WebMD, Channel 4, Boots and the NHS: Is NHS Direct being primed for a Private sector future?

In February last year at the Guardian’s Mobile and Wireless Healthcare event in Birmingham we learnt that the NHS Direct had been secretly trialing a “3G Doctor style service”. I was very surprised by this move but welcomed it as not only is competition a very good thing but the low value of the current service to the British taxpayer (who contributes more than £100 million per year in running costs) has in my opinion been undermining wider healthcare provider confidence in remote care opportunities.

I also thought it might mark the end of it’s use of a premium rate number and end the perception of the service by NHS Doctors as “NHS ReDirect” (because in most instances NHS GPs feel patients end up going to see them anyway and have to repeat the same thing they told the call handler as there is no effective documentation of the history taken and advice given).


Fast forward 16 months and a lot has changed and with a new coalition Government in power the NHS Direct service seems to have been shown the door in favor of a new free to call (from landlines AND mobiles) “NHS 111” service created as part of efforts to increase private sector involvement in the NHS.

This seems to have driven the NHS Direct to start exploring opportunities that have been are out there with private sector partners for some time and the latest development is a collaboration with some industry giants: Channel 4, WebMD and Boots (the leading UK high street pharmacy chain that’s 45% owned by Walgreens the largest retail pharmacy chain in the USA):

My VideoDoctor is funded by Channel 4, and was created in partnership with NHS Direct, using algorithms which also appear in NHS Direct Symptom Checkers but incorporating interactive video featuring the Embarrassing Bodies doctors rather than text. Many users of My VideoDoctor will save the NHS money by using this as their first point of interaction, rather than immediately making an appointment with their GP for example

Looks good but where’s the value for patients?

The site design is very cool and there’s video content made featuring celebrity Doctors with great personalities (Dr Pixie McKenna, Dr Dawn Harper and Dr Christian Jessen) that seem to be video adaptations of the text that’s used in the NHS Direct’s Online Symptom Checker website/apps and that make up the scripts that NHS Direct call handlers and nurses read to patients who phone in on the 08454647 premium rate telephone line:

This idea of turning “text into video” is something we’ve been asked to explore with various partners and prospective clients over the years. All seemed to be convinced that the text based interactive medical history taking questionaires that we use to take a history at 3G Doctor lacked something. I think it’s mostly because they’ve approached the idea of a remote Doctor/Patient engagement process taking a provider rather than a patient point of view. Here’s several reasons why I think it’s not a good idea:

1) It’s quicker to read which let’s patients share more information eg. you can read “Do any members of your family have a history of heart disease or have suffered heart attacks?” and choose a “Yes/no/not sure/don’t understand” answer much quicker than I can load and play a video of me saying exactly the same thing with the clarity that a question as important as this requires.

2) It’s quicker and easier to edit. Perhaps this originates from my own personal belief that in healthcare we shouldn’t be trying to build services that are perfect but instead focusing on the capacity we have to improve them eg. based on on the realtime feedback of Doctors and Patients we can quickly and inexpensively edit or add a question whilst maintaining the continuity of the questionnaire (something that’s not possible with an editing process that requires a video sequence to be reshot).

3) Appreciating that a patient is challenged by text on a screen is a massive opportunity eg. you’d be amazed at how many patients have Doctors who don’t know they’re illiterate, we can suggest screen reading tech to those with visual impairment, etc.

4) There is a video opportunity but it’s probably in animatations rather than with Doctors reading scripts. Check out the tools created by firms like XtraNormal if you’re unfamiliar with what can be achieved with animations. Here’s a few benefits that I think the My VideoDoctor service would gain by using animations rather than casting real Doctors:

a) It can be translated easily.
b) Edited dialogue isn’t jumpy (it can be distracting to watch a presenters make up/attire change with every question)
c) Patients can choose their own/favorite Doctor to feature in the animation
d) We can have the animated character present the information the patient shared back with them

“Live Consultations” and “The Doctor Will See You Now”

Of course the contribution this series has made to raising the profile, awareness and acceptance of embarrassing health problems is without question but now that it’s got the TV audiences and managed to also draw the all important website visitors (I don’t think there are any other British TV shows drawing anything like these numbers) some care needs to be made not to hype exactly what’s on offer eg. there is the possibility for patients to be misled by promises of “Live Consultations” and “The Doctor Will See You Now” (which is obviously very similar to the strapline we’ve been using at 3G Doctor since 2006).

