A version of this blog was first featured in November’s issue of Health Investor.
It’s been around four years since a number of equity-backed companies entered the digital primary care market, all making video consultations with general practitioners (GPs) available to NHS patients. It is estimated that at least eight to 10 million patients in England have the option of consulting with their GP over a video app. The uptake is just a fraction of these numbers.
There are two market models emerging. The first, used by providers such as Push Doctor (which ZPB advises), Livi and others, is video consultation within a patient’s existing practice, meaning these individuals don’t need to change GPs and register with a new practice.
This minimises disruption for the patient and offers better access and choice, but it makes the cost of patient acquisition high and relies on GP practices to promote the service. Accessing the GP can be clunky, and patients need to download an app and prove their identity before speaking to the GP.
The second option, including Babylon’s GP at Hand, involves a digital-first approach where patients (if eligible), leave their existing practice to join a new one. There are face-to-face consultations, but the trade-off for the patient is that these may take place some distance from their home. The provider has effectively set up a new GP practice and so receives full NHS per capita funding for every patient regardless of whether they ever have an appointment. Their acquisition cost is comparably lower, and the patient is actively encouraged to take a digital consultation at (almost) all times. Initial analysis of these models indicates ‘buyer’s remorse’ with a high number of people signing up, but being unaware that they need to leave their GP. Also, careful consideration must be given to leaving the existing practices which might not take you back. Women considering starting a family or people at risk of developing chronic conditions may not want to take the risk of losing the option of easy local face-to-face appointments. A consequence of this model is that many patients registered at the digital-first practice don’t live within the area covered by the host clinical commissioning group (CCG).
This is the first example I can think of, since 2012, that the ambitions and success of a practice could seriously deviate from those of the host CCG. For example, the CCG may have very low rates for early detection of cancer and prioritise its GPs to improve this outcome. While the digital-first practice may be excellent at doing this, it does not improve figures for the CCG if the majority of its patients are out of area. NHS England’s digital-first consultation is looking to address some of these issues.
For both models, interoperability of records is a must, meaning the GP on video can access and write into the patient’s notes.
The bifurcation of the market is actually a good thing and offers different options to patients, all with the assurance that this is NHS funded care. Diversity in the providers’ business models will bring a degree of longevity and choice to the marketplace.
One thing that still needs to be addressed is any widening of health inequalities, especially for those with low data packages on their mobile devices that they may not want to use up on healthcare. Network providers are now offering packages whereby customers can stream movies or watch sport without affecting their paid-for allowance. An easy win for the NHS would be to negotiate a similar arrangement with the main network suppliers for accredited apps. Whichever parts of the market succeed, it seems that finally, those who want to access their primary care digitally will find options in their local area very soon.
For more, contact Alex on Alex.Kafetz@ZPBAssociates.com