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Online consulting enthusiasts must engage with criticism, says GP leader

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k4045 (Published 25 September 2018) Cite this as: BMJ 2018;362:k4045
  1. Gareth Iacobucci
  1. The BMJ

Advocates and providers of online GP consulting must engage with criticism and be more receptive to “rigorous evaluation” of new technologies, the vice chair of the Royal College of General Practitioner has argued.

Martin Marshall, the college’s vice chair and a GP in east London, told a Westminster Forum debate on the future of general practice that there was “enormous potential” in online consulting, and said he conducted some consultations this way.

But he said it was crucial that the potential risks and benefits were properly evaluated, and that those that raised concerns over the potential downsides were not merely dismissed as Luddites.

Marshall said, “The advocates of online consulting—of which there are many, including our new secretary of state for health—need to be more willing to listen to critics than they have been so far. Critics are often dismissed as conservatives or dinosaurs, and sometimes the language is abusive and unpleasant. It seems to me that policy that’s driven by deaf enthusiasts and by commercial interests is not likely to be good policy.”

Marshall said online consulting services such as GP at Hand, which is currently available in London, offered potential benefits such as convenience for patients and career options for doctors who may be seeking portfolio careers.

But he said the benefits needed to be assessed against potential risks, such as the possibility of diagnoses being missed if patients are not seen face-to-face, fragmentation of care, and health inequalities.

The new health secretary Matt Hancock was recently criticised1 for calling for GP at Hand to be rolled out across the country.

Marshall acknowledged that technology moves fast, but urged policymakers—and providers of digital services—to commit to “rigorous scientific processes” to ensure that policy is evidence based.

He said, “We know online consulting has great benefits. We know it has great risks. We have no idea how that balance will play out, so we need to have evaluations. We need to expose the results to a peer review process, we shouldn’t be publishing them at big glossy seminars for the media first. I’m not asking for randomised controlled trials or studies that take five years and give the answer after the technology has moved on. I’m asking for pragmatic forms of evaluation. We need to be making policy decisions on the basis of the learning that comes out of those.”

Marshall also warned against overclaiming what online consulting and artificial intelligence could achieve.

“We have lots of experience of e-health technology in the NHS and the evidence is fairly clear that, by and large, they overpromise and underdeliver. The challenge is to help potential benefits come to the surface and to diminish the risks.”

He added, “If we integrate online consulting into the established model of a general practice, it’s much more likely to be effective.”

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