Why I WON’T be seeing the video doctor now! As NHS health chiefs say they want 30 million medical appointments via Skype, the Mail’s Dr Max Pemberton gives his verdict
- Tech companies are falling over themselves to provide solutions to the NHS
- These include virtual appointments, where patients are assessed via video calls
- However, the trend could have devastating consequences for GP surgeries…
Eveyone knows the NHS is struggling. Its finances are being stretched gossamer thin as a result of the combination of an ageing population, immigration, increasing costs of health care and chronic underinvestment.
Economists have warned that if things don’t change, the health service could collapse.
Technology has been hailed as the answer, and tech companies are falling over themselves to provide solutions to the ailing NHS.
Politicians have responded to the crisis by putting all their faith in the fact that tech innovation will revolutionise healthcare, making it cheaper and more efficient.
Health Secretary Matt Hancock has announced he is making the digitalisation of the NHS one of his top priorities, and suggested up to 30 million GP appointments each year could be carried out via videolink on smartphones, tablets or laptops rather than in person.
But have we been too hasty in our rush to embrace innovation?
Many doctors think so. They claim that far from saving the NHS, online GP services such as GP at hand — a private company working with the health service — risk destroying it by ‘cherry-picking’ patients.
At present, GP surgeries receive a fixed fee for each patient registered with them. The majority of these patients don’t see the GP or need treatment, so this money offsets the cost of those who do.
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However, those younger, fitter patients are more likely to register with online GP services, leaving regular GP surgeries with the sickest, frailest and most complex patients who are also the most costly.
This could spell financial disaster for GP surgeries — and even increase the length of time patients have to wait for an appointment.
There’s also the risk that online GP services will drain GPs away from surgeries, as they offer more flexibility and doctors can work from home, putting further pressure on already understaffed practices.
Others have pointed out that there is an issue of priority. Mobile apps such as GP at hand are popular with the relatively young and fit who are more concerned with convenience than continuity of care. But they aren’t the ones whose care is suffering the most because of the health service’s difficulties.
The priority, it’s argued, should be finding ways to improve the care of those with complex needs — the elderly, the frail and the mentally ill.
As a doctor myself, for me, perhaps the biggest question is whether the medical care these apps provide is actually any good?
For some time I’ve been unconvinced that an app can replace seeing a doctor face-to-face. So I tried one to see for myself. What I experienced left me even more worried.
I decided to try a GP app to which I have access via the private health cover I get through my partner’s job. While I rarely use it, on this occasion I felt it was the quickest, simplest option. After all, that’s the point of modern technology, isn’t it?
How wrong I was.
I was due to fly to Spain the following day, so I went for a haircut. The barber noticed a rash on the back of my scalp — I’d been aware that there was something sore there, but had dismissed it as I’d had an operation on my foot earlier that week and had other things on my mind.
When the barber showed it to me in the mirror, I was shocked. It looked far worse than I’d realised. It was mid-afternoon and knowing there was little chance of seeing my GP before the flight the next morning (and the rash was hardly life-threatening, so I didn’t like to bother them), I decided to log onto the online GP app on my phone.
I was offered an appointment for an hour’s time when a doctor would video-call me. I was impressed. But then the time of the appointment came and went. I sat — and waited.
Nearly 20 minutes later, the GP finally called. There was a problem with my account and she’d been on to technical support to find out why. She still couldn’t see that my account was verified — despite my having it for over a year — but decided to go ahead with the consultation regardless as she was already late for our appointment.
(I had actually verified my account — which requires you to take a copy of your passport or other formal ID and then a selfie and upload them to the app — several times, including just before the appointment, but it kept saying I hadn’t.)
The GP was lovely and kind, but looked just as harassed as any in the NHS.
The next problem was trying to show her the rash. It was in an awkward place to show on camera, and I couldn’t tell if I was holding it in the right place.
In the end she saw enough to be able to say she wasn’t sure what it was. But whatever it was, she didn’t think it was infected. Perhaps a steroid cream would help, she said, but seemed at a loss to know what else to suggest.
This all seemed a bit vague and I began to wish she’d been able to see it in person to establish exactly what it was. The appointment ended and I waited for the prescription to be emailed to me. And waited.
I had some things to get from the chemist anyway and, as it was about to close, I made my way there so I could show them the prescription. But at the pharmacy I received an email saying my account wasn’t verified so they couldn’t send me my prescription.
I told them I had verified it and, in fact, had done so several times — each time, receiving a message to say ‘account verified’.
I waited, but heard nothing, and then, more than an hour later I received the same email again, saying I needed to verify my account. I wanted to scream.
This was followed shortly after by a half-written email that was barely in English: ‘They may be an issue as to why your ID is not verifying hence why I ask for your ID to be sent over to myself and unfortunately we are unable.’ It stopped abruptly there and I heard nothing more.
Reader, I’m still waiting for my prescription several months later.
In the morning, just before going to the airport, I took a chance and called my normal NHS GP practice. Sure, they said, pop in, which I did.
My regular GP examined the rash closely and said, in fact, it was infected and strongly advised against steroid creams — which exacerbate skin infections — and prescribed an antibiotic instead.
The whole process with the online GP had been frustrating and time-consuming, beset with glitches and, given that the app has been around for several years, can’t be dismissed as mere teething trouble. It is more frustrating dealing with these because you are reliant on a faceless, impersonal call centre for admin support.
