Patients risk having serious conditions including cancer being missed under plans to make millions of hospital appointments virtual in a bid to tackle the NHS backlog, experts warn.
Virtual appointments plan
From next year, doctors will deliver millions of hospital appointments virtually under plans set out by former health secretary Wes Streeting. Patients referred by their GP will be able to select a virtual appointment with a consultant anywhere in the country through the NHS app.
The new 'NHS Online' service will initially focus on specialties including gynaecology, urology, gastroenterology and ophthalmology, with 8.5 million appointments expected to be delivered by the digital trust in its first three years.
Concerns from health leaders
But health leaders and patient groups fear the move could result in vulnerable patients 'slipping through the net', with serious illnesses harder to identify without face-to-face examinations. One patient representative consulted on the plans raised concerns about 'serious conditions slipping through the net'. Another respondent from Healthwatch said: 'It's not a fair choice' with historically long waiting times pushing patients towards the digital route, where 'things can easily be missed if not seen in person.'
The concerns come just weeks after a survey found older patients already feel 'dehumanised' by the NHS's increasingly digital-first approach to GP care.
Former health secretary's view
Wes Streeting, the former health secretary, insisted that 'everyone will benefit' from the online service, even if not using it directly. When announcing the plans last year, Mr Streeting said patients would 'be seen faster and more conveniently... by someone who will be able to get a sense of their condition and give them a course of action.'
However, doctors and patient advocates warn many conditions still rely heavily on physical examinations and procedures that cannot be replicated remotely. For example, experts are unconvinced the model will work for gynaecological cancers, where doctors may need to inspect the cervix for abnormalities that could indicate disease. Gastroenterology patients are often referred for gastroscopies, where a camera is inserted into the stomach to investigate possible problems including cancer.
Unanswered questions
Questions also remain over how NHS Online will work alongside local NHS services and how patients with worrying symptoms identified during virtual consultations will be referred for further tests or treatment.
Dr Becks Fisher, director of research and policy at the Nuffield Trust, said that while the service would be helpful for some patients, 'tricky questions remain', particularly around how the service would be funded. She added: 'NHS IT infrastructure could also pose a problem, as it will need to enable relevant information – like scan results to be seen across different NHS organisations, something that is infamously difficult at the moment.'
Healthwatch also warned there was a risk patients could become more lost in the system, leading to confusion over who was responsible for their care. The organisation is calling on the Government to model the impact the online service could have on in-person capacity, finances, appointment targets and over-diagnosis. Currently, no such modelling exists.
Inequalities in access
There are also concerns the plans could deepen inequalities in access to care. Current NHS rules state there must be a range of booking methods to avoid creating a 'two-tier' health system in which wealthier and more digitally confident patients can access care more easily than older and more vulnerable groups.
Older patients may particularly struggle with the app-based model. Charity Re-engage warned last week that vulnerable older people are already being forced to self-medicate, attend overcrowded A&Es or simply hope symptoms resolve on their own because of difficulties accessing healthcare.
How the service will work
The online service will rely on NHS doctors taking on additional paid hours while working remotely from home. Jonny Brown, director of the NHS Online programme, said: 'They'll be employed by the NHS, but we will ask them to do additional hours for us and they'll be paid fairly for the hours that they work for us.' He also said the NHS believed the flexibility would attract doctors 'and make them keen to work for NHS Online.'
An NHS survey found 60 per cent of consultants were interested in joining the service, with doctors already working part-time more likely to express interest.
Political reaction
Stuart Andrew, the shadow health secretary, said: 'Those that need face-to-face appointments shouldn't be fobbed off with a video call if it means serious illnesses like cancer have a greater chance of being missed.'
An NHS spokesperson said: 'The NHS Online hospital will never replace in-person care. People will always have the option of face-to-face care if they wish or need – and this initiative is designed to give patients the convenient option of receiving specialist care for common conditions from the comfort of their own homes.'
