for a simple way to book and keep track of appointments and medication.

But there are concerns. GP at Hand has one major, controversial condition: instead of being offered as part of existing GP practices, the NHS has partnered with a private health company, Babylon, to provide a separate service. And you'll need to deregister with your existing GP to use it.

This has proved a sticking point for many. Indeed, when we asked Which? members if they'd be happy to register exclusively with an online GP service, 96% said no.

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Impact of digital-first services

There are concerns that services such as GP at Hand could create a two-tiered health system where some patients receive better care than others.

Dr Phil Whitaker, GP and New Statesman columnist, explains: 'GPs basically receive a fee for each patient' (according to a formula that allocates resources for different types of patients, with enhancements for more complex patients that critics argue are inadequate). 'Services like GP at Hand attract young, fit patients - who consult infrequently, and typically with minor complaints - leaving neighbouring practices struggling to look after their complex and chronically ill patients, with ever-dwindling resources, threatening their very viability.'

Dr Mobasher Butt, medical director at Babylon, sees the situation differently. He says the service is suitable for all sorts of people, including those with complex care needs. Babylon says that GP at Hand aims to solve the problem of doctors being inaccessible, which it sees as the biggest safety issue. At present, though, Babylon has an overwhelmingly youthful patient demographic: almost 50% of its patients are aged 20-29.

Some argue that it's the GP funding model that needs to change, but there are also concerns that the digitisation of health services could exacerbate digital exclusion. A 2016 report by The King's Fund: 'A Digital NHS?' noted that 'the people with the greatest health needs are often less likely to have the technology and skills to engage with and benefit from digital services.'

NHS online GP service - who can use it and how does it work?

GP at Hand is the NHS service run by private health company Babylon. Currently it's only available in London to people who live or work within 40 minutes of a participating clinic, but it's due to expand to other major cities.

How it works:

• Patients can use the smartphone app to book near-instant consultations that take place via video chat or a phone call.
• You will usually be seen within two hours. Appointments last around 10 minutes.
• If you do need to see a GP in person, you'll be referred on to a clinic run by NHS GP at Hand.
• If you don't want to deregister from your GP, you can become a private Babylon patient and pay for appointments through the app (around £25 per appointment, or via monthly / annual subscription).
• If you then need to be seen in person, the doctor will refer you back to your NHS GP.

Online GPs put to the test

We tried out Babylon's private online GPservice, which itsays is identical to the NHSversion from a userperspective, exceptthat you pay eitherby appointment (from£25) or for a monthly/ annual subscription(£10/£90).

We bookedthree consultationsfor different healthcare issues,and asked two expert GPsto provide comment. The healthcare scenarios were designed to test the system, and included:

• Patient with insomnia - wants sleeping pills. Should be signposted as anxious or depressed.
• Patient with asthma - has had recent flare-up and wants an inhaler. Should be offered a physical assessment.
• Patient with sore throat - wants antibiotics, but should be denied them.

Our GPsrated the consultationsas generally adequate,and most of what wasflagged for criticismcould happen in anyGP consultation.However, they felt that physicalconsultations wouldhave provided morefreedom for thedoctors to properlyassess symptoms.

For example, withthe asthma patient,one of our expertssaid: 'This scenariodemonstrated thelimitation of an onlineservice for me: ifyou're really ill, you'llneed to be seen inthe flesh anyway.'

In the insomniaconsultation, thepatient was referredback to his NHS GP forcounselling and to askfor medication. Bothexperts felt that beingdirected back to theNHS demonstrateda limitation of theprivate service.

Babylon's private service has some restrictions in place on medications, categorised as high risk or with potential for misuse, which would need to be requested from your normal NHS GP. This seems like a good safety netting feature.

Our sore throat patient was flatly and quickly denied antibiotics, which both experts felt was appropriate.

GP at Hand:patients' views

We asked users of the online GP service to tell us about their experiences. Some found it highly convenient, but others weren't so convinced:

Your concerns about online healthcare

In October, the Advertising Standards Authority ruled that Babylon's advertising on the service was 'misleading,' because it didn't make clear that patients would have to deregister from their usual GP when signing up.

This was the key sticking point in our survey of Which? members, but other concerns included: not knowing who the consulting doctor was (71%), privacy (69%), and what would happen if you needed a physical appointment (66%).

This suggests that the way the NHS is currently rolling this service out is not in line with what many patients would be comfortable with.

Some health professionals are also skeptical. Elizabeth Murray, Professor of eHealth and Primary Care at University College London, says: 'We have to make digital health work, but the issue is in the implementation.' Murray says online services need to be integrated into the established ways doctors work. We can't just 'go digital' and expect problems to evaporate.

As part of the 10-year plan, there has been an indication that this approach is set to change and patients should be able to access online GP services via their existing GP practice.

Could online healthcare make your life easier?

If you've ever struggled to get anappointment with your GP, the idea ofbeing offered one within two hoursof tapping twice in a smartphoneapp could be attractive.

The array ofdifferent options for online healthcare, from appointment booking to actualconsultations, might also mean youhave more control over when andhow you deal with health issues.

It won't appeal to everyone, though.Most GPs already offer online booking,prescription ordering, and access tomedical records online or via an app,but only 6% of patients are currentlyregistered for these services.

Make the most of digital NHS services

It's worth finding out what your GP offers and signing up. This will cut down on admin time for simple requests and mean that you have a record of what's been prescribed to you.

The new NHS app is now available to download, withmost practices due to sign up between April and June this year. It is 'expected to be fully rolled out to practices and patients by 1 July 2019,' according to the NHS.

You can also ask to find out more about other online resources that support regular GP care. For example, there are online programs that helpyou and your GP track conditions overa period of time and make reporting easier - such as stopping smoking,or diabetes management.

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