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webGP – where is the evidence?

Dr Arvind Madan is the architect and chief salesman for webGP.  His record in using new technology was cited by NHS England as a key factor in his recent appointment as National Director of Primary Care.  However his major shareholding in Hurley Innovations Ltd, which owns and markets the product, makes this controversial because of the potential conflict of interest.

Both his new role and the expenditure of public money via the Prime Minister’s Challenge Fund (PMCF) on the service must focus attention on the evidence for webGP (recently rebranded eConsult).  According to Hurley’s own information, the development was funded by NHS London and Tower Hamlets CCG.  Our FOIs have not yielded any data on how much, and with what conditions, but the IP appears to be owned by Hurley Innovations Ltd (HIL), a commercial company legally separate from Hurley Group.  The latter is a GP partnership, holding NHS provider contracts, of which Dr Madan is a partner along with 3 others (also major shareholders in HIL, 21% each according to Companies House in April 2015).

To our knowledge the only evidence published for webGP is their own pilot report, covering 133,000 patients in 20 practices over six months to May 2014.  The meat of this on page 6 is that 1600 patient submissions or e-consults were made online.  Our analysis shows this represents around 0.71% of total expected demand during the period.  Most of the rest is survey information, and claims that clicks on links from the website have reduced demand. Expected numbers rather than measured numbers are quoted freely.  However, no evidence is presented on total demand.  One may question whether 0.71% amounts to “the virtual general practice.”

Much is made of diverting patients away from consulting a GP, by presenting NHS Choices information and the option to phone NHS111.  Both services are publicly funded, free to the patient, widely advertised on practice websites and well used.  Every day, more people visit NHS Choices than visit their GP, without the aid of webGP, and an unknown number google their symptoms to get help online.  No one is saying that this new world of information has reduced overall demand on GPs.

Of the 20 practices in the study, 15 were run by the Hurley Group and 5 not.  To our knowledge, no evidence has  been published by independent parties or practices not associated with Hurley.  Several have spoken to us off the record about their experience, patient usage and feedback, and a consistent picture emerges which is very different from the sales pitch.

Dr Madan said at this year’s EMIS National User Group meeting that a “flying height” of 10 submissions per day could be expected for a practice of 8,000 patients (this would be about 10% of demand).  Has this been achieved by any practices?  How has this rate affected total demand?  With at least 2 years experience in their own practices, these numbers must be known to the supplier.

For Rydal practice in North London, independent of us as we are not a provider, such a level of online demand would be only a quarter of their average of over 60 askmyGP online submissions per working day, over 40% of demand, for a list of 12,500.  Even with a rate 50 times the webGP evidence, we have measured the total demand before and after the service was introduced and found it to be unchanged.  We are not claiming a reduction, simply that it is more efficient to deal with and better service for patients.  In a similar time period to the webGP report we’ve seen over 10,000 online submissions from patients of Rydal and two smaller practices.  In the last six months we have presented evidence at the King’s Fund, Society for Academic Primary Care, European Forum for Primary Care, RCGP conference and elsewhere.

On 23rd September 2015 at the EMIS meeting, I invited Dr Madan to share evidence on webGP, both publicly and in private.  He is claiming over 1 million patients have access to it, and some practices have 2 years experience.  Five weeks later we’ve seen nothing more, nothing since May 2014.  Given the large sums of public money now being spent on the service through PMCF schemes, the public has a right to know, and independent analysis is long overdue.

How many patients have submitted e-consults?  Over what time period and patient population?  What is the total demand over the same period and how has it changed?

We will of course give the same unfettered access to a suitable independent party, guaranteeing anonymity to patients and practices.

England expects that every man will donate his data.

Harry Longman

Founder, Chief Executive,  GP Access Ltd

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