GP at Hand, a new service that will allow patients to book a video GP appointment through an app at any time of day or night, has caused controversy among healthcare professionals and health policy makers in recent weeks.
As a GP, with a specialist interest in asthma, I’ve heard from other GPs who say the service, which is being piloted in London, marks the start of losing ‘our NHS’. There is anger about the involvement of Babylon Health, a private company, and fears that the service focuses too much on those who ‘want’ rather than ‘need’ help, taking resources away from those who need it most, and placing greater strain on struggling primary care services.
But on the flipside, remote GP access does seem to offer some clear benefits. With a recent survey of GPs revealing that the average patient waits around 13 days for an appointment, surely any service that can help people access primary care services more quickly and easily can only be a good thing?
With the traditional GP system some people have to take a day off work to get an appointment, which can mean losing a day of pay. Using technology to deliver different access models could make this a thing of the past.
However, I believe projects like GP at Hand are currently most valuable in opening up the debate about how this kind of health technology in general can benefit patients and the NHS. It also draws attention to what is needed to ensure technology is relevant, clinically safe and implemented successfully.
Multi-channel access to GPs may not just help patients get earlier treatment before their health deteriorates - which could save the NHS money in the long run - it could also be an important intervention for hard-to-reach patients. For those with chronic conditions, who are housebound or who rely on carers or family members a virtual GP appointment could be much less disruptive than seeing a GP through the traditional route.
Unfortunately, many of these services exclude a lot of patients with ‘complex’ conditions. It seems unfair that so many people are unable to access a GP digitally. These models should look to tackle a greater range of health conditions rather than appearing to cherry pick.
As well as offering multi-channel access, GP at Hand has an artificial intelligence (AI) symptom checker that it claims will deal with 40% of queries. It promises to ask patients questions to analyse their condition and give them medical information and advice on what to do next.
AI technology such as this offers the capability to understand a patient’s digital and health behaviours. It may help patients manage their health through individually tailored algorithms and ‘nudging’ positive health behaviours. So, in the case of asthma, it could help people understand what to do if they see an increase in their symptoms before they have an asthma attack.
This may mean they don't end up in hospital. This benefits the patient and could reduce the volume and complexity of NHS interactions. Helping people navigate the NHS system better means resources can be used in a more fruitful way.
But this technology is still in its infancy and for it to be truly useful, it will need to tailor its communication to individuals. The algorithms need to be sophisticated enough to adapt to a patient’s vocabulary so it can understand their needs – and make its advice more personally relevant and insightful. For example, while a GP can use clinical expertise to understand what someone means they say their pain is ‘killing them’ and assess how bad the pain might be, we are some way from being able to trust a robot to do this effectively for a variety of different people.
In principle, I think health technology models such as GP at Hand are a step in the right direction, opening people’s eyes to the transformative impact technology can have. But health technology must provide a frictionless and noticeable benefit to patients, otherwise people will stop using it. That's why at Asthma UK, we offer tech companies who are driving innovative solutions around asthma care access to our insights into the health needs and digital behaviour of people with asthma. You can create the best product in the world but if it doesn’t address someone’s need or it is too difficult to use, it’s pointless.
It’s vital too that systems and processes are redesigned to get the best use from new technologies. Innovation shouldn’t create an extra service or extra workload for an already strained workforce. Policy makers need to pay urgent attention to regulation and governance, data flows, interoperability and payer models.
The NHS is a trusted brand and that’s why research by Asthma UK revealed that people with asthma were more likely to use smart inhalers if they carried NHS branding. But the NHS needs to create an environment where innovation and adoption of technology is properly tested so that this trust is maintained.
Only time will tell if models such as GP at Hand for delivering access to NHS services by digital means will begin to win the hearts and minds of patients, healthcare professionals and policy makers. However, it should be recognised as an important first step towards providing tech-enabled healthcare for the people who will benefit most.
- Dr Andy Whittamore is clinical lead at Asthma UK and a GP with a specialist interest in asthma