There has been a growing trend over the last few years of private providers of healthcare such as Babylon and Push Doctor offering online virtual services for primary care direct to the public in the UK.
Primary care services provide the first point of contact in the healthcare system, acting as the ‘front door’. Primary care includes general practice, community pharmacy, dental, and optometry (eye health) services.
Traditional NHS primary care providers have always used telephone consultations for both triage and clinical management, with The Guardian confirming that 48% of NHS consultations were carried out through video calls in May 2021. Historically, the use of video consultations within the NHS had been very limited to specific clinical situations (e.g. for prisons, remote locations etc).
Covid has had a dramatic impact in the way that the NHS, in both primary and secondary care, have offered clinical consultations to the public and the use of video consultations have been widely employed along existing access to care methodologies such as telephone and face to face consultations.
The use of video consultations has made it easier for patient’s to access care without the need to miss work or facilitate child care thereby improving worker productivity and it has reduced the likelihood of catching/transmitting illnesses such as Covid that patient’s would have been exposed to whilst waiting in the doctor’s waiting room. It may not be Zoom, Google Meet or Whereby, but rather a white labelled service on behalf of that clinic or platform like Babylon.
The use of these technologies has definitely improved patient access but the impact in terms of patient outcomes has not been equally matched. This is due to a variety of reasons. Firstly video consultations have their limitations in terms of diagnostic accuracy.
For many conditions a physical examination is required and it can be challenging to assess very young children using the medium of video consultations – these patients still require a traditional face to face appointment.
Also a large proportion of users of healthcare are either elderly (who may lack the technological know how to operate online consultations), very young (challenging to assess in a virtual environment) and many of the at risk groups may come from poorer backgrounds (with lack of access to devices) or from ethnic minorities (where there is a significant language barrier and an online consultation may be extremely challenging).
In many cases a video consultation will not provide much more of an improvement in diagnostic outcomes when compared to the traditional telephone consultation which has been historically widely employed prior to the COVID pandemic.
For the existing private providers of online healthcare the above limitations to video consultations have meant that they have had to change their business model to more of a hybrid offering. Babylon has taken over the running of traditional ‘bricks and mortar’ NHS practices so that they can offer their existing online video consultations and if necessary bring patients in for a formal face to face review as per traditional healthcare models.
Looking forward, video consultations will provide part of a blended model of access to healthcare complementing both telephone and face to face consultations. It is clear that they are more convenient for patients, however due to a combination of limitations when it comes to diagnostic accuracy and specific patient group needs there will always be the need for the traditional face to face review at the doctor’s clinic.