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Doctors question Hancock’s idea of GP video consultations for all

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3934 (Published 14 September 2018) Cite this as: BMJ 2018;362:k3934
  1. Adrian O’Dowd
  1. London

The government’s call for GPs in England to offer all patients smartphone video consultations have been met with scepticism from doctors’ leaders and health experts.

In an interview with the Telegraph newspaper published on 12 September, the health and social care secretary, Matt Hancock, said that he wanted to see a system in which all patients could use their smartphone, tablet, or computer to have Skype-like video consultations with their GP.1

Hancock has admitted that he uses the GP at Hand app provided by Babylon Healthcare. The service, which is offered by the NHS in some parts of London, enables patients to have video consultations with a doctor or to arrange a face-to-face appointment with a GP. The service is currently keen to expand across England, but NHS England recently upheld a Birmingham clinical commissioning group’s objection to a request from GP at Hand to subcontract its digital service there.2

Hancock said in the Telegraph interview, “GP at Hand is revolutionary—it works brilliantly for so many patients and goes with the grain of how people access modern services.

“I want to see GP at Hand available to all, not based on their postcode. Where a new service challenges the system, the right response isn’t to reject the new service but to change the system. The current postcode lottery cannot continue.”

He went further in a speech delivered on 13 September at Babylon Healthcare’s office in London, saying, “We need to harness technology in the NHS. If we need to we will change the rules so we can harness new technology in a way that works for patients and practitioners.”

The BMA said that the concept was good but had to be adopted carefully and be funded appropriately.

Richard Vautrey, chair of the BMA’s General Practitioners Committee, said that most GPs would like to offer smartphone consultations but were hampered by funding, resources, and training limitations. “Providing online consultations is not as simple as picking up the phone and making a video call. There are issues of ethics, confidentiality, and accountability that must seriously be considered before systems are put in place,” he said.

Naureen Bhatti, a GP in East London and vice chair of Tower Hamlets Local Medical Committee, whose practice has lost patients who left to join GP at Hand but who later wanted to re-register with the practice, was also sceptical. She told The BMJ, “My priority is to provide good quality care to the whole local population. I welcome technology in healthcare, but I want evidence that it will improve patient care.

“It’s not strictly about age but more about having a toolkit of different access methods that is available to everyone. It must be evidence based, and where is the evidence that this is better?”

Sophie Castle-Clarke, a senior fellow in health policy at the health think tank the Nuffield Trust, told The BMJ, “There is so much we don’t know about this model at the moment. We don’t know how cost effective it is, how it impacts on health outcomes and care, if it serves a diverse case mix, or if it’s useful for people with long term conditions as well as the young healthy population.

“It’s way too early to roll out this as a model of care before we know those things, and there is an evaluation under way at the moment due to report next year, so this seems premature.”

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