Several insurers have launched a Virtual GP service in recent months. But is it the future of healthcare, or another example of technology displacing a valued face-to-face interaction? Madeleine Davies reports.
A brave new virtual world was outlined by the head of the NHS this year.
In an interview with the Financial Times, Simon Stevens suggested that, for those under 30 “the idea of booking appointments and physically turning up to GP surgeries for routine things is an alien concept”. His vision of consultations via smartphone is shared by the Government, which believes that telecare will be a crucial means of delivering its promise of improved access.
Consultations via Skype are already being piloted in the NHS. At one London practice, 95% of patients said that they would use the service again.
The private sector, too, appears to share this enthusiasm for technology. Health Shield, Exeter Family Friendly, Aviva and VitalityHealth have all announced Virtual GP services in recent months.
Peter McAndrew, sales director at Health Shield, reports that the response from members has been overwhelmingly positive.
“They seem to love it,” he says. “When we are selling new business, it is one of the things they really like. The public is ready for it.”
Health Shield’s Virtual GP Surgery gives members access to online GP consultations between Monday and Friday, from 8:30am to 6:30pm. This convenience is appealing, says McAndrew, given the fact that, in many circumstances, it is necessary to ring first thing in the morning to secure an NHS appointment.
The inability to pre-book is a particular problem for those who commute across long distances, he says – “You are virtually going to have to take a day off” – and for those in professions like construction for whom taking time off at short notice is almost impossible.
Another major advantage of the service, he says, is that members can get a private prescription, which can be delivered to any address, including workplaces. He reports that this service is often being used by people on holiday, who fear the cost of accessing primary care abroad or cannot find a doctor who speaks English.
Stuart Scullion, managing director of PHP, the specialist intermediary that is part of the Punter Southall Group, agrees that GP access is a problem. He points to the “massive number” who struggle to get a GP appointment and the one million who, as a result, have gone to A&E to seek help. But he cautions that, when it comes to these new private offerings, there is “quite a difference between the breadth and depth of services”. The public will need help to understand “subtle nuances” in what is being offered, he thinks.
He wonders, too, whether insurers may start using these online GPs as “gatekeepers”, who direct members down specific pathways of care, to specific providers.
Colin Boxall, commercial director at ADVO Group, is thinking along the same lines. He believes that such services will “increasingly be the norm as the use of virtual diagnosis and online referral become expected as our work lives catch up with our personal online lives”.
He adds: “The use of online GPs to manage and instigate a claims process at last opens up the possibility of seamless care through one insurance policy. By bringing together and managing the initial process there is more control over the claims pathway.”
This appears to be the thinking behind VitalityHealth’s new service, launched in recent weeks. It offers all Vitality members 24-hour access to a medical professional via telephone and video appointments within 48 hours. The GPs are able not only to prescribe medication but to make immediate referrals into consultant care. They can also arrange for care to take place in a member’s home, for example by arranging for a blood sample to be taken.
Neville Koopowitz, chief executive of Vitality Health, describes this ability to refer into the system as “a big change in the way that private healthcare will be delivered”, eliminating the need for members to “go public before they can go private”. The GPs signed up to the service, all of whom have been practising in the UK for at least seven years, are trained in how insurance works, he points out, unlike NHS GPs who may “leave people on their own to try to navigate that environment with their insurer”. With access to the member’s Vitality wellness data, the GPs will be able to advise more broadly on lifestyle choices. Members can choose not only the speciality of the GP, but their gender. It’s worth noting, however, that unless they choose Vitality GP Select, they are limited to four consultations a year.
Although Koopowitz stresses that the service is not designed to replace a member’s NHS GP, he estimates that around 70% of consultations can be done through telemedicine alone. He is emphatic that the service is not designed to save the insurer money by keeping people out of secondary care.
“We are not trying to escape paying for healthcare,” he says. “This has been a significant investment and we are giving members access to benefits they never had before. The GP has absolute discretion around onward referral. There are no targets; we have just told the GP that appropriate care must be given.”
But despite these assertions, Magnus Kauder, commercial director at Blossoms Healthcare, which provides occupational health and private GP services, has reservations about virtual care.
“I do not feel threatened by innovation in healthcare, which is a really, really good thing,” he says. “But there are clearly limitations as to what you can do at the end of a telephone or video, and nobody seems to be talking about potential harms and limitations.”
He reports that there are “not that many doctors comfortable purely in this medium”. While in some environments, such as oil rigs, it might be the only option, it is, he argues “second best in our minds to an actual consultation. Doctors need to be physically able to assess and diagnose a condition. […] You would not survey a house from a photo.” He gives the example of a cough that might be a symptom of heart failure – it would not be possible to determine this without a stethoscope.
He also worries that some consultations may be “missed opportunities” to get a quick diagnosis.
“All you have done is double the demands on care infrastructure and delayed diagnosis,” he says.
There is evidence to suggest that his reservations may be well-founded.
A study led by the University of Exeter Medical School involving 20,000 patients across 42 surgeries found that telephone triage conducted in primary care did not save money or reduce practice workload because the patients involved were more likely to require further support or advice when compared to patients who saw a doctor in person.
‘SAFE – AND EFFECTIVE’
Dr Umang Patel is clinical director at babylon which has partnered with Aviva to offer some of the insurer’s members access to video or phone consultations 12 hours a day, six days a week. A practising paediatrician, Dr Patel is confident that the service is both safe and effective. All doctors signed up to the service have to have at least five years of NHS experience, and undergo a “robust” interview process. Users are also able to rate each consultation and comment, and any low score is investigated: a medical panel reviews the consultation recording.
“Safety is paramount,” he says. “All of our doctors are very experienced and well-tested. We do lots of mystery shopping.”
The heart of the service, he says, is directing people to peer-reviewed advice online, helping them to avoid the maze of potentially inaccurate information that a Google search might generate. He recently saw the mother of a five-year old with a temperature who had been waiting to see him for four hours in hospital. All that she needed to be told was that it was safe for her to give her child paracetamol and ibuprofen on the same day.
He cites “really good studies” which suggest that “80% of the time, the doctor does not need to touch you”. babylon’s own data suggest that 90% of the consultations can be closed without needing referral. The same percentage of users rate the service four stars or above (out of five).
While nobody is suggesting that this, and other services, will replace the NHS, there appears to be a growing consensus that technology, with the proper safeguards, offers a solution to a time-pressed public unwilling to wait for healthcare.
“There will be a further emergence of virtual, online, digital GP services and we expect there to be more entrants, not less,” says Scullion. Rumours of who is next, are already circulating.
Testing the service
I tried Health Shield’s service on a Thursday afternoon at 3:00pm. I got straight through to the operator, briefly passed on my details, and arranged a call-back from the GP at 6:00pm. In the meantime, I downloaded the app for free onto my iPhone. The GP called a few minutes late, but was extremely helpful. My “test” complaint was headaches in the evening. He asked lots of questions before concluding that they were probably brought on by lots of staring at a screen and suggested an eye test. He was very reassuring but also careful to suggest that if the eye test didn’t suggest that the problem was screen-related, I consider going back to my own GP. Overall, I was impressed by how easy the process was, and how professional, helpful and careful the GP was – just like my own one in the NHS. But for other conditions, for which I would expect to need a physical examination, or for which I would prefer to see a GP with whom I had built up a relationship, I would still prefer to go down the NHS route.