The DH has announced £240m for online access to GP appointments, repeat prescriptions and patient records. This will be match funded by other providers, so the figure could be doubled, but let’s stick to £240m for the sake of argument.
Why? Do we see marchers in the streets demanding online access to their GP? Is the Daily Mail screaming for repeat prescriptions on the Internet? Doctors holding back the hordes desperate to see their records? I’m not deaf yet, and I haven’t missed anything, much. What patients are queuing up for, and hanging on the line for, is access to see or speak to their GP. £240m is around £5 per patient registered in England, man, woman and child. That seems to me rather a lot of money to miss the point.
I’m no Luddite, in fact I’m all in favour of doing whatever it is online. I even have a blog, ner. And I care enough about access to medical care to devote my career to it. But online appointments are happening anyway – most of the GP websites I go on already offer it. The GPs have a DES or a LES which pays them to do it. And I also know that the take up is very low – just a tiny fraction of appointments are actually booked that way. It may increase, but that will happen anyway because if it’s a good idea and saves time and money, GPs will do it, as they will with repeat prescriptions. Patient records are another matter with questions asked about the wisdom, security and ethics on which I dare not offer an opinion.
But I do have a view about online access, concerning inequality. If access to a GP were freely available, the argument might only be about convenience. I’d love to book online, would suit me perfectly – book a phone call from a GP, or ask a question and get an expert clinical email response. If only – but access isn’t freely available, for most patients in most practices it’s scarce. There aren’t enough appointments to go round. What this means is that online bookings have to have some capacity reserved for them, capacity which is no longer available to those who don’t have internet access or skills. Think for one second, how strong is the correlation between those most often in need of a GP, and those most at home with the internet? Not good.
So in an economy of scarcity, to those who have, more will be given and from those most in need, more will be taken away. Julian Tudor-Hart called it the Inverse Care Law.
Our political leaders are intelligent, well meaning and say they want to reduce inequality. But they are spending huge sums on an itch which will look after itself in the fullness of time, a “minor self limiting condition” as doctors tell me. Invest this money where there’s the need, in simply improving access to a person.
When we work with practices who want to change, we begin with a question not about technology but about purpose, “How are we going to help all our patients, all day, every day?”
Could I suggest the same question for the corridors of Whitehall?