26th April 2018
You may have seen adverts for GP at Hand all across London. It’s a brand new service that allows patients to see an NHS GP at the click of a button through a video link on their phone.
Unlike other ‘FaceTime your GP’ Apps that seem to be popping up left right and centre, the GP at Hand App is completely free for people living within London.
For people that can use this service, it seems a fantastic alternative to waiting weeks on end to see their usual GP. It’s clearly popular too; so far, 24,000 people have signed up and use the App. The ages of users are skewed slightly to the younger of us, but there were roughly 4,000 signups to the service in a month. This demonstrates that health service users, no matter their age, want a digital service.
However, despite the amazing reviews on the App stores, it has GPs up in arms about how they are losing patients to GP at Hand.
To give you a bit of background, GP at Hand is not an NHS service in the sense that it has been funded by NHS England or the Department of Health. It is actually commissioned by a GP surgery in Hammersmith & Fulham CCG, a local health authority area.
Every time a patient signs up to use GP at Hand, their medical records are transferred to the GP surgery that has commissioned the App. For every patient registered at the surgery, the practice gets a payment. The GP surgery that commissioned GP at Hand gets a payment for all the new people that join its list, meaning patient’s previous GP surgeries lose that payment. Patients that have ‘un-registered’ from are left with less cash in the pot to pay for services. It also means that the virtual practice is getting lighter/easier case loads with younger patients, leaving the original practices with a higher concentration of more complex patients.
Arguably, GP at Hand are poaching patients from people’s existing surgeries, so you can see why GPs are kicking off. However, it would seem patients are doing this purely from a convenience point of view as they don’t want to wait days/weeks for an appointment.
So can you really blame patients or GP at Hand? Does the main issue lie with the traditional GPs where, due to their waiting lists, a problem has arisen and so technology has come along and provided a solution.
Another issue that has come to light is the Clinical Commissioning Group (CCG) for the area but be able to afford to pay the GP surgery for all their new patients as well as having the cash deposits to pay for any hospital care you may need no you are on their books. So, even if you live in Carlisle and not London, for example, it would be the London CCG paying for your care.
This is less than adequate, so NHS England stepped in and set a location boundary so that GP at Hand could only be used in a specific region of London. Yes patients are still re-registering at said GP practice, but at least they’re not too far from their real GP practice (as opposed to virtual one).
From a patient perspective though, it means that if you lived in Carlisle for example, and needed an X-ray on the NHS after using GP at Hand (even for a condition unrelated to the virtual consultation), this would have to be done in Hammersmith & Fulham. Not great, right?
Original GPs have therefore been having to deal with previous patients ringing up trying to re-register with their old surgery.
Is this all a bad thing? Or can we use this as a tool to look into the future and see speed-bumps to innovation? We believe it’s the latter.
Are GPs averse to virtual consultations? Not all of them, but they do want access to your medical record so they can offer you advice and support based on your history, complex or otherwise. So this means that these virtual GP services need to connect to your GP record! They need to integrate!
The problem with the ‘re-registering’ rigmarole we discussed earlier is a problem because it shows that NHS funding systems are old fashioned and not geared for digital disruption
It’s like pharmacy, in a way. Their primary funding is through the dispensing of medicines so even if they want to help you with all sorts of health checks; cholesterol checking etc, they are only funded for dispensing medicines and these health services would be either at a cost to the patient or absorbed by the pharmacy. This limitation hinders potential innovation.
We can see the intentions of GP at Hand. There are some GPs who are against disruption, as there are in any industry, but we think there are two major factors (we’re not saying these are the only ones) that need to be addressed by innovators and the NHS to enable a better success story: integration with GP records as a standard and funding mechanisms fit for the 21st Century & the digital revolution.
To all health professionals: the patient is now a healthcare service consumer.
We need to keep up with their expectations.