Digital Doctors: Are Video GP Consultations The Future?

Photo: Sydney Hass
The quality of care you receive at your GP surgery can be a location lottery. Last week I attended a walk-in clinic because my surgery didn't have a free appointment for a couple of days when I called – and when they do, the doctor is usually running late. I've also found one of the GPs at the surgery particularly unhelpful. At my last address however (where I was registered at a different surgery), appointments were available on the same day, waits were short and doctors were attentive. Whatever your experience of doctors' surgeries, it’s hard to deny the appeal of being able to see a GP almost instantly and without leaving your bed. Perhaps this is why more and more paid-for GP services are springing up on the web. The website and app Push Doctor, for example, can get you a speedy diagnosis via your webcam. And while the medium might not be appropriate for every common ailment, it is growing in popularity. Earlier this year, Push Doctor surveyed just over 1000 British adults and found that more than 1 in 5 Brits have communicated with a GP online in some way, while 1 in 7 have already used video consultation services to speak to a doctor from their home. Push Doctor has racked up thousands of hours in video calls from users since its inception in 2013, and they’re not alone in the service they offer; Doctor Call also offer paid for consultations with certified GPs; Healthcare Express allow you to live chat with a doctor via your keyboard; and Boots, Lloyds and Superdrug also offer online video services for a small cost. Being able to order repeat prescriptions online and book appointments for your surgery via its website is not a new thing – but there are now a host of websites and apps selling consultations with qualified doctors. A friend tells me he regularly uses an app called Babylon for “small things that you need a prescription for when you can't be bothered to go to the doctor.” It works on subscription and costs him £5 a month. Eren Ozagir is the CEO of Push Doctor. He founded the company after he fell ill in the United States and “wanted to experience a friction-free process by which to see a UK doctor.” The website’s appeal, he says, is that it’s so simple: “Users tap the app and see a doctor in six minutes,” he tells me. “They get their issue resolved there and then.” Ozagir says that Push Doctor particularly appeals to people who have “found visiting a traditional surgery difficult either due to work commitments, pressures at home or mobility issues,” and adds that parents-to-be or new parents, as well as people in rural areas, have been particularly receptive to the service. He says, generally, it’s not a service only enjoyed by people who are used to paying for healthcare: “ is designed for everyone and so absolutely the majority of our users are the 89% of the population without private medical insurance.”
To find out just how easy Push Doctor is to use, I decide to try it for a consultation. After signing up to the website with my personal details, I claim my first 20-minute session with one of their GPs for just £1, with the cost rising to £14 for future calls. I book an appointment for a time slot later that day, and return to the website’s virtual waiting room to video call the GP. Disappointingly, it’s no different from visiting my local surgery in that I end up waiting around 15 minutes for the doctor to become available. Then there’s another problem: the microphone on my laptop won’t seem to capture any sound (it usually works), meaning my GP can see but not hear me. I enter my query in a text box. The doctor assures me it’s nothing serious and recommends a treatment that can be bought over the counter from a chemist. In more serious cases, I’m told that these GPs can issue prescriptions (£4.50 for next day delivery), referrals and fit-for-work notes (£12.50).

In cases where the diagnosis from the history is inconclusive, clinical examination is essential and I cannot see how this would be done reliably or safely via webcam

