12 Nov ‘Smartphone GP’ – great technology but disappointing implementation?
The announcement last week of a new ‘smartphone GP’ solution, to be piloted in the London area, has caused considerable concern across general practice. Much of the negative reaction stems from disappointment that, just when additional funding is made available to implement new technology, it is used in a way that doesn’t directly address current challenges. All parts of the NHS are struggling with demand pressures, so offering additional services to those who are the least unwell, seems like an opportunity missed. It is the complex patients who require speedier access to care and advice, and it is this group to whom newly funded initiatives should be directed.
My sense, from talking informally to colleagues, is that most GPs can see a place for this method of consultation. Many are using telephone advice and triage approaches already, and certainly this highly convenient method of accessing medical advice will suit those who do not feel the need for a personal and ongoing relationship with a GP. However, many doctors would argue it is not a priority development at the moment, when there is an urgent need to improve morale, recruitment, and capacity across a sector that is struggling with insufficient resource to manage the demand that stems from increasing numbers of patients with highly complex needs.
Additional burden on struggling practice?
The RCGP Chair, Prof Helen Stokes-Lampard, has highlighted the risk of creating a ‘twin-track’ system of general practice, where certain groups of patients can access faster support than those with frailty, mental health conditions and other complex matters requiring face to face consultations. She also raised the concern that pressures on GPs could increase if the more straightforward consultations were ‘cherry-picked.
Patients within the pilot are asked to move practices, so the capitation payment will move too. While there is a uniform payment, there is a risk that practices will see their total resource depleted, whilst being left with continuing responsibility for the patients most likely to need support and access their services. GPs will also be required to work in the new digital service, at a time when recruitment in general practice is extremely challenging.
There are concerns too that creating a new, easy to access service might generate new demand, rather than divert demand from practices. We saw this, of course, with Walk In Centres, that were mostly found to have stimulated additional activity, without having any measurable impact on demand for existing GP or hospital services.
Or an opportunity?
There is, of course, much that new digital technology can offer the NHS and it is always uncomfortable opposing the introduction of exciting new technology, such as the ‘symptom checking’ algorithms and video consultation that are being introduced here, when they can offer a good service if used appropriately. For all the potential downsides, it does feel like the future. Indeed, many people already subscribe to such services and are satisfied with their benefits.
From my experience, most GPs are quick to embrace change, and are pragmatic about the need for practices to evolve and develop to keep pace with wider societal trends as well as the changing demographic. A more inclusive approach to utilising this funding, and technology, would have paid dividends. A representative group of front line GPs could have come up with a number of ways for this exciting development to be trialled in the local surgery, benefiting the patients most in need, and minimising the risk of untoward consequences. Instead, it feels like the funding is going to create a new service elsewhere, that will not impact at scale, leaving the local practice to continue as before.
Digital technology offers opportunities to do things differently, but for this to happen we also need to introduce innovation differently. If we do, then these sort of announcements will be greeted with excitement rather than concern.