The launch of the GP at Hand app-based primary care service in London has been met with accusations that it is damaging the NHS.
The service is being run by a practice in Fulham, but people across central London are able to move their GP registration there. It offers video consultations 24/7 and face to face appointments at five clinics so far. It uses technology provided by Babylon Health, which bills itself as “the world’s first AI-driven healthcare service”.
GP at Hand has been accused of trying to make an easy profit by avoiding the patients who create the most work, threatening the viability of other practices. There have also been concerns that app-based GP services could pull lots of healthy people into the primary care system at the expense of those who really need it.
The recent annual conference of England’s local medical committees opposed the rollout of online consulting until there was “clear evidence” of the benefit to patients.
The biggest problem with the service is the long list of people who are discouraged from signing on. The website says it may be “less appropriate” for 10 categories of patients, which can reasonably be summarised as people who are, or are likely to be, sick or pregnant. This has been done on the advice of NHS England.
There is some validity in the argument that avoiding the most complex patients means other practices could lose significant income while keeping most of their work. However, the payments to GPs for each patient are weighted in favour of the elderly and women on their list.
The NHS has been slothful in using consumer technology for the benefit of patients. For example, people with long-term conditions struggle to get advice on which apps could help them manage their health. NHS Digital is beginning to approve some apps, but rigorous checking is a long process.
GPs who say online services are a threat to the existing primary care network are right. They will disrupt healthcare just as they have disrupted the media, retail and music. Opposing them when their colleagues have already delivered millions of online consultations is futile.
But the way this service and others are being rolled out needs to be reversed. The 2000 Days Project on primary care reform, which I discussed in my last column, highlights the advice of internet evangelist Martha Lane Fox, who argues that healthcare technology should be designed to meet the needs of the people who need it most, not the most people. If the service works for an older person with multiple conditions, it will work for everyone.
Smartphone tech is the best opportunity we will have to get healthcare information, support and access into the hands of the people who need it most. Instead of signing up those who wear a Fitbit to their pilates class, GP apps should be turned into a big, independently run clinical trial targeting precisely the people who are being discouraged from using them.
Smartphone access for people with serious mental health conditions could save lives. The benefits for frail elderly people are obvious (and can we nail the myth that old people don’t use IT).
We need to understand how different types of service user interact with clinicians online, and how online services can be crafted to meet their requirements. We need data on whether fit young people really are clogging up online channels, and the impact of online services on the battle against antimicrobial resistance.
At long last the consumer tech revolution is coming to healthcare. It will change primary care skills, training, practice ownership, payment systems, demand, access, outcomes and much more. It could also widen health inequalities if it is handled badly.
It is vital for the NHS and the people who need it most that GPs lead and shape this revolution. Complaining from the sidelines is a waste of time.