Is Video Consultation the way forward for General Practice?



I was sat with one of the most tech savvy and IT literate GPs in London, Dr Numa Thebe, enjoying coffee before our presentation to the NHS SBRI panel, and we were looking at the challenges faced by busy GPs especially in London. Every time I talk with GPs, I am always inspired by their dedication and commitment despite all the pressures they face and want to hear how they can improve the service they provide.

We started to talk about video consultation and whether this was a good or bad thing – I confess I was slightly pre-warmed up having talked with nearly 14 CCGs in the past month on exactly the same subject. Video does sound enticing as you could be sitting in a home office or in the practice and instead of facing the stream of sniffles and coughs from patients coming into the surgery, you could be sat behind a video screen with all the patient data in front of you. After all no-one ever got flu from a video camera.

So why isn’t this technology taking off, after all isn’t it convenient for the patient and clinician?
In reality, video consultations have been monopolised by the providers of private GP appointments. This is where a doctor you have never met, who can’t access your medical history, who has no way of taking any measurements eg BP, and can’t add any notes digitally to your continuing record of care, listens to you for about £2 a minute, and the faxes or emails a prescription to a pharmacy somewhere within a 50 mile radius of your house.

Outside of the private providers, this has been tried in Scotland where patients are geographically distant from their GP, but even then the technology wasn’t sustainable. In fact, when we can’t make simple mobile phone calls work on a Virgin train from Euston to Birmingham (last week) how can we hope to hold millions of video consultations across inter and intra-operable networks. Point-to-point video, like the private providers provide is as easy as me “Face-timing” or “Whatsapping” my mother, but general practice is not that simple and security is a concern.

The other issue is that 95% of GPs I have spoken with (n ~ 150) don’t like, want or need video as desperately as non-clinicians think they need it.

  • Reason 1:
    GPs multi-task, and a video call means they need to be front and centre for all the video call. They can’t be looking through papers, reading reports or having a cup of tea at the same time.
  • Reason 2:
    GPs look for cues apart from video, and rely on more than one sense e.g. How did the patient look as they walked to the chair in front of the clinician, did their foot drop?
  • Reason 3:
    Being a GP is a vocation not a call centre, most (OK not all) GPs like human contact, this is one of the benefits of the job, helping people.

So will video take off and all the money allocated to it be used? In my opinion the answer is No. Any money allocated to this will be underspent and not available for doing really important health initiatives with measurable health outcomes such as improving attendance at cancer screening clinics, expanding the immunisation bracket for shingles or promoting Measles vaccination for children.

Video is for gaming and entertainment, on which note back to the box set of Walking Dead.