Sick? Click: launch of the virtual GP
If you're too busy (or embarrassed) to see your GP, don't despair. NHS treatment could soon be available online. Diane Taylor reports on a medical revolution
Fed up of making long journeys to your nearest hospital for an appointment, then waiting for hours to be seen? Had your fill of unfriendly receptionists at your GP surgery and of bureaucratic hoops to jump through before you can see a doctor and get test results?
Receiving treatment in cyberspace could be the solution to your woes. London's Chelsea and Westminster Hospital has just become the first NHS establishment in the country to treat patients online. It has launched a new service offering male patients the chance to have erectile dysfunction dealt with over the internet, rather than face-to-face in a sexual health clinic.
"Lifestyle" health problems such as erectile dysfunction, weight problems and hair loss are among the commonest conditions for which people already seek treatments over the web. But many private healthcare websites are unregulated and offer counterfeit medication. Some UK websites fail to abide by the stringent rules set out by the General Medical Council and the Medicines and Healthcare Products Regulatory Agency. And even though all private online healthcare providers in the UK are required be law to be registered with the Healthcare Commission, most are not.
One of the advantages of the new NHS service over many of its internet rivals is that it complies with all the relevant regulations. A clinical audit is being conducted to compare outcomes of people seen in one of the hospital's clinics and those who are treated online. The cost of treating patients online is far lower than with face to face consultations; savings can be ploughed back into other NHS services.
Chelsea and Westminster has linked up with Dr Thom, a private UK internet-based healthcare provider registered with the Healthcare Commission. Dr Thomas Van Every, the medical director of Dr Thom, is a doctor at Chelsea & Westminster. The advantage to the hospital of its new service is a reduction in the cost of face-to-face consultations; for patients, it is less embarrassment and speedier service. The fee is £45.
According to the Sexual Dysfunction Association, 2.3 million men in the UK suffer from erectile dysfunction. The condition is usually fairly simple to treat, and the drugs prescribed rarely have problematic side effects. Chelsea and Westminster patients using the online service will first fill out a medical questionnaire, then have an online dialogue with one of the hospital's doctors. If they are deemed suitable candidates, medication will be prescribed and mailed to them.
"We hope that the launch of this service will be an important step in helping to improve standards of online healthcare in the UK," said Dr Simon Barton, the hospital's clinical director for HIV and sexual health services. "All clinical aspects of the new service are overseen by Chelsea and Westminster, and all the doctors who prescribe treatment online are NHS specialists in sexual health."
Erectile dysfunction is seen as a good place for the NHS to start because it is a fairly straightforward condition. But the potential range of treatments that the NHS could offer online is vast. Tests could be ordered online to screen for a range of conditions such as high cholesterol, chlamydia and HIV. For countries like Cuba that have a health service budget a fraction of the NHS's and a focus more on the prevention of illness and early interventions, online screening could be extremely beneficial – saving money not only by allowing for early intervention, but by avoiding the need for costly face-to-face consultations.
A report from the the King's Fund, a healthcare think tank, suggested that patients with long-term conditions such as asthma and diabetes require increased flexibility from health services to allow them to take a more active role in managing their own conditions. Many of the surveyed patients said that increased use of email, texting and internet-based health services would be beneficial to them. Professor Flis Henwood of the University of Brighton is currently researching the role of the internet for people who want to manage obesity. "The potential may be there for radical transformation of service delivery in the NHS by offering treatments via the internet. But it's only through case studies of services such as the one Chelsea and Westminster has launched – where they are comparing outcomes for patients treated online and those treated in the clinic – that we can find out what kind of differences online services can really make in terms of health outcomes."
Could cyberspace also be an appropriate medium for treating more complex conditions? Apparently it can. Some of the most difficult, cutting-edge surgery can now be performed by robotics, but usually the surgeon has to be in the room with the patient, directing proceedings from a computer console. But according to International Journal of Medical Robotics and Computer Assisted Surgery, the internet can now be used to link surgeon, robot and patient. Often, only a handful of surgeons can perform the very latest procedures; rather than spending half their lives flying around the world to different operating theatres, they may soon be able to sit in their office overseeing them online.
Dr Barton says that his department is using the internet to have case conferences with doctors from other hospitals regarding complex HIV cases. Seven or eight consultants with particular expertise in HIV gather together and conduct a "virtual clinic", offering advice to doctors at smaller hospitals about the best way to manage some of their trickier HIV cases. These clinics were among the first to text patients their test results, obviating the need for another time-consuming hospital visit. Patients whose results need further discussion are asked by text to call a dedicated number at the hospital to discuss treatment options.
Dr Barton's team is also developing a 24-hour online booking service. After describing their symptoms, patients are referred to the appropriate clinic. Those whose symptoms sound most serious will be prioritised for a next-day appointment in an "e-triage" system. "We are changing the environment of the old NHS," says Dr Barton. "Our department is known for innovation, and the NHS is not like a private company where information is commercially sensitive and has to be kept secret. We want to share our new ideas across the NHS."
But, he warns, large, dramatic changes are not always successful, as the introduction of the new NHS computer system demonstrates. "The best way to transform the NHS is by sharing lots of new, local endeavours. No big bangs, please."
To access the service, go to www.drthom.com and fill in a free questionnaire. If a doctor judges your case suitable, you can trial the online treatment for £45