Dr Steven Raphael
My Push Doctor GP was professional and helpful, but still dubious as to how well a doctor can solve a medical issue via a low res video call, I asked a GP who works with patients face to face just how reliable the service can be. “I would say that most common ailments could be diagnosed by webcam,” says Dr. Steven Raphael, a GP working in a surgery in South East London. “Most things can be diagnosed from taking a clear history from the patient, and we do this quite a lot by telephone in general practice. But in cases where the diagnosis from the history is inconclusive, clinical examination is essential and I cannot see how this would be done reliably or safely via webcam.” Dr Raphael offers a hypothetical example of where video calling a GP might not be sufficient: “A patient may complain of tummy pain. This could be a simple tummy bug or it could be acute appendicitis, and in the early stages the history would be the same. It's only a physical examination that would direct you towards appendicitis, which is a medical emergency.”
Dr Adam Simon, Push Doctor’s Chief Medical Officer, has a response prepared when I ask him the same question. He points out that Push Doctor doesn’t offer a robot or an A.I. doctor, but a real and experienced GP. He explains: “As with traditional GP surgeries, the majority of our cases do not require a physical examination in order for patients to get triaged to the next stage of care, have their issue dealt with there and then get diagnosed or receive treatment.” But, he concedes, it’s really up to the doctor on the call to assess the individual patient and in doing so to establish the limitations of the channel in that particular instance. If the patient does seem to need a physical examination, the doctor “will advise patients that is the case and arm them with all the relevant information they may need to provide the next clinician with details of why the physical examination was necessary.” Overall, I found Push Doctor’s online video service relatively succinct: I got an evaluation, and I didn’t have to take time out of the office for it. However, I can’t help thinking about the £14 costs I’d incur next time I called, or if I needed a longer session, or if I were to order the prescription via the website with next day delivery. Ultimately, Push Doctor is a service for people who can afford it, and thus – like private healthcare – it’s not an option for everyone. And yet, apps and websites like Push Doctor are being taken up by more and more people. At a time when the NHS is undergoing intense pressure – suffering severe budget cuts, staff shortages and strike action – do patients feel they’re better off eschewing busy waiting rooms and paying for their medical care?
“I don't think it's to do with the move towards privatisation,” says Dr Raphael, when I put this question to him. “I think it's someone tapping into an easy market to make some money. Everyone knows it can take a long time to get a GP appointment, especially if you’re young, working and have better things to do. This service is very convenient, so it's good for that patient group, but generally speaking, they aren't the people blocking the appointments in the GP practice.” Hopefully, concludes Dr Raphael, people with ongoing medical problems aren’t going to be the ones relying on this service.

For every one patient who chooses for an appointment; that is one NHS appointment that is now free for someone else to use

Eren Ozagir, founder and CEO of Push Doctor
A final question for the future of tech-based health services is how they can compliment the NHS. These apps undoubtedly relieve the pressure put on doctors at busy surgeries and Push Doctor CEO Ozagir believes that, “for every one patient who chooses for an appointment, that is one NHS appointment that is now free for someone else to use.” But what more can they do? Ozagir tells me that Push Doctor are beginning to work with the NHS directly – one of the first digital health companies to be commissioned to do this in what he describes as “a new digital era of primary care.” Together, they launched the collaboration 'Push NHS' which is a video service being trialled in certain rural areas of the UK, “which looks to overcome the problem of accessibility and transportation, as well as targeting demographics who are more hesitant to see a doctor.” It’s described on the Push Doctor website as “a smart-consulting experience.” Ultimately then, it seems like the NHS are keen to learn from private companies who are embracing technology to meet patients’ needs. Just last month they issued a document called GP Forward View, which outlines funding programmes for GP services in the UK. It included a £45 million plan to get more patients having consultations with their GPs online. This includes “online access for patients to approved clinical triage systems to help patients when they feel unwell.” Dr Raphael is keen to remind us, however, that while any additional point of access to healthcare would take the load off NHS appointments, it doesn't necessarily mean it's best for the patient. He says: “The most efficient way of providing primary healthcare is by finding a GP that you can see regularly, form a rapport with and work through your health problems with. This is not something that can be offered online. Any relationship is better with face to face contact. It allows you to pick up on emotions, which can be so important to address in healthcare.” Personally, I’ve started to miss my elusive doctors’ surgery. Why? Because I am now receiving a barrage of Push Doctor marketing emails offering me “deals” to speak to a doctor. Conversely, each time they land in my inbox they serve as a reminder that we’re very lucky to have a free NHS.


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