It is 9am and the morning rush is on at the DrThom surgery in Central London - but there’s not a patient in sight. no screaming babies, no harassedlooking new mothers, no coughing pensioners.
Instead, the doctors - some dressed casually in shirts, jumpers and jeans - sit quietly at their computers. this is life at Britain’s first online GP service.
Run in conjunction with Lloyds Pharmacy, it is the first national web clinic to be accredited by the Care Quality Commission, which regulates health and social care in England.
DrThom founder Thom Van every, right, with colleague Tom Brett. this is Britain’s first online GP service
More than 150,000 patients have used the service since it was launched in 2008 and there are currently seven doctors involved in the project.
They respond to hundreds of medical queries which flood into their email inboxes daily.
DrThom offers a remote diagnosis service for a limited range of conditions - patients describe their symptoms and fill in a check-list concerning their medical history.
The doctor then makes a diagnosis and emails a prescription to the in-house pharmacy to be packaged up and sent out.
There was widespread concern last month when Government plans to introduce a similar service to the NHS were announced to aid community management of those with long-term conditions such as diabetes and heart failure.
The Department of Health maintains that it is making the NHS more convenient for patients.
‘Electronic medical advice can never replace face-to-face consultations but it is a supplementary way to reach out to people in the community,’ says a spokesman.
However, the British Medical Association warns that a move away from face-to-face contact might mean that life-threatening illnesses could be missed.
DrThom founder Dr Thom Van every explains that such a service would never replace regular GPs.
‘We offer an excellent service if you have specific problems which are low-risk, but you struggle to get to a surgery,’ he says.
‘So if you’re flat out at work or have small children, you can log on to our site and email us your queries. if you’re bored of visiting your GP for such mundane issues as repeat contraceptive prescriptions or too embarrassed to see him or her with sexual health issues, this is just the place for you. within 15 minutes you’ll get an answer to your medical situation.’
Patient-free zone: Alice with a member of the clinic staff. more than 150,000 patients have used the service since it was launched in 2008
There is a specific menu of treatments. if you are going abroad, the doctors will prescribe vaccinations - travellers just turn up at one of more than 300 pharmacies to have the injections administered.
Contraception, cystitis and hairloss treatments can all be prescribed. the doctors also provide home tests for a variety of sexually transmitted infections. Patients send the kit back to DrThom and if the result is positive, appropriate medication is posted out.
The online doctors will - with the patient’s consent - inform recent sexual partners by text. Critics argue it would be horrendous if someone received such information via a text, but supporters of the scheme say it is much better than contracting an infection and unwittingly passing it on.
Interestingly, last year 75 per cent of the patients submitting sexual health queries were male.
‘This is partly because of the sensitive nature of many complaints,’ says Dr Van every. ‘Men are unlikely to visit their doctor with conditions such as erectile dysfunction but they may use our secure messaging service.’
As if to prove the point, new details come in about one man’s embarrassing rash.
‘In these cases we may ask patients to send a picture,’ says Dr Van every. ‘Men who would die rather than show such intimate things to their GPs will happily email us.’
In this case, Dr Van every is concerned enough to email another doctor at Chelsea and Westminster Hospital’s genito-urinary department to ask for a second opinion.
‘It’s impossible for a GP surgery to have three doctors look at a condition and then immediately refer it to a specialist,’ he says. ‘We are sitting next to each other and don’t have the patient listening so we can confer on any situation.’
Boxes have to be ticked before the doctors issue prescriptions - even the tiniest quirk is double-checked.
‘We have even asked men to send us pictures of their hair loss,’ says Dr Van every.
‘This may seem over-cautious, but certain patterns of loss suggest auto-immune or thyroid conditions.’
Although the online clinic only deals with a limited number of issues, the doctors still receive emails from patients with alarming symptoms, such as shooting pains in the arms or chest pains. Because they don’t have access to the patient’s medical notes they are unable to help in such cases.
Dr Van every says: ‘It may be that they have strained their arm lifting something or they may be about to have a heart attack. All we can do is suggest that they seek urgent medical help,’ Medical governing bodies may regard online medicine with some trepidation, but many accept that it’s inevitable.
‘There is no question that email consultations have their place,’ says Dr Peter Swinyard, chairman of the Family Doctor Association.
‘As technology develops, I imagine we will soon be able to diagnose using Skype (the video conferencing software).’
Dr Swinyard’s only concern is the online diagnosis of erectile dysfunction, which can be a sign of underlying heart problems. when this is put to Dr Van every, he is in complete agreement.
‘But these men have already decided not to take their concerns to a GP,’ he says.
He also cites a case where a man in his early 40s suffered from the condition. the patient was asked to send in his blood pressure details before being prescribed medication, and they were high, and so was his weight. the online doctors strongly recommended that he see his GP.
‘Two weeks later the man emailed us. it transpired he had extremely high cholesterol and type 2 diabetes. had we not flagged up our concerns he wouldn’t have discovered his illness until he was in serious trouble,’ says Dr Van every.
Regarding abuse of the system, with patients lying in order to be prescribed certain medicines, Dr Van every says: ‘We have many safeguards designed to protect against abuse, including the flagging of multiple log-ins with similar details. if in any doubt we will try to contact the patient by telephone or reject anyone we deem unsuitable and recommend they see their GP.’
The doctors finish at 6pm but some will be checking their computers over the weekend if they are on call. the great thing about the cyberdoctor is that he never really sleeps.
The Mail on Sunday had no access to any patient records or notes during the visit. lloydspharmacy.com/doctor