The irresistible entrepreneurial spirit of Silicon Valley is slamming into the immovable object of UK healthcare regulation, with the Care Quality Commission (CQC) exposing significant concerns with at least 10 online clinical services.
Online services range from tiny startups to enterprises contracting thousands of doctors. High-profile respected players include Lloyds Pharmacy's Online Doctor and Babylon, led by technology evangelist Ali Parsa. They typically offer GP consultations, pharmacy and advice.
At least two providers inspected by the CQC have been criticised for prescribing large quantities of asthma inhalers, with Frosts Pharmacy's Oxford Online Pharmacy accused of putting patients at risk of life-threatening exacerbation.
White Pharmacy was prescribing a high volume of opioid-based medicines with no system in place to confirm patients medical or prescribing histories.
Health regulators are having to move fast to keep pace with the proliferation of online services. In March the CQC, General Medical Council, General Pharmaceutical Council and Medicines and Healthcare Products Regulatory Agency warned online services that they had to follow the same professional guidelines as any other provider.
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While the CQC is carrying out inspections, NHS England is beginning to check the quality of apps. It has awarded its first NHS Approved status to a third-party app myCOPD after it passed effectiveness tests. NHS England is also building an apps library around 40 so far, including online GP consultations. But it will only ever be a fraction of the thousands of available health apps.
With the potential to reach vastly more patients than any GP practice, the risks from a rogue online service are severe. Poor performers are often in a hurry to secure another sale without doing proper checks, in some cases risking serious harm.
The tension between regulation and smartphone healthcare is inevitable. As Silicon Valley physician and tech entrepreneur Jordan Shlain put it last year at a DigitalHealth.London conference, the techie attitude of move fast and break things comes up against the medical attitude of move slowly and dont kill people.
Eventually the weaker players will be forced out of the market through a combination of regulatory action and poor reputation, and standards will be raised as entrepreneurs are compelled to embrace rigorous procedures.
But it will take time for the public to become discerning customers of online services. Many will not realise that digital healthcare is subjected to the same regulatory regime as their local clinic or hospital, and even if a patient manages to find the inspection information, interpreting it is not straightforward. The CQC needs to find new ways of presenting information on digital services although it is difficult to imagine the regulator's website peppered with emoticons.
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But the appeal of well-run online services is compelling. Access to doctors is provided day and night at a time to suit you, tests are handled quickly and efficiently and the charges are manageable. Many people prefer the relative anonymity of an online consultation. Services such as Babylon already feature a significant element of artificial intelligence, which a data-driven generation may find more reassuring than sitting in front of a human being.
Online services are challenging our primary care model. People fed up with having to take half a day off work for a few minutes consultation are using them in huge numbers, and GPs in clinics need to respond. As a start, consultations should be conducted remotely if that is the patient's choice.
The whole principle of list-based general practice will be called into question as healthcare is increasingly accessed via smartphones. Thousands of doctors are already working for online services; the NHS needs to find a way to incorporate this approach into the mainstream of care.
Soon the first channel for delivering primary care will be digital, not clinics. The NHS needs to embrace this or be left behind by the private sector.
- Richard Vize is a public policy commentator and analyst
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