Exclusive: ‘Virtual hospitals’ to be launched in 10-Year Plan

Senior sources have indicated the proposal will involve a major overhaul and expansion of the existing “advice and guidance” model, whereby GPs can seek advice from a consultant before referring a patient to hospital, in the hope of finding an alternative.

Described by one well-placed official as “Uber for consultants”, the new proposal would create a system for GPs and individual patients to directly seek advice from any consultants, including those outside their home area, who make themselves available.

It is being described as “virtual hospitals” or “virtual clinics”.

One source said there was currently an ongoing internal debate about how to accelerate the work, such as by launching pilots, but widespread implementation would be planned for the latter seven years of the plan, rather than the initial three. Expanding existing outpatient-avoidance models, such as advice and guidance and patient-initiated follow-ups, is likely to be an early focus.

A “virtual hospital” type model was explored earlier this year in a report by public service think tank Re:State. It recommended a nationally procured “NHS-wide clinician-to-clinician communication platform” with an “NHS directory” component supported by generative AI, for GPs to look up common queries.

It recommended this be backed by “financial incentives” to “encourage secondary care providers to allocate clinician time for specialist input via the clinician-to-clinician platform”.

Speaking at a session hosted by HSJ at NHS ConfedExpo this week, NHS England chair Penny Dash described a similar model which she said was “in the foothills” of development and could reap large benefits.

She said there should be a “much easier way” of GPs getting advice “from anywhere in the country” to help divert a patient from secondary care.

Dr Dash said: “It could be, for example, a model whereby you put in your question, let’s initially say as a GP or a practice nurse, it goes into a central repository as it were, and you have a team of [consultants] who are available for that time who are looking at it and responding to it.

“It doesn’t have to be the [consultant] in your local district general hospital, it could be anyone anywhere in the country.”

She said similar models were already widely used for diagnosing skin concerns by sharing photos, but it could be significantly expanded.

Dr Dash also supported wider use of AI bots for some outpatient consultations, which often involve “very standardised questions” and could be asked by “a machine”, she said.

In an earlier session at the conference, the NHSE chair – formerly an integrated care board chair and McKinsey consultant – said the organisation may “bring back” a digitised version of “national service frameworks”, which were used to drive service improvement in the 2000s.

She said best practice tariffs would also be used to incentivise best practice and productivity, and ICBs would in future “only [be] commissioning things that have impact and improve outcomes [and] commission them at the right cost… what things should cost if we are working efficiently and effectively, not what things do cost”.

The 10-Year Health Plan is due to be published in coming weeks.

HSJ has previously reported that it will call for the procurement of technology to be centralised, and the introduction of a single care record controlled by the patient.