Chatdoc: Ending the GP phone lottery

We have all been there. Phoning the GP surgery at 8 am and then waiting on hold for half an hour listening to Vivaldi before finding all the appointments have been snapped up. It’s hugely frustrating but to be fair most GPs realise that and many are looking for ways to end the lottery which sees the quickest dialler, not the person most in need of help, get to the front of the appointment queue.

But I’ve been speaking to one GP who thinks he’s found the answer. Dr Prad Velayuthan has a busy NHS practice in Lewisham in South London but has also been working with a healthtech company Doctaly for some years. Together, they’ve come up with Chatdoc, a system to triage the 1,000 patients who contact the surgery every week.

Dr Velayuthan knew he and his colleagues had a problem because the surgery was getting poor reviews from patients:

“My patients are complaining they can't get through on the phone, they're all trying to get through at eight o'clock. Then when they get through, it's a first come first served basis. You have expert patients who will basically know what time to call and how to get their appointments and then those that occasionally need to access - but urgently - their GP, can't get an appointment.”

Other surgeries, he explained, had tried to solve this problem by getting one of the doctors to sit with the phone team deciding whether callers needed a face to face appointment. “The GP comes in very energetic at the beginning of the morning and is very robust in working out who needs an appointment on the day ,” he says. “But two hours in, their energy levels wane and then they start bringing everyone in, worried about risk, and it's not very efficient.”

So the answer was to design a chatbot which would ask the same kind of questions as a doctor without getting tired after a couple of hours. Doctaly’s Phil Tyler, a healthtech veteran, explained that rather than designing a bespoke app, Chatdoc relied on familiar tools: “You interact with our platform through a channel that you choose to use like WhatsApp, iMessage, whatever. So that makes it frictionless. The whole idea behind this was to lower the technology barrier to adoption for patients as low as you possibly can.”

I tried it out, WhatsApping the surgery and being taken through a series of multiple choice questions about my problem. Phil Tyler explained that at the other end the practice’s response team would have three layers: “Your reception staff as first line. You'll then have people like physician associates and pharmacists as your second line. And then you have your GPs as your third line.” He compared it to a customer service contact centre: "Gather all the information you can up front in an automated way, filter, and understand what your patient or customer wants, and then give them to the right person.”

I could see how that would work for most patients but a minority would find the technology impossible to deal with - and on occasion even I want to ignore the “please press 3” commands and just speak to a human being. Dr Velayuthan explains that patients can still speak to a receptionist but the hope is that most will find they prefer using Chatdoc:

“They'll find that the experience they get through the self serve route is much quicker and far more interactive with them and allows them to do it at their own pace.”

You might think there would be a lot of pushback against a scheme like this from people who saw it as just another way to stop them seeing their doctors. But after a month in full operation, Chatdoc seems to be a hit, if the patient review site is a guide:

“It was good, particularly because there's a way to book an appointment without having to queue on the telephone line,” wrote one patient.

“The WhatsApp experience is a quick and easy way of contacting the surgery which produces a quick response,” said a five star review.

One patient was unhappy to get no further information after being told that a blood test showed he had diabetes - but he did then use WhatsApp to request more advice.

The arrival of Chatdoc has seen a big drop in time on hold to the surgery.

As for the other big aim of making the whole practice more efficient, it seems to have delivered, with a big fall in telephone waiting times as more people opt to use Chatdoc. Then there is the more effective use of both doctors’ and patients’ time - 60% of queries are resolved there and then by the chatbot and only 25% require a face to face appointment with the GP, way down on what happened before:

“They're getting what they want,” says Phil Tyler, “but we're delivering it more efficiently, more conveniently, saving everybody time and freeing up that time for the people - as Prad said - who really need it.”

I suspect there will be questions about the risks involved in using automation in the sensitive business of health, however much Chatdoc’s creators insist that it doesn’t make any clinical decisions. “It is essentially gathering the information in some intelligent and consistent way and presenting to the clinical person to make a decision about prioritisation” says Dr Velayuthan. 

Equally, with surveys showing roughly half the patients turning up for GP appointments don’t need to be there, you can bet that plenty of doctors will be on the phone to Prad Velayuthan and Phil Tyler wanting to know more about their system.