Digital-first approach in underdoctored areas risks short changing patients

Plans to tackle GP shortages by allowing digital-first providers to expand in underdoctored areas threaten to 'short change' patients with high levels of need, GP leaders have warned.

Video consultation (Photo: Bronek Kaminski/Getty Images)
Video consultation (Photo: Bronek Kaminski/Getty Images)

NHS England believes controversial 'digital-first' GP services could help tackle the inverse care law in general practice - a 50-year-old term that describes the principle that the availability of GP services in any given area tends to vary inversely with the need of the local population.

An NHS England consultation on digital-first primary care published earlier this month says that providers of these services - which offer primarily video consultations via a smartphone app - may be allowed to expand in the 10% or 20% of CCG areas with the least GPs.

NHS leaders hope that if providers are required to demonstrate that GPs staffing these services will be 'wholly additional' to the local area - rather than attracted away from existing services - and actively target support at deprived communities, they could help reduce health inequalities.

Two-tier service

But BMA GP committee chair Dr Richard Vautrey warned that if the NHS looked to provide services remotely via digital providers in underdoctored areas - rather than doing more to increase GP numbers - it could create a two-tier service that means patients in these areas lose out.

He said: 'There is a risk that we end up short changing areas that have real need for face-to-face consultations, with complex problems that need proper time with healthcare professionals. [It's unfair] to say they can receive a secondary service compared with other parts of the country that can recruit GPs more easily.'

One of the key findings of a recent evaluation of Babylon GP at Hand - a digital-first service that has attracted more than 50,000 NHS patients - was that it had registered predominantly young, affluent, healthy people who were nonetheless relatively high users of healthcare services. The sustainability of a model that relies on large numbers of GPs often doing shifts working from home was also questioned.

Under the NHS long-term plan, published earlier this year, all patients have been promised the right to digital-first primary care by 2023/24. Emerging primary care networks (PCNs) will be expected to play a key role in helping local practices 'digitise their offer'.

Out-of-area patients

NHS England is also looking at reforms to rules around out-of-area patient registration. Concerns that the rise of digital-first providers could undermine plans to create more integrated healthcare around geographical communities have led to proposals that in future providers could be forced to open a physical clinic in any CCG area from which they have registered between 1,000 and 2,000 patients.

GPonline reported earlier this month on areas with high patient populations per GP and large elderly populations. Several CCGs in Kent are among underdoctored areas.

Kent LMC medical secretary Dr Caroline Rickard said she could not see many local patients engaging with a digital-first service. 'It could be a strand of the solution,' she said. 'But there is no single solution.'

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