Author: Judy Cooper
Digital GPs tend to work for independent or private organisations and undertake the majority of their consultations remotely, usually by video call via an app.
This means they can deliver appointments and services for patients far more rapidly than traditional GP services.
Employers of digital GPs tend to be private health insurers, private health providers or technology companies.
There are now more than 35 such providers and the market is growing rapidly cementing its reputation as a ‘disruptive technology’ within GP services.
The patient base varies according to the business model of the provider company. Some deliver services to companies and their employees on a subscription model, some offer instant care to anybody at any time with services priced individually (ie issuing a prescription is considered a service separate to the fee for a consultation). Some deliver NHS services where GP practices have outsourced their digital-first commitments or out-of-hours services.
The type of care provided can also vary. Some are pushing the boundaries of what digital care means using artificial intelligence to help triage patients and developing other digital solutions to monitor patients with chronic conditions as well as remote consultations. GPs working for these companies can often be actively involved in developing new services and solutions.
The most common delivery method is that patients download an app and use this to book and conduct the consultation. The app also holds their details and previous history and allows them to choose the same GP to talk to as previously if they wish.
If a face-to-face consultation is required digital GPs will usually signpost patients to appropriate services. A few can provide face-to-face consultations at a small number of sites in certain areas.
Referrals can be sent onto private consultants or given to the patient to hand onto NHS services. Notes from private digital consultations are not shared with NHS GPs unless the patient does so.
Critics say these services disrupt continuity of care and can put patients at risk. Proponents say they increase choice and flexibility and free up what is a dangerously overburdened system which, in itself, carries patient risk.
Providers are still inspected by the Care Quality Commission and digital GPs must still be GMC registered and have permission to work in the UK.
How is it different to working in a GP practice?
The differences have narrowed considerably since these services first started appearing in 2016, most notably since the 2019 publication of the NHS Long Term Plan and its stipulation that every patient should be offered digital first primary care by 2023/24.
GP practices are now required to ‘offer and promote’ online consultation tools, video consultation tools, secure electronic communication methods and an online facility to provide and update personal or contact information.
With patient backlogs building up during COVID online consultation systems are seen by many as the key to managing this pressure effectively - enabling better triaging of patients and prioritising face-to-face consultations with those who need them most.
However, the difference working with an online provider is that digital and remote work forms the bulk of your workload rather than just a proportion of it. You will also often be using cutting edge technology that has had considerable investment.
This is important as a 2021 RCGP report on the future role of remote consultations and patient triage’ found 94% of GPs felt they needed better digital technology to get the most out of remote consultations.
Patients do not need to be registered with an online provider and most medications can be prescribed, with prescriptions sent directly to nearby pharmacies.
Perhaps the biggest difference is the flexibility these employers tend to offer the GPs who work for them. GPs are usually home-based; can work as many or as few shifts as they like and GPs can either be self-employed or salaried; part-time or full-time.
Almost all providers will provide those GPs who work for them access to senior clinicians to help and advise. They will also conduct clinical audits to maintain quality thresholds similar to NHS practices.
What are the key skills and experience required?
Remote diagnosis skills including listening and confident history taking as you may not have access to the patient’s notes
Swift risk analysis and decision-making abilities
IT skills and a willingness to engage and learn new systems
Ability to work independently
Most ask for a minimum of six months post CCT experience and some look for previous experience working in out-of-hours services
What are the advantages?
Working within an innovative, disruptive sector means GPs have the opportunity to help shape the potential future of GP service provision, developing new solutions, services and products.
As the world changes and the number of online providers increase, the type of work is likely to become more varied.
It offers the opportunity to strengthen skills that are increasingly in demand within the NHS as the Long-Term Plan looks to modernise the NHS digital offer.
But by far the biggest advantage is the flexibility and control over your own working life while still earning a competitive salary. In addition to the choice over hours, shifts and employment contracts, many are able to allow GPs to choose if they want to work with NHS patients or private patients.
Those who are likely to find the job the best fit will be those who are currently struggling to juggle work and family commitments or those nearing retirement and are looking to reduce their working hours and commitments.
It can also help those struggling with burnout and stress in existing roles as a means of using their clinical skills without putting their own health at risk. Many advertise that GPs can even do the work whilst overseas provided they are able to maintain their GMC registration.
The digital infrastructure is modern, impressive and usually consistently invested in which makes the remote consulting task much easier.
Those working in these services also say they get great job satisfaction from offering a service that patients are grateful for. Many patients use these services because they find it difficult to attend face-to-face appointments, whether that be because of work or caring commitments or because of mental health or physical mobility problems.
What are the challenges and risks?
The clinical risks of your decision making can be higher as you are operating outside the NHS often without access to the patient’s notes. Nor will your notes or conclusions be seen by the patient’s GP unless they specifically request or hand it on themselves.
