The recent story of ‘GP at Hand’ in the UK was easy to miss, but when we look back at it years from now, it may turn out to be a seminal moment in the history of public healthcare delivery.
Launched in late 2017, GP at Hand is a National Health Service (NHS)-funded service offered by Dr. Jefferies and Partner, a GP practice powered by Babylon Health, a five-year-old subscription health service that enables online consultations with physicians.
Patients don’t pay for GP at Hand services but must de-register with their existing primary care provider and register with the southwest London practice before they can book a telephone or video consultation. At the time of launch last year, there were 2,500 registered patients in the Jefferies practice. In June, Digital Health reported that within three months, 40,000 patients had applied to join.
Meanwhile, the UK’s Doctors in Unite — a 1.5 million member union – wants policies around GP at Hand changed, indicating it is destabilizing other practices. They have accused GP at Hand of “cherry-picking” younger, healthier patients, leaving other general practices with fewer registrations to fund the costlier care of the old and sick.
In fact, you can’t register with GP at Hand if you’re pregnant, have complex mental health problems, complex “physical, psychological and social needs”, dementia, require end-of-life care, or have learning difficulties or drug dependence. Traditional practices are not allowed to reject patients because of their health status.
What do I think? Well, the drama here is obvious. While clearly the gold standard of virtual health care is holistic primary care, patients are voting with their feet – looking for convenience and customer service.
While I full-heartedly agree with the physician union response rebuking the “cherry-picking,” the real point of the experiment has been neglected. People are clearly aching for better access, convenience and a better customer experience. They see the virtual channel as providing this in spades for many minor health issues.
So why are providers calling to end the cherry-picking but not equally calling for the introduction and funding of virtual health care in ALL primary care practices?
As it turns out, most publicly funded health systems are not structured in a way that encourages or rewards great customer service. In Ontario, we have started to make efforts, such as the ‘Excellent Care for All Act’ which impacts mainly hospitals, but efforts in the community have been much weaker.
For example, in primary care, physicians are mainly paid to deliver services. Wonderful though these clinical services are, physician remuneration is not tied to the quality of their customer service. The costs of running an office and paying staff doesn’t leave much time or resource left over for improving the overall customer experience.
Patients know this. They spend plenty of time sitting in the waiting room, watching their stressed-out provider scrambling just to keep up with the load!
In Ontario, OTN has been working with the Ministry of Health and Long-Term Care, LHINs, and primary care providers on a program similar to the Babylon service. So far about 160 primary care provider champions have enabled their own patients to access them via secure message, video or audio using technology provided by Novari Health, Think Research or QHR/Medeo and supported through a pilot set of fee-for-service codes*. Currently available in four LHINs, with another going live in the next 60 days or so, the goal is to make this service routinely available throughout the publicly funded health system.
This experiment has been fascinating because many physicians have been slow to participate. Though offered the technology – at no cost – and fee codes that support the work, even the best intentioned providers struggle with designing and implementing the positive changes that would bring new consumer-focused services into their practices. Change is always hard – but is especially hard without the corporate resources and corporate DNA needed to implement new business processes. For example, imagine a corner store trying to implement the customer service level of an Amazon.
However, GP at Hand illustrates that with modern technology, creating a much better consumer experience is possible and practical. Here is a possible recipe for success: Provide patients with secure messaging, audio and video access to their primary care provider. Add in online scheduling and access to their own personal health information. Train front-line staff in positive customer service. That’s all it might take to create a much better experience.
GP at Hand is an omen of what is to come. When people discover virtual care and can access more consumer-centric services, they will flock to it.
If current providers can’t bring a consumer experience vibe to their practices, then beware. The big players like Walmart, Costco, Shoppers and especially Amazon are experts in delivering large-scale customer service and have the resources to back it up. Once these sleeping giants wake up to the opportunity, all bets are off for traditional health care delivery.
*eVisit Primary Care is a project that enables patients to have virtual visits with their own primary care provider. The project is seeking to determine how to make this an insured service and a regular part of public healthcare delivery in Ontario. Patients connect with providers through dedicated platforms that offer secure messaging, audio, and video. As a result, patients can access their health care in a timely way from their location of choice, for simple health requests that do not require an in-person visit. The project is being led and tested together by the Ontario Telemedicine Network (OTN), five Local Health Integration Networks, and family doctors in those regions. A physician payment model was developed with the MOHLTC and is being evaluated as part of this project.
Related Blogs by Dr. Ed Brown:
The 1, 2, 3 Guide to Disrupting Health Care