Push Doctor is a UK-based startup developing digital technology that allows patients to book video consultations with a doctor and manage their health through an app. The company was founded in 2013 and in September 2018 entered its first large contract with the NHS; Push Doctor will offer online consultations to more than 99,000 patients registered at six GP practices run by Modality, a GP Federation.
The company states that its vision is to use digital technology to facilitate (rather than replace) doctor-patient interaction.
The company, founded in 2013 by businessman Eren Ozagir, who remains the CEO of the company, offers private consultations with NHS GPs. Individuals can book appointments on an ad-hoc basis or become a member. In September 2018, membership was £3 per month plus a fee of £20 per consultation; non-members are charged £30 per appointment with additional payments possible.
In May 2019, the company announced that it was temporarily stopping all appointments for under-18s whilst it changed the way accounts were linked and set-up. Under-18s accounts will now be linked to that of their parents' and/ or guardian(s). Under-18s will no longer be able to have their own accounts and the changes will also see parents having to authorise sharing their child’s medical records with their GP. No date was given for when child consultations will return to the website.
The company reports that it has a network of over 7,000 GMC registered GPs available from 6am to 11pm, 7 days a week, 365 days a year.
Push Doctor is one of 39 online providers of primary care registered with the CQC.
The company has grown in the last few years following large investments, increasing from 4 employees in 2016 to 118 in 2018.
Alongside the two directors Eren Ozagir and Matthew Ellcock, the company’s two largest shareholders are Oxford Capital and Share Nominees Ltd.
The most recent financial report filed with Companies House reports net assets of £9,773,962 in 2017 up from £752,789 in 2016. The company incurred a net loss of £5,730,405 in 2017, up from £1,948,072 in 2015.
Push Doctor has had a total funding figure of $37.5 million with 3 lead investors - Draper Espirit, Oxford Capital Partners and ADV. This total funding amount was boosted by $26.1 million worth of Series B shares in July 2017 with investment led by Draper Espirit and ADV.
Draper Espirit is a Pan-European venture capital fund that invests into disruptive tech companies at the early and growth stages. ADV (Accelerated Development Venture) is a patient venture investment engine, designed to support generation-defining digital tech companies.
Other lead investors include Oxford Capital Partners, with non-lead investors including Seventure Partners and Partech.
Some of these companies are using technology to facilitate connections between patients and doctors. Others are claiming to augment or replace healthcare with technology (e.g. Babylon Health’s “AI” diagnosis platform). What they have in common is that they are using technology to rethink access to primary healthcare, and in doing so have attracted significant attention from investors. This hints at strong underlying growth and a large perceived market opportunity.
In September 2018, Push Doctor managed to acquire its first NHS contract with Modality Partnership, a GP Federation. Push Doctor will provide online consultations, on a pilot basis, to more than 99,000 patients across six of Modality's GP practices. Depending on the success of the pilot, Modality hopes to expand the service to all its patients.
Modality expanded to a further three practices in Lewisham in July 2018 and now serves more than 400,000 patients. The organisation provides online consultations to all its patients via its own GPs; the new partnership with Push Doctor will use GPs working for Push Doctor.
In April 2018 it contacted all Birmingham GP practices in search of partners that could use its technology and service. In January 2019, Push Doctor signed an agreement with two primary care networks in Birmingham that contain 88,000 patients. The company's service offers patients the option of a virtual consultation with Push Doctor GPs when they go to book their usual face-to-face appointments with their practice. service will be piloted at the Halcyon Medical surgery in central Birmingham, but the plans are to roll it out to all practices in the two networks.
There have been controversies surrounding the company's advertising, whereby it claimed people would be able to ‘access an NHS doctor’ anytime they needed, without making it clear that this required a fee.
The Advertising Standards Agency (ASA) banned these adverts following an investigation, ruling that they must not be used again. The ASA also noted that Push Doctor encouraged customers to leave Trustpilot reviews but omitted any reviews below 4 stars from their website, which they did not make clear to customers. The ASA commented: "We told them that if they were selective about which reviews to reproduce on their website, they should ensure it was clear to consumers that it was not organic content reflective of all recent reviews."
There have been concerns from GPs that Push Doctor's GPs are not prescribing safely. In Wales, a group of GPs reported concerns of ‘inappropriate prescribing’ of antibiotics as common theme. The GPs said the use of Push Doctor was also increasing their workload, as they were having to call patients in for review after they had used the service.
Quality and safety
A Care Quality Commission investigation in early 2017 concluded that the Push Doctor service was neither safe nor effective. The CQC’s report found that GPs working for the online service had prescribed high-risk medicine without appropriate patient checks; in particular blood thinners and antidepressants were prescribed without adequate checks and monitoring. Doctors from the service were also temporarily banned from treating children after some were found not to have identified young patients. In addition, a total of 137 prescriptions were dispensed for items on the provider’s ‘do not prescribe’ list in the last 12 months.
The CQC also criticised the IT systems and record keeping of the service. Of 36 medical records reviewed some key fields were missing including diagnosis. In addition, proper clinical assessments and red flag symptoms were not always recorded.
GPs also warn that these types of services ignore how vital physical examinations are.
There is a general concern with these new digital services and their use of NHS GPs; although the doctors will be paid extra, their time and energy is being taken directly from the NHS with nothing given back. In addition, GPs already work inhumanely long hours and inviting them to work through their lunch-breaks or after hours will make this worse, meaning that all patients will receive sub-par treatment if doctors work longer days. This is just a quick digital fix for the rich that overlooks the bigger picture.
Safety concerns led to Push Doctor stopping under-18s making appointments on their platform in May 2019. Push Doctor will now link under-18s accounts to that of their parents' and/ or guardian(s). Under-18s will no longer be able to have their own accounts and the changes will also see parents having to authorise sharing their child’s medical records with their GP.