While patient care delivered by digital GP services has undoubtedly improved, the last CQC report on online GP services, in 2018, found 43% of organisations were not delivering a safe service. These concerns related to inappropriate prescribing of antibiotics and opioids, safeguarding, lack of information sharing and inappropriate prescribing of medication for long-term conditions.
Some of these concerns the CQC noted were already being addressed and many online providers will no longer prescribe opioids or sleeping medication. It is worth checking the CQC inspection rating of the provider you intend to be working with as well as their clinical audit and quality systems.
The RCGP report found back-to-back remote consultations can be exhausting for GPs leading to ‘zoom fatigue’ with 63% of GPs saying it reduced their job satisfaction and 61% believing it made the role more transactional.
The British Medical Association also warns that, while many offer 15 minute and even 20-minute appointments, you may still be expected to do your own paperwork and write up patient facing notes within that time. It is worth checking the expectations upon you around administration tasks. Some providers have dedicated administration teams, in other cases the GP is expected to take responsibility with the help of the technology being used.
The downside of impressive tech is when it goes wrong – if a server goes down or there is a ‘bug’ in the system it could affect your ability to see patients during your shift. You will need to carefully check the legal ramifications of such situations.
Finally, it can be isolating working from home for long periods of time, particularly if they are anti-social hours and you are used to a busy GP surgery and daily interaction with colleagues. You may need to be more creative when thinking about your support networks and professional interactions.
These companies are private businesses so will look to provide the most profitable services rather than the services that are most needed. There have been cases of providers withdrawing from contracts or certain geographical areas because the business case no longer stacks up.
What’s the career path for a digital GP?
Most online providers have a similar medical hierarchy to private health providers or the NHS including clinician, senior clinician and medical director.
However, digital health services can also offer alternative career options and skills development such as helping develop health technology solutions, research, teaching and mentoring others. Many of these providers are based not just in the UK but globally, increasing the opportunities to work overseas within the same organisation.
It is also likely that the learning and skills in these environments will be in high demand in the future in both the NHS and other private providers. Online GP services are set to form an integral part of the delivery of patient care in the NHS. Experience in this area will be needed to accelerate and improve NHS services.
What’s the pay?
Pay rates are comparable and in some cases much better than for NHS jobs. A BMJ Careers analysis of current (November 2022) jobs being advertised by digital providers shows:
- Self-employed GPs can earn between £70 - £110 per hour depending on experience and if the work is in-hours or out-of-hours. This means a full-time, self-employed GP could earn up to £183,000 per year gross.
- Part-time salaried GPs can earn between £10,000 to £15,000 per session, per annum depending on experience and whether the sessions are in-hours or out-of-hours (one session is usually 4 hours). A GP working five sessions a week could earn £50,000 a year gross.
- Full-time salaried GPs can earn between £80,000 - £110,000 gross.
The benefits that come with these roles vary between providers but can include private medical insurance, technical equipment (such as laptops, headsets etc) or financial contribution towards purchase, pension contributions, annual leave, sick leave, medical indemnity cover, study leave, professional registration fees as well as training fees.
The latest NHS Digital figures on GP earnings showed an NHS full-time contracted GP earns on average £142,000 (gross) per year while a salaried GP earns an average of £64,900 (gross) per year.
Checklist before accepting a role as a digital GP:
Check your contract and what’s on offer – it can sometimes be a useful exercise to try and put a financial calculation on benefits to help comparison.
Where will you be working? Are you entirely home based? If so, have you got a suitable space set up for the work and do you get any financial assistance for this?
What are the opportunities for meeting other professionals or the rest of the team?
What CPD and training is on offer? Will it help you build on your desired skillsets?
What clinical supervision and decision-making support is on offer and how do you access it? Is this reliable?
What are the limits on prescribing and making referrals? Are you clear on the professional limits and boundaries of the role?
What are the protections around seeing inappropriate images if they are uploaded to the system? How are images of children dealt with. What safeguarding procedures are in place when treating children or adults who may be mentally incapacitated?
What medical indemnity insurance is required and/or provided?
What level of experience is required?
How much flexibility is there over shift patterns. Can this increase or decrease within your contract depending on your circumstances?
What’s the induction like? How long does it take? Are there shadowing procedures in place or are you expected to work on your own from day one?
What IT support is on offer and how do you access it?
Do you need to manage patient expectations in any way? For example, do you need to mention the costs of treatment up-front? Is there a list of exclusions that you need to make clear?
What’s the set-up for those patients who may not speak English? Do you have translators available and can you have longer appointments with them?
How are handovers managed for those patients who may need more than one appointment and want to continue using the service? What continuity of care is offered?
Is the rate you’re being offered realistic for the number of appointments you are expected to provide (ie follow-up administration, referrals etc)?
What’s the work like?
