Having just celebrated its 10,000th sick note, controversial online GP consultation service Qoctor has set its sights bigger and better things.
As well as medical certificates, Qoctor has been offering prescriptions for almost half a year now, and chief executive Dr Aifric Boylan says business is thriving.
“It’s still early days,” Dr Boylan said. “But we would prescribe anywhere between 10 to 30 prescriptions a day.”
The group is also now starting to see its first patients coming back for repeat scripts, which include medications for everything from acne and asthma, to contraception and erectile dysfunction.
“We have got around 15,000 registered users on the website and we’re getting around 1000 new views on the website each day, so there’s a lot of interest,” the GP said.
The next step will be to expand into offering treatments for patients with hypertension and high cholesterol, and the group will be looking into ways of arranging pathology and radiology referrals.
Every treatment currently prescribed by one of the eight GPs working for the service had been “chosen very carefully”, Dr Boylan said, to ensure it was not high risk.
“We would be wary of anything that’s got addictive potential or abuse potential. Those things we would not be looking at offering in the near or medium term.”
Dr Boylan sees Qoctor’s service as potentially being useful for for reas such as mental health and chronic disease management.
Mental health was currently underserviced, and an online service offered a “gateway” for people to engage in mental health care, the GP said.
“Again, it will have to be backed by a thorough assessment,” she said. “It has to be as good as a clinical assessment, if not better.”
But there may be many patients for whom the mental health issue is the very reason they are unable or reluctant to visit a doctor in person.
Dr Boylan was well aware of the concerns around her service. RACGP President Dr Bastian Seidel has said the increasing use of online services fragments care and “poses a serious risk to patient safety”.
The college, instead, wants online services offered by the patient’s own doctor or usual practice.
“Completing requests via an online survey can easily result in misdiagnosis due to a range of factors,” Dr Seidel said.
“Without access to the treating GP’s notes, the doctor has no means of otherwise confirming the information provided.”
The AMA has also expressed concern, saying a simple video call would rob clinicians of an opportunity to pick up on body language and less obvious illnesses.
But Dr Boylan disagrees that the service puts patients at risk. Instead, patients fill in a form prior to the video call with the GP, offering an opportunity to, in fact, be more thorough than the usual assessment that occurs within the GP consult.
“I would contend that our assessments ask every relevant health question every time, which sometimes doesn’t happen in a busy clinic environment.
“We all know that,” she said.
Dr Boylan said it wasn’t uncommon for women to go in for repeat prescriptions for the contraceptive pill and never be asked about a history of migraine with aura.
On the other hand, she said the online system “offers a level of thoroughness and it removes a certain level of human error”, provided the conditions and ailments were carefully selected.
She also said her clinicians understood the bounds of the online system and when to refer patients to a face-to-face consultation.
Between one in 10 and one in 15 patients who come for a medical certificate are told their condition is not appropriate for assessment online and Qoctor provides a refund.
The proportion was lower for a prescription, Dr Boylan said. “If they’ve got a condition that’s complicated or they’re worried about, they’ll want that physical assessment. People are generally quite sensible.”