Intended for healthcare professionals


Online consulting in general practice: making the move from disruptive innovation to mainstream service

BMJ 2018; 360 doi: (Published 26 March 2018) Cite this as: BMJ 2018;360:k1195
  1. Martin Marshall, professor of healthcare improvement and vice chair12,
  2. Robina Shah, chair, patients and carers partnership group2,
  3. Helen Stokes-Lampard, chair2
  1. 1Department of Primary Care and Population Health, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF
  2. 2Royal College of General Practitioners, London, UK
  1. Correspondence to: M Marshall martin.marshall{at}

Services must be rigorously evaluated if we are to maximise benefits and minimise risks, say Martin Marshall and colleagues

People are familiar with using digital technologies to make their lives easier. The health sector has been slower to adopt technological innovations than the banking, retail, and travel industries, but it is catching up. In 2017 the global digital health industry was worth £19bn (€21bn; $25bn) and over 320 000 mobile health apps were in regular use.1

Online consulting is one of the fastest growing technologies. In the US it has been commonplace for over a decade, and many health insurers, emboldened by some supportive research evidence,2 offer such services routinely to reduce costs. Similar services are now being established in the UK, driven by rapid developments in the supporting technologies, consumer demand for convenient and accessible services, and the need to find solutions to rising workload and constrained resources.3

We examine how online consulting is developing in UK general practice and its emerging benefits and risks. We focus on text and video based online technologies, which are being used as alternatives to face-to-face consultations. In addition, we explore a number of complex questions that the emergence of online consultations is raising for policy makers, practitioners, and patients.

A rapidly expanding market

The online consultation market in UK general practice is expanding at pace: eConsult, Babylon, askmyGP, Dr Matt Ltd, Push Dr, Doctor Care Anywhere, GP at Hand, Anytime Dr, Dr-Plus, and many others have been established in recent years. Most of the online systems have been developed by private entrepreneurs and some have substantial backing from private investors.4

No independent national data exist on the relative uptake of these different systems by individual patients or by service providers. Such data would be rapidly outdated as new providers regularly emerge, change, …

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