If I had to make a suggestion perhaps “the public will see you” and “Live consultations between 8-9 next Tuesday” would be more accurate?

Each week during the show you can ask your questions to our online doctors in a live consultation. This week Dr Nathan Curran and Dr Anita Sturnham answered your general health questions. Mr Shaw Somers and Dr Ricky Shamji looking at obesity, fitness and weight loss in the specialist chat. These consultations are now closed, but you can still read the questions and answers by watching the replay below

Save the NHS money so it can buy “Baby Ventilators”

Many users of My VideoDoctor will save the NHS money by using this as their first point of interaction, rather than immediately making an appointment with their GP for example. Although we don’t retain any individual user data from My VideoDoctor we do monitor the end point (ie final piece of advice) of each user journey, using an analytics programme. Through our partnership with NHS Direct, we know from user surveys what action users would typically have taken (for example visiting their GP) if they hadn’t used an online symptom checker. In many cases the advice given to users includes low-cost advice, such as self-care, or a pharmacy visit for example. In cases where the first alternative would have incurred a cost to the NHS, a saving may be generated. This doesn’t happen in all cases however, as some advice points users to visit Accident & Emergency for example. We also know that not all users follow the advice given, so although we attempt to be conservative with our savings calculations, the actual savings total may vary from our calculation, depending on the number of users who do not follow the advice

Visitors to the site will immediately notice a continually updated counter running in the header informing visitors of the number of “Baby Ventilators” the website is saving for the NHS. I wonder if we’ll see more private sector websites with healthcare content trying something similar?

I wonder if anyone’s thought about applying this logic to the NHS Direct itself eg. if £759k gets you 37 “Baby Ventilators” scrapping the service outright would save the NHS enough cash in one year to buy 5000 – enough to put one in every single NHS Ambulance.

Isn’t this all just more Data rather than actionable Information?

Sadly as with almost everything we’ve seen from NHS Direct behind the headlines it’s all let down by the actual service being just basic symptom checkers (like you can find on almost any free healthcare information website eg. WebMD) and any advice comes with disclaimers that totally undermine patient confidence:

Important Notice: The information and advice provided on this website (including, without limitation, the advice of our online specialists) is for use as information or for educational purposes only and is not a substitute for professional medical care by a qualified doctor or other suitably qualified healthcare professional. We do not warrant that any information or advice included within this site will meet your health or medical requirements. This website does not provide any medical or diagnostic services so you should always check with a health professional if you have any concerns about your health. Live from the Clinic Terms and Conditions

Where’s Microsoft?

I’m surprised there’s no mention of Microsoft (new owners of video call giant Skype) as clearly this is how the patients are calling into the program. A massive missed opportunity unless of course like Hoover/Vacuum Skype has already become synonymous amongst consumers with making a video call?

Boots

I think this is a very smart tie up for Boots (they’ve been trailing Lloyds – part of German pharmaceutical wholesaling giant Celesio – who have since 2009 been making millions in extra revenue from online prescriptions through Dr Thom the online Doctor prescribing service they acquired last year) as it’s a high profile TV programme and reinforces their relationship with the NHS in the minds of patients.

Channel 4 and My VideoDoctor

I think the success of this series leaves Channel 4 with no option but to develop it further or spin out the brand to prosper on it’s own. With BAFTA’s, 20 million website visitors and such a memorable brand I can imagine this has easily exceeded the expectations of all involved.

Investors could expect an attractive exit as Boots/Walgreens will no doubt look to follow in the lead of their competitiors at Lloyds who have already taken over the successful Dr Thom service (which also started out with a similar focus: selling online sexual health tests and prescriptions to patients who were embarrassed about presenting to a Doctor).

NHS

In my opinion the NHS is still only waking up to the opportunity to engage with private media companies and it hasn’t even begun to start to imagine never mind explore the possibilities that mobile network operators can open up for them.

Saying that the enormous success of a TV show like Embarrassing Bodies has highlighted the opportunity there is for public health objectives to be met via innovative brands in the private sector rather than through strategies focused on obscure dedicated satellite TV channels. One can only imagine the potential for such content to be distributed with a targeted mobile strategy.

As for the well recognised NHS Direct brand, at the moment all it seems to be doing is lending the NHS brand to the program (WebMD of course already has it’s own Symptom Checker service and there’s little to prevent them copying the NHS’s freely/widely accessible data) so while this activity is no doubt driving more call volumes it’s still very uncertain if there’s a private sector stand alone future for the service.

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