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The doctor may see you now – if only virtually

digital GPs are the future for the NHS

With GP appointments increasingly difficult to come by, how will digital fit into the future of local patient care?

‘I can’t get an appointment to see my GP!’ We hear that cry of desperation on a regular basis.

The system for making appointments seems to vary from surgery to surgery. Sometimes it’s fine, and you can get an appointment for three weeks’ time or an emergency appointment today. Another time you try to book a follow-up appointment on your way out from seeing the GP, and find you’re not allowed. At my son’s surgery, you try calling on a Monday morning to make an appointment, and all you’ll get is a recorded message asking you to try again on a less busy day.

So how do you get an appointment for you or your parent when you need one? Here are today’s options, and where healthcare is heading for in future.

Face to face, booked by phone

For most of us this is the system we and our parents understand, but find more and more frustrating.

Many of us have learned the exact time to call the surgery in the morning to get an emergency appointment for that day. That’s fine for those of us who are out of bed early, but not so good for anyone who takes their time to rise – like the elderly. Yes, we can call on behalf of a relative who’s not available at that time, as long as we’re not on the way to work or driving children to school.

However, not all surgeries are the same. Some, for example, offer a telephone triage service, so anyone calling for an appointment will get a call back from a GP who will listen to the problem and decide whether the patient should come in or not.

Face to face, booked online

Many areas now offer the option to book appointments and order repeat prescriptions through GP online services.

As ever, there are a number of different providers, but the general principle is that the patient will need to visit the surgery with proof of identity to register for the service. They will then receive a letter with login details and can go from there. The sort of services available includes being able to order repeat prescriptions and choose where they should be sent, view parts of the medical record, and book appointments. GPs have just been given the go-ahead to create electronic prescriptions for some controlled drugs, which should simplify the process for those who use drugs such as morphine and pethidine.

The trouble with trying to book appointments online is that it’s hard to find a space in the near future. Sometimes it’s a matter of logging on at the right time in the morning, but the dark secrets of online appointment booking seem to be peculiar to each practice and taken time and energy to discover.

Online NHS consultations

The smartphone-based app looks like it is the future of GP appointments, eventually. The NHS England long-term strategy, published earlier in 2019, has set out plans to give patients a ‘right’ to access online GP consultations by 2023/24. Scotland would appear to have a plan for digital health, but is some way behind the English example. Currently we can’t find any information relating to the introduction of digital GPs for Wales or Northern Ireland, but if we hear anything we’ll report back.

The benefit of the online doctor model is that you can ‘see’ a GP within minutes. If you’re looking for information or reassurance, or you know what you need, it’s a great way of ticking that one off the to-do list. And the online GP can fire off prescriptions to your pharmacy if you are already signed up for the electronic service. If you need an examination, you will of course have to see the GP.

In theory, taking the ‘minor’ issues out of the face-to-face system could relieve the pressure on appointments, enabling people who can’t or don’t wish to be seen online a greater chance of actually seeing their own GP.

There are two services we know of that are available to NHS patients at the moment, both only operating in certain regions. What’s interesting is that one seems to be infuriating GPs, while the other has been introduced quietly without complaint. Why have GPs reacted this way, and what does it mean for patients in the future?

GP at Hand

GP at Hand is currently available in West London and has been endorsed by one of its enthusiastic users, Matt Hancock, who also happens to be the Health Secretary. Hancock admits to a passion for technology and has already been expressing frustration at the lack of speed within the NHS towards a digital future.

Under this model patients actually de-register from their current practice and then register with GP at Hand instead. That entitles them to video consultations and, if necessary, face-to-face appointments at one of the company’s five surgeries in the area.

More than 110,000 people have downloaded the app so far. The service’s owner, Babylon, has plans to expand into other areas, with the next being Birmingham. The NHS in England and local commissioning groups are being cautious about growth though, and the Birmingham option is still on hold. Their concern is reported as being that they have been unable to find a way to ensure invitations from national screening services, such as bowel or breast cancer checks – are being sent to the right places.

Would this model work for older patients? The website for the service suggests not. Interestingly though, the CQC is currently showing its assessment of GP at Hand as being ‘Good’ in every area, including older people, people with long-term conditions, and people with mental health conditions – including dementia.

GPs are concerned that as the young and healthy migrate to video services with hubs near to where they work, they are leaving local GP surgeries to care for a greater proportion of the chronically ill and those with multiple issues, for less funding. That already appears to be happening in London, where the GP at Hand practices have grown massively, and the local CCG is having to call upon help from other centres to support them financially.

LIVI

The second videoconferencing system now being rolled out is called LIVI. It’s a free NHS service, owned by a Swedish firm that delivers digital healthcare across Europe. We’ve already published an article on my positive experience of LIVI, which appears to complement rather than compete with GP practices.  In this model the GPs you ‘see’ are not from your practice, but they do have access to your notes.  LIVI is accessed by an app and according to its website is currently a partner with the GP Federation in North West Surrey. The company has recently been joined by NHS England’s chief digital officer, Juliet Bauer.

Other video doctors

There are also a number of private GP video services available such as PushDoctor, which is also advertising NHS-based digital consulting, although the area it covers is unclear.

What is clear is that at least in England, the NHS is hoping that digital appointments will provide patients with faster access to consultations. GP practices are under orders to support this move, so if you’re in England you can expect a letter from your doctor to go online – some time in the next five years.

Author Kathy Lawrence is a freelance copywriter and editor of When they Get Older.

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