Dr Mazin Alsaffar, Digital Lead (UK), Babylon
Q. How did you end up in this role?
I was a salaried GP in a NHS GP practice. With technology advancing at a rapid pace, I wanted to learn more about digital health as I felt that a Digital First model of care would become mainstream in the future. Babylon is a leader in this field and offered this service to NHS patients. It was an ideal opportunity to join an innovative employer in this area of primary care.
Q. Tell me about your current role as a digital GP
My role involves seeing patients in both digital and physical clinics. As always, clinics are busy but it has allowed me to see that not everyone needs to come into the physical clinic. I would describe the case mix as very similar to any inner-city London practice. It is generally a younger demographic but we also see patients who are older with complex comorbidities.
Q. Describe the main advantages of this work?
I feel well supported in the organisation. It allows me to focus on patient care directly with less focus on administrative tasks that can be delegated to other members of the team. As a Digital GP, I am grateful to work alongside colleagues who are working remotely in other parts of the country. This enhances my clinical skills as I learn from them every day.
As well as GPs, I am very impressed with the multi-professional digital team that has been created to provide the best care for our patients. This includes Digital Advanced Nurse Practitioners, Physiotherapists, Pharmacists and Mental Health Practitioners.
This pool of diversity not only enhances patient care but also creates an impressive learning culture in the organisation.
Working remotely as a GP allows me to vary my working week. Not having to commute every single day gives me more time to focus on my family life.
Q. What would you say are the biggest challenges of the work compared with working as a traditional GP doing face-to-face consultations?
Initially I was worried about not being able to see patients face to face, however, this fear quickly subsided as I learned that video consultations add a lot of information to a remote consultation.
If I do feel a patient needs a physical assessment, this can be arranged through one of our physical clinics available in London.
Working from home has many advantages and although I do not feel isolated at all, there is also great value in working alongside colleagues in a physical clinic.
Q. Many people are worried about losing the continuity of care for patients in this model – what are your thoughts?
I do not feel that continuity of care is difficult to achieve in a digital first model of care. It is all about having the right infrastructure and teams to ensure this is possible. At Babylon, we have care navigators/care coordinators that ensure that patients have the best experience of continuity of care. Patients also have the ability to book with the same Digital GP via the app.
Q. Do you need different or more specialised skills working as a digital GP?
GPs are high skilled communicators, they have been trained for many years to conduct thorough and high quality telephone appointments. Therefore, I think the transition to digital health is very straight forward and often provides a better experience both for the patient and clinician.
Q. What kind of training and CPD do you get?
We have a mixture of CPD events ranging from digital lunchtime learning from specialist GPs and consultants to podcasts. We also have access to GP CPD courses and resources provided by an external, well-established provider ‘Red Whale’. They also offer face-to-face training courses for clinicians held across England.
Q. What has been a highlight of your career as a digital GP so far?
It has been interesting to see this area of primary care advancing so quickly. I have been very impressed with the Digital Multi-Disciplinary Team approach that has been implemented in the organisation. Patients are happy with the service and this alone brings me a great deal of satisfaction as a GP.
Q. Has there been a moment when you have found this work really difficult and how did you get through it?
Moving from a traditional role to a completely new way of providing care can be daunting at first. However, the training and clinical/non-clinical support allowed me to transition very smoothly.
Q. What advice would you give to other GPs who are perhaps considering working as a digital GP as their next career step?
Being a Digital GP does not mean you will be alone/isolated, there are teams in place to help you along your digital consulting journey.
Do your research about the organisation you are considering joining. Try and speak to colleagues who are already working for them and see if it fits in your work week/job plan!
References and further reading:
NHS England Digital First Primary Care https://www.england.nhs.uk/gp/digital-first-primary-care/
British Medical Association Advice and Support - Online digital remote consulting role https://www.bma.org.uk/advice-and-support/gp-practices/employment-advice/gps-outside-of-traditional-practice/online-digital-remote-consulting-role
NHS England: New digital and online services requirements - guidance for GP practices https://www.england.nhs.uk/gp/investment/gp-contract/digital-requirements-guidance/new-digital-and-online-services-requirements-guidance-for-gp-practices/
RCGP: The future role of remote consultations and patient triage (May 2021) https://www.rcgp.org.uk/policy/general-practice-covid-19-recovery-consultations-patient-triage/
NHS Digital: GP Earnings and Expenses Estimates https://digital.nhs.uk/data-and-information/publications/statistical/gp-earnings-and-expenses-estimates
Care Quality Commission: The state of care in independent online primary health services https://www.cqc.org.uk/publications/major-report/state-care-independent-online-primary-health-services
Health Care and Protection. Digital health and virtual GP services here to stay despite return of in-person care – analysis. Graham Simons, 26 April 2022. https://healthcareandprotection.com/digital-health-and-virtual-gp-services-here-to-stay-despite-return-of-in-person-care-analysis/