Diane Abbott told an RCGP fringe meeting at the Labour party conference in Liverpool on Monday that £45m of funding announced in the GP Forward View to stimulate providers of online consultation systems should not have been awarded without more piloting of the technology.
Moving too quickly to online access to cut costs risked disadvantaging older patients, warned Ms Abbott, and delaying diagnoses of serious illness.
The shadow health secretary also warned that many patients had concerns over data security and privacy, raising the threat of private healthcare providers using patient data for commercial aims.
Ms Abbott told the conference event that many of her elderly constituents in east London would not be confident using the kinds of online GP access technology being rolled out by the NHS. Online consultations, she said, risked GPs missing out on building relationships with patients or allowing vulnerable patients to build the trust required to discuss sensitive issue.
‘What I know after 29 years of talking to people about their problems week on week is that people come in to see you with problem A, and it is only eight minutes on, when they relax and engage with you personally that they actually come out with problem B, which is the real thing that is concerning them,’ she said.
‘If elderly people are having to access people on Skype or through an app, they don't go through that cycle of trusting the person, engaging with the person. What worries me is that an over-reliance on tech in place of people going to see a GP will be difficult for precisely that section of the community that take up a lot of the time in general practice.’
Ms Abbott added that online consultations risked delaying diagnoses of serious conditions such as cancer.
‘I think of my constituents and I think they would find it difficult,' she said. ‘They would not be able to engage. They value that one-to-one relationship. And you would miss things - even how they carry themselves, even the look in their eyes - you would miss things which might help you to get to diagnosis.’
Ms Abbott said the £45m announced by NHS England in the GP Forward View to stimulate suppliers of online consultation systems should not have been awarded without more piloting. Governments, she said, had a ‘vexed’ record on IT projects. ‘I think probably with this it would have been better to pilot the project. And also see what works with different demographics.’
Ms Abbott said she feared technological solutions were being pushed through too fast on the back of unrealistic claims because of potential cost savings for the NHS.
Released sustainability and transformation plans (STPs), she suggested, revealed a ‘a real reliance on tech to cut costs, and to improve access’.
‘It will discredit the use of digital if people just see it as a money saving device.’
RCGP honorary secretary Professor Nigel Mathers said he thought only around 10-15% of patients at his practice in a ‘tough, deprived’ part of Sheffield would be interested in online access.
‘They are not a very trusting lot. They feel very embattled, a lot of my patients. They trust a one-to-one consultation and I do think that is the gold standard. But all these other methods can be used to supplement that.’
The ‘key issue’, said Professor Mathers, was ‘what do we stop doing if we start doing all these additional things?’
‘We've got to be sure it's the patient need first. The person that comes first and the technology that serves the person and enables us to deliver person-centered care.’
While apps offered ‘a huge amount of opportunity’, he said. ‘Siri can't replace a receptionist, and Dr Google can't replace your GP.
South London GP Dr Brian Fisher, who set up a company helping to provide patients with online records access, said technology would free up GP capacity and benefit patients with most need.
‘The people that benefit most tend to be people with long-term conditions. They tend to be older. And research we have done suggests that if 30% of people were to access their records at least twice a year then practices would save about 10% of their appointments and hundreds of telephone calls,' he said.