Push Doctor CEO Wais Shaifta is only a few weeks into his new job but has already set himself an ambitious five-year target.
"I would love to get into 75 percent of practices in the UK offering our digital solution," Shaifta tells Techworld. "I think video consultations are the start with that."
The startup provides private online GP consultations via video to thousands of patients each week for roughly £30 per appointment and recently launched a corporate healthcare service, but it's the public sector that most interests Shaifta.
In September, Push Doctor announced that it had acquired an NHS contract to provide free at the point of use online consultations to the multiple Clinical Commissioning Groups (CCGs) in the Modality Partnership, a GP "super partnership" that serves more than 400,000 patients.
Shaifta says Push Doctor partnered with Modality after turning down approaches from a number of other practices who believed that the company could quickly bring them a lot of patients, an objective that didn't fit Shaifta's long-term strategy.
"We said no, because that doesn't grow and that doesn't scale, and the big thing for me is I want to grow a business which grows and scales and is in this for the long-term, not for the short-term," he says.
Modality gave Push Doctor the chance to launch a pilot in two practices and then extend it to five and observe the adoption rate before scaling further.
It's since been extended to 11 NHS practices and close to 160,000 patients. Other NHS partners are on the way, but Shaifta can't announce them yet.
"Private is still the majority of our business - the patient to consumer. However, I do feel as though that will change pretty rapidly over the next year or so," he says.
Push Doctor growth
Push Doctor was founded by Eren Ozaiger and Matt Elcock in 2013, when the duo was working at ecommerce website Entertainment Magpie. Ozaiger fell ill on a business trip to Baltimore and wondered why he could order a cab on his phone but not a doctor.
The colleagues teamed up to fill the gap in the market. By 2018, they had built the largest provider of primary care digital appointments, with about 7,000 NHS doctors in its network, when their partnership was suddenly severed.
That summer, Ozaiger stepped down from his role as CEO under circumstances that remain unclear, and Shaifta stepped up to replace him.
Shaifta had joined the company in 2017 as Chief Operating Officer after spells as an international operations director at food delivery company Just Eat and beauty treatment booking platform Treatwell.
“The restaurant sector was massive, the beauty industry was huge, but when I got the call for Push Doctor and saw the wonderful things we were doing with healthcare I naturally got excited, but I also thought healthcare was a sector which remained relatively untouched with digital," he recalls. "So I saw it was a huge opportunity and thought what a wonderful industry to enter.
“Also though, from a personal perspective, I spent six years at Just Eat - probably responsible for a lot of obesity in the land - so this also helped in coming full circle and repaying my sins."
He joined the company at a challenging time. In June 2017, an investigation from healthcare regulator the Care Quality Commission (CQC) "found that the service was not providing safe, effective, or well-led services but was providing caring and responsive services".
It claimed that some GPs had prescribed high-risk medicines without checking whether the patient had the correct monitoring and blood tests and dispensed items on Push Doctor’s "do not prescribe" list, and that no consideration had been applied to the risks of consulting and prescribing for children.
Push Doctor has to address all the concerns or risk losing its registration.
In response to the CQC report, Push Doctor recruited a chief medical officer to lead its in-house clinical team, introduced new risk assessments for prescriptions and created a Strategy and Governance Advisory Board of healthcare experts that’s headed by former NHS Improvement chairman Ed Smith.
New doctors are trained for 30-40 days on all the relevant clinical guidelines and regulations as well as on the digital skills they need for online consultations. Once that’s over, their first 20 appointments are reviewed and the rest are tracked through a continuous audit.
"How we try to approach the NHS is we've got a network of thousands of doctors that work with us, and if you want to launch in London we'll try to find you a doctor that's in London, knows your local regulation, knows everything to follow there," says Shaifta.
"If we don't have any local doctors then we'll need to onboard that doctor in sync with your practice to ensure that they know local regulations and guidelines, to ensure there's that continuity of care. Definitely there's sign off from a Push Doctor perspective digitally, but also from the practice's perspective to ensure there's local buy-in too."
The CQC praised the changes in an April 2018 follow-up report that found that Push Doctor "was now providing well-led services" and "delivering effective services".
Shaifta adds that CQC had to make some changes of its own.
When the regulator did its first inspection of Push Doctor, it had no specific guidelines for reviewing digital services and scrutinised the company as it would any traditional practice, asking where the waiting room was for a consultation that’s online.
"Next year CQC are going to be moving digital providers onto a rating system similar to what they have in practices, and we've played a big part in helping to support them in that," says Shaifta.
"It's constant communication to ensure that CQC get what they need, but at the same time we ensure we're very safe with what we do."
A changing healthcare system
The recent appointment of a health secretary who professes to have an "unsurpassable enthusiasm for tech" in Matt Hancock could open up further opportunities for Push Doctor and its competitors, but concerns are growing about their effect on the NHS.
Hancock's government has been criticised for allowing private companies to profit from NHS underfunding while the companies have been accused of taking doctors away from public healthcare.
Shadow health minister Justin Madders demanded an investigation into Hancock’s repeated endorsements of Push Doctor rival Babylon after he praised its GP at Hand app in an Evening Standard supplement sponsored by Babylon Health.
Hancock responded that such services free up resources for people who don't want the technology or can't afford it, and claimed that he was not aware that Babylon Health was sponsoring the feature.
Shaifta promises that Push Doctor is determined to support the NHS rather than disrupt it. Push Doctor syncs with NHS clinical tools to offer continuity of care and reduce administrative work and its users don’t need to deregister at their current NHS GP practice and join the company’s practice, unlike Babylon’s business model.
"It was very important for us when we entered into our partnership with the NHS that we did it in a way which was in partnership and collaboration," says Shaifta.
"It wasn’t a way which disrupted the system it was one which supported the NHS…Patients don't need to deregister from their local trust and family GP to join us. Patients stay at the practice. The practice is the holder of the contract."
Shaifta met Hancock last week and is enthusiastic about his digital ambitions.
"His vision for me is in total collaboration. I've spoken to him, I've spoken to his special advisors, and we're very aligned in the approach. There needs to be an adoption of technology…Customers are demanding a service such as ours and it's how we best support one another in doing it."
Shaifta believes collaboration will both help the NHS and boost Push Doctor's business by allowing it to scale within the system.
The NHS is notoriously slow to adopt new technology, but Shaifta believes this is not due to resistance but to them being given inferior tools and insufficient support.
"Our approach for the NHS and with doctors in general is we've got great technology here, we've got a great product, we want to help support you in adopting the technology and we put teams in place to help support that," he says.
His ultimate goal is to give patients control of their healthcare and make them more engaged in their own wellbeing.
The plan dovetails smoothly with that of NHS Chief Clinical Information Officer Simon Eccles, who wants patients to co-produce their own digitally-accessible care plans alongside their clinicians and self-monitor, self-manage and self-serve their healthcare.
"The vision that we have is we want to become a holistic hub through which patients can control all elements of their well-being," says Shaifta. "That starts from instant consultations with a GP, which we have now, [and extends] to all other aspects of healthcare.
"At the moment, patients feel somewhat marginalised with the current relationship they have with healthcare providers. What we really want to do is empower them to make informed decisions regarding healthcare."