Covid-19 has redefined the workplace. For some the office is more important than ever, while others have leapt at the chance to work remotely, including from abroad. Madeira’s “digital nomad” visa certainly piqued my interest. But how far has the NHS been able to embrace these new ways of working?
In a new report from Policy Exchange, we argue that policymakers should use remote consultation (particularly high-quality video) to reduce inequality in the provision of GPs across the country—an issue which has persisted since the foundation of the NHS. Specifically, we believe the government should introduce a scheme whereby doctors could deliver sessions from overseas. Digital consultations are already carried out between doctors in Birmingham and patients in Essex, so why not between a patient in Billericay and a doctor living in Brisbane?
There are plenty of questions to be answered. Would GPs based internationally be given prescribing responsibilities? What about liabilities when something goes wrong? Can remote doctors really navigate the cumbersome IT systems which bedevil many surgeries?
Then there is the regulatory environment. Where policies to regulate cross-jurisdictional healthcare exist, they are often inter-state, such as between Canadian provinces. As well as updates there, licensing and registration would need to be adapted, with changes required to current General Medical Council rules. Patient consent would need to be handled carefully, as would the sharing of data.
Yet the need for new approaches is obvious. Since 2015, almost 1,000 qualified GPs and more than 4,000 “non-specialists,” including junior doctors, have left the UK register. Many have headed to Australia, prompting the introduction of a “relocation package” worth nearly £20,000 to lure GPs back from “down under.” That scheme has produced limited returns, however. The government’s international GP recruitment scheme, meanwhile, is far from reaching its target of 2,000 to 3,000 GPs—which would only represent roughly half the number of GPs many feel we are short of.
Any new scheme on the lines we propose would start with doctors who originally trained in the NHS, but it could gradually be extended to doctors trained by other advanced English-speaking healthcare systems. The Royal College of General Practitioners and General Medical Council found in a recent review that Australia, Canada, New Zealand and South Africa meet similar standards of clinical training, so these would be a priority for negotiating mutual recognition of qualifications. Safeguards would ensure the patient’s location was defined as the “place of service,” with providers required to adhere to regulatory standards set in the UK.
Might this be one pragmatic solution to present staff shortages? For all the discussion of a need for long-term workforce planning in the NHS, the issue is here and now. Other short-term measures are available too. While the UK accepted 4,000 GPs onto training places last year (a significant increase from 2,670 in 2014), roughly one-third are international students requiring visa sponsorship to remain. Having benefitted from studying at the best UK medical schools and honing their skills in our surgeries and on the wings of hospitals, many end up practising elsewhere. We could require each trainee to work (either in the UK or remotely) a minimum number of years in the NHS post-qualification—perhaps five years out of their first ten—to repay the investment from the UK taxpayer.
For some, the idea of a remote doctor challenges traditional conceptions of general practice. It would be more difficult to deliver relationship-based medicine, often seen as the unique strength of general practice. But the latest GP Patient Survey shows that only a minority of users now report having a preferred doctor. GPs are increasingly co-ordinating care for patients among a multi-disciplinary team, including first-contact physios and practice nurses. Here, informational continuity becomes increasingly important, with a patient's history, test results and up-to-date information accessible in any NHS setting (including those working remotely). This is the type of continuity we should offer everyone—and doing so will support relationship medicine too.
While the global GP idea will divide opinion, there is a consensus that something radical must be done. Patient satisfaction with GP services is at its lowest level since the early 1980s. With historic levels of investment going into the NHS, we need to design services in a way which is responsive to the needs and preferences of consumers. Hybrid approaches are increasingly becoming the norm. With remote GPs already here, perhaps now is the time to go global?