Written by Karen Morton, Consultant Gynaecologist and Obstetrician and founder of Dr Morton’s – the medical helpline

On today’s edition of Inside Health on BBC Radio 4, Dr Mark Porter interviewed Dr Karen Morton, from Dr Morton’s – the medical helpline, and Dr Margaret McCartney, a Glasgow GP who blogs for the British Medical Journal (BMJ) and is a regular contributor to Inside Health. The discussion brought up some interesting questions about the ethics and safety of online GP services. In this blogpost, Dr Karen Morton’s speaks of her reaction to the debate…

I have been a Consultant Gynaecologist for over 20 years, and I believe that I have the highest possible clinical and ethical standards. Together with 50 well qualified and principled GP and consultant colleagues, I founded an online and telephone GP service: Dr Morton’s – the medical helpline. As I still have a full-time NHS job, setting up the business has involved a lot of time and hard work, but I believe this kind of service is desperately needed.

I was as prepared as I could be to face questions from Mark Porter on Inside Health today, and I knew my views would face strong opposition from Margaret McCartney. Her remarks certainly were challenging, and some of them were even a little hurtful, but actually I think this provides me with a great opportunity to counter some of the opposition to online and telephone GP services, and show you how health provision has changed.

The world has changed, and Medicine must move with it. Gone are the days when people lived in the same place all their lives, had their own GP from cradle to grave, and felt indebted and in awe of their doctor. It is frankly arrogant to assume that people can take endless time off work at the drop of a hat, or find someone else to collect their children from school, to come and sit in a GP waiting room when all they might need is advice about a chin rash. I disagree with Dr McCartney’s idea that continuity of care is always needed. In this scenario, what is wrong with sending a picture of acne rosacea to a doctor by email and receiving some metronidazole gel through the post? So much of Medicine is not rocket science.

I resent the suggestion that our doctors ‘can be bought’ into giving antibiotics. We plan to audit our consultations to show this is not the case. Dr McCartney also challenged us for sending out urine dipstick kits to patients so they can self-diagnose, but I think the thousands of women who get cystitis on a regular basis will feel insulted at the idea that they are too stupid to wee on a stick and see if the colour changes pink and purple. This is exactly what happens in the GP surgery.

Equally, I don’t believe there is anything wrong with preparing people for simple health problems they might face abroad, which is why we created our Dr Morton’s Travel Packs. Why shouldn’t someone have a tube of Fucidin H cream with them when they travel abroad in case they get an infected mosquito bite in Peru; or a course of antibiotics for a bout of Delhi-belly in India? I wonder if Dr McCartney would send her children off on their travels without being fully equipped for such eventualities?

Anyway, enough of my indignation. Here are the facts:

• 70% of people’s problems can be solved on the phone without going to the doctor’s surgery

• Dr Morton’s is simple! If you register online with us, you’ll be given a thorough medical questionnaire to answer and you’ll set up a PAYG or subscription account. Then, whenever you want advice, you just have to ring 012 123 123 123. Our system will recognize your phone number and your medical history will pop up on a screen in front of the doctor, who will confirm your identity. Then the consultation starts. No time is wasted, as all the background story is there. You will only be charged for the actual consultation, which on average takes around 5 minutes. You’ll have full access to your electronic portable medical record. If you’re happy to give us the details of your regular NHS GP, Dr Morton’s will pass on information with your permission so your GP can stay informed. We can prescribe if appropriate and the medicine is delivered directly to your door, be it a home address or a place of work. We are open 7 days a week from 7am to 11pm.

That’s it!

