Patients in England will be able to access care using a new “online hospital” service from 2027, Keir Starmer has announced, in Labour’s latest move to transform the NHS.
The service, to be called NHS Online, is intended to cut waiting lists and allow patients who have been referred to hospital by a GP to talk to a specialist by phone or video instead of going to a face-to-face hospital appointment. It will be rolled out from 2027, the prime minister said in his speech to the Labour party conference in Liverpool.
Experts immediately raised questions about whether the service would destabilise hospital-based services, who would staff it, its implications for patients’ medical records and how it would affect people who are digitally excluded.
Labour said routinely interacting digitally with hospital specialists would be more convenient for patients, ensure they are seen more quickly and give them more control over their appointments.
It will involve a massive expansion of the NHS app, which 38.5 million people have already downloaded and which more than 12 million a month use.
The service will help clinical teams to assess how urgent someone’s illness is. NHS Online will initially cover only a small number of health conditions and will build on the success of the approach that some hospitals already deploy for some types of patients.
Wes Streeting, the health secretary, said: “It will mean that for some patients with some conditions where it’s safe and appropriate, patients will be given the opportunity – instead of being sent around the houses to their GP, then to hospital, then for checks and scans, then back again – they’ll be seen faster and more conveniently from the comfort of their own home or their desk at work by someone who will be able to get a sense of their condition, give them a course of action, which might be going to a community diagnostic centre, or they might be given a course of treatment, and it’s faster, convenient and easier for patients.”
It will expand on digital triage and remote outpatient appointment schemes already in place at some NHS trusts. For example, University Hospital Southampton found itself so overwhelmed by the number of patients with flare-ups of inflammatory bowel disease (IBD) seeking follow-up appointments that it began letting patients access care remotely and seek help when they needed it, rather than being given a pre-determined appointment.
That has led to a 73% drop in the number of consultant-led outpatient appointments, more than 75% of IBD patients being managed virtually and a 58% fall in waiting times, NHS England said.
“If it’s good enough for Southampton, why isn’t it happening everywhere?”, Streeting told PA Media.
Patients who would prefer to continue going to hospital to see a consultant in person rather than using NHS Online will be able to do so, the health secretary added.
The service is also meant to cut sometimes very long delays in securing a first appointment by letting patients talk to a consultant virtually anywhere in England, not just at a local hospital.
NHS experts welcomed the ambition and broad thrust of the plan but said much more detail was needed about how it would operate.
Daniel Elkeles, the chief executive of the hospitals group NHS Providers, said: “The way the NHS provides outpatients services hasn’t changed much for decades but during Covid we learned a lot about opportunities for new approaches using digital technology.
“This is a bold, exciting initiative but the benefits should not come at the cost of destabilising vital services patients will continue to rely on.”
Dr Tom Dolphin, the leader of the British Medical Association, said: “We are told that there will be dedicated doctors assigned to this service. We’re keen to find out where this extra staffing is going to be sourced from. Doctors are already flat out across the NHS and there is little spare capacity to go around.
“Secondly, how are patients going to be directed to care? The great thing about GPs is how they guide patients on their journey to the right service, managing the risks as they go. This online service will need to have something similar so patients are informed of the kind of specialist opinion they need.”
Dr Becks Fisher, a policy expert at the Nuffield Trust, a thinktank, said: “Will doctors and nurses for this service be able to take on this work without it impacting on existing face-to-face work? And how will they pass patients who need care from digital to physical services?”
She added: “This service will only be safe and suitable for certain patients. How will we make sure it is kept to them? There is a risk that those who meet this standard will be mostly the relatively healthy and those with the digital literacy to choose.”
