Outsourcing GP services overseas could be 'legal minefield', experts warn

Using digital technology to outsource GP consultations overseas could leave the NHS facing a 'legal minefield', medico-legal experts have warned.

(Photo: iStock.com/golubovy)
(Photo: iStock.com/golubovy)

The warning comes after a GMC report this month revealed that 'with advances and developments in technology and telemedicine, we are exploring how to maximise the longer-term potential for internationally based doctors to treat UK patients’.

GP leaders warned that plans to allow doctors based overseas to treat patients in the UK remotely using digital technology would ‘challenge regulators’ in all countries and could prove highly complex.

Medical Protection Society (MPS) medical director Dr Rob Hendry told GPonline that laws governing provision of medical services digitally across borders were likely to be ‘underdeveloped’.

Under the UK Medical Act, doctors treating patients in the UK must be registered with the GMC and hold a license to practise.

However, the GMC cannot force doctors outside the UK to register with it – and under European law, cross-border prescribing within the European Economic Area (EEA) is allowed, meaning that doctors anywhere in the EEA can legally offer consultations or prescribing to patients in the UK.

Legal minefield

Dr Hendry said there had been concerns about the impact of the existing rules allowing cross-border prescribing. But he warned that if GP consultations for UK NHS patients began to be delivered digitally from overseas, a ‘legal minefield’ could open up.

‘I suspect legislators and regulators haven’t yet given it a lot of thought,’ Dr Hendry said. ‘This would be grist to the mill for lawyers to sort out. The tech is running ahead of the law and there are bound to be some interesting test cases where this happens.’

The GMC currently expects any doctor providing services remotely to patients in the UK to be registered ‘in the jurisdiction they are physically based in’, and says that ideally these doctors would be regulated to comparable standards to those that apply in the UK.

But with some providers offering GPs work providing online consultations only, it is conceivable that a doctor could live in one country and provide services entirely in another - and potentially be unable to register in their country of residence.

Online consultations

‘If I was a UK-registered doctor providing services to patients in England, but I happen to live in France and work from France,’ Dr Hendry said, ‘would that mean I needed to register in France? And could I be prosecuted under French law and according to French regulations?’

GP leaders have warned that allowing doctors based outside the UK to treat NHS patients could pave the way for an international version of GP at Hand. The controversial video consultation service has attracted tens of thousands of predominantly young patients away from their existing GP practices - prompting accusations of cherry picking, which it denies.

Europe’s largest provider of video GP consultations - Swedish provider LIVI, which currently employs UK-trained GPs based in England to deliver a digital GP service in parts of England - has welcomed the GMC’s plan to explore how to allow internationally based doctors to treat UK patients.

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