• Our main target market is busy people who have a simple medical problem or just need reassurance. This is the group of people who are most let down by the NHS, which is otherwise a wonderful service. The NHS to which I give my heart and soul is drowning, and in my view it should be saved for when it is really needed, such as maternity, accidents, emergencies and chronic illnesses.
• The biggest challenge to launching Dr Morton’s is helping people understand that they actually CAN phone a doctor and get straight through. Gaining and maintaining the trust of our customers is paramount to us, and that is why we only recruit extremely experienced doctors. Scalability will also be a challenge, although I am now being approached daily by GPs who are interested in getting involved.
• Our customers hear about us through word of mouth recommendation and by finding us on Google. Our website contains a wealth of information; using our research into how people search for health information on the internet, we have our 20 expert consultants writing articles that people really find useful. We also write about current medical news, such as the ZIKA virus and the recent new treatment for multiple sclerosis.

Deloitte’s centre for Health Solutions recently published that 75% of people Google their symptoms before going to the doctor. Dr Google often causes more alarm than he helps, so often reassurance is all that is required. Deloitte also said that the NHS has not kept up with how most other services, such as banking or insurance, are delivered in the UK. At Dr Morton’s we intend to remedy that.

So how quickly is demand growing?

We started with just 500 customers and we have grown quickly from there – particularly since Christmas. Emails with photos attached are particularly popular. We can only see this increasing in the run up to Easter, which is a well known NHS pressure point. When we looked at a similar service in the USA called Teladoc, we found they had New York Stock Exchange flotation last summer raising $157 million at a $728 million valuation. They have reported nearly 100% growth last year with over half a million consultations during 2015. Now that’s demand!

So, is the consumer in the UK prepared to pay now?

I really hope that the NHS is not going to break apart, but it is truly in crisis.

I agreed with Andy Burnham, the former shadow health secretary, when he said that Britons must be more realistic about what the health service can provide and stop treating it as an “on-demand” service.

Maureen Baker, Chair of the Royal College of General Practitioners, said in 2014:

“General practice carries out 90% of NHS contracts for just 8.4% of the NHS budget in the UK. It is patients who are receiving the raw deal as GPs and practice staff struggle to meet increasing demand. We’re calling on governments across the UK for a modest increase of just one percentage point per year.”

Sadly there is little chance of this happening, which means that the shortfall for primary care by 2017 will be over £4 billion. This demand will need to be met by the private sector, and we think that Dr Morton’s is perfectly placed to fill this gap.

The cost of using Dr Morton’s is not unreasonable, considering the convenience and quality of service. Some people would pay more for a monthly mobile phone subscription, and the evidence is that people are willing to pay small amounts for great healthcare.

There is one more point about the economics of this. Taking time off work to see a GP costs British industry £5 billion a year. Health insurance is very expensive, and not needed by the majority of people, so the current trend for health insurers to add a GP call line to the policy is a very expensive alternative to Dr Morton’s. People aged 20 – 50 would be much better having unlimited access to Dr Morton’s –the medical helpline, and this would be an affordable benefit.

Dr Morton’s is not just an on-line pharmacy. We off what most people want – advice from an experienced doctor. If the doctor then feels a prescription is needed, we can get it to you. If the doctor believes that emergency care or further examination is needed, they will give you advice on what to do next.

Many of our doctors have such confidence in what we are doing that they have invested in the business. Our doctors are not motivated by money however; they truly believe there is a better way to deliver primary care. I myself hope to raise money for various charities and have set up Dr Morton’s Trust, initially supporting Blue Sky, which helps rehabilitate young offenders. I am sure all my colleagues feel much the same.

So, Dr McCartney, I hope you might think again about telephone consulting. Coming from Scotland, she is not really best placed to comment, as their NHS telephone service still has qualified nurses on the other end of the line. Since 2013, the rest of the UK has used NHS 111, which is a set of long, time consuming algorithm that simply tells two thirds of people to go and see their GP. There is also no prescription charge in Scotland, while in other part of the UK, patients pay £8.20 for every item on their script. I also find it amazing that out-of-hours GPs are often left to do emergency consultations without having access to the patient’s medical records. Dr Morton’s is much safer than this!

However, I really do want to thank Dr McCartney for her time and the debate, and thank you very much to Dr Mark Porter for the opportunity.

P.S. It was humbling indeed to be followed on air by the wonderful Professor Stephen Hawking. What a privilege.