At least when there’s a problem at the GP surgery, you’re sitting in front of them and they can deal with it. But it also showed me that technology can’t replace sitting in front of someone. Sometimes in medicine you need to see the patient, touch them, do tests and take samples.
The cold, brutal fact was that the GP I saw through the online app misdiagnosed my skin problem and prescribed the wrong treatment. Worse, the medication I was prescribed by her would have made my condition worse. Thank goodness that prescription never did turn up.
Last year, the Care Quality Commission (CQC), the healthcare watchdog, found that 43 per cent of online GP services were unsafe. And, according to the GP newspaper Pulse, the General Medical Council was investigating 30 doctors in cases connected to online prescribing.
But the biggest concern is that these ‘unsafe’ services were overprescribing antibiotics — the CQC found that they were more likely to prescribe them as a physical examination was not possible.
Without being able to examine the patient or run further tests, it’s all too tempting for online GPs to reach for the prescription pad. This is at a time when there are serious concerns about overprescribing antibiotics.
Indeed, this is exactly what happened to me another time I used the same app as before when I suddenly developed lower back pain just over a year ago.
The GP I ‘saw’ then admitted she didn’t know what it was and, as she was unable to do a urine test (to check for a kidney infection), said I could take antibiotics just in case.
She sent over the prescription — which arrived promptly — but I didn’t like the idea of taking something without a clear rationale why, especially antibiotics.
I apologetically phoned my NHS GP surgery and within an hour I was sitting in front of a doctor who tested my urine. This showed that I didn’t have an infection — so didn’t need antibiotics. The test did show some blood and, indeed, later that day I passed a small kidney stone. Once again, misdiagnosis and the wrong treatment.
There’s no doubt that getting to see a GP can be frustrating, and the idea of an app which is easy to use and seems to be able to offer appointments whenever you want them is tempting. But my experiences have been far from positive.
I think technology has a lot to offer the NHS, making things more efficient and cutting costs. I also think there’s a place for apps.
But this app will not save the NHS. It provides a convenient alternative, but it cannot replace physical GP surgeries. Using the app made me appreciate my own GP and being able to sit in front of someone even more.
But we see this all the time in medicine. Something new comes along and is hailed as a panacea. Over time, though, we start to realise that — while often good — it’s not quite the answer to all the problems. The same will be true of the health tech revolution.
There will always be some things, such as sitting down in front of your doctor, that technology simply can’t replace.
So how do patients know which health apps will be up to scratch?
There are 320,000 health apps available in the UK, including those that allow you to have a live consultation with a GP. But how do you know which are any good?
Only a tiny fraction — 77 — have been vetted by the NHS and can be found in the NHS Apps Library. However, the NHS checks only for safety and security; many of the apps in the library have no clinical evidence to support their use.
The library apps that have been clinically tested by the NHS carry a tick symbol and the words ‘NHS Approved’
Of the apps listed, only one — the myCOPD app for managing the chronic lung condition Chronic Obstructive Pulmonary Disease — is ‘NHS Approved’, while only three others are undergoing clinical testing: mental health support apps called Chill Panda, Cove and Cypher.
WORRIES ABOUT WHO CAN SET-UP NEW APPS
A report published last year by the think tank the International Longevity Centre (ILC) concluded that the best apps are often lost among swathes of poor quality, ineffective ones, some of which had serious data security flaws.
Jon Date, of the ILC, says: ‘While poor-quality drugs or medical machines rarely, if ever, reach the market, it’s not the same for apps because the barriers for entry are so low.
There’s no kind of formal regulation — anyone can set up an app without any kind of checks.’
Some apps offer live consultations with doctors and healthcare professionals via text or video messaging.
Some of the most popular apps in the UK include GP at hand, an NHS-backed app which is free but patients must give up their usual GP; Push Doctor, which offers membership at £3 a month and charges for GP appointments; and Now GP, which offers ‘on-the-go’ video consultations for a fee.
Partnerships with NHS practices mean that appointments with Livi, which offers video calls ‘within minutes’, are free in some areas.
IS ENOUGH BEING DONE TO PROTECT PATIENT SAFETY?
Professor Helen Stokes-Lampard, chair of the Royal College of GPs, is concerned about patients using ‘live doctor’ app.
She fears they could be misdiagnosed or given inappropriate treatment because the online doctor does not have access to a patient’s full medical history or their medication details.
‘We have concerns about apps that offer patients access to GP services without being rigorously evaluated in terms of the potential impact they have on patient safety,’ she says.
SOME SYMPTOM-CHECKERS FOUND TO BE INACCURATE
Other mobile apps offer automated consultations, where patients can check their symptoms against computer software
But a 2015 study at the University of Southampton of 19 apps designed to predict the risk of a heart attack, found only half were accurate, with paid-for apps performing worse than the free ones.
Even accurate results could cause damage, warns Jeremy Wyatt, professor of digital healthcare who did the study.
‘There is a risk patients could waste valuable time in critical situations because they are focused on entering symptoms into an app and waiting to be told to call 999, instead of calling for help as soon as an emergency happens,’ he says.
…BUT HIGH HOPES FOR THE NHS’ NEW APP
The official NHS App — which will let patients book GP appointments, order repeat prescriptions, see their medical records and contact NHS 111 online, among other services — is currently being piloted.
Unlike other apps offering similar services, this is the first to be made and run in-house by the NHS. Experts are hopeful it will make it simpler to access treatment and share relevant information. Professor Wyatt adds: ‘Apps are potentially a great idea — if we can get them right.’
– Rosie Taylor
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