# You can’t replace the GP with an algorithm – so don’t try to, Matt Hancock



## Northerner (Aug 20, 2019)

The health secretary has announced a proposed overhaul of NHS health screening that could scrap GP consultations for millions of people, replacing them with online programmes and AI. The idea is that the one-size-fits-all system for routine health MOTs offered to those over 40 has become old hat.

Those between the age of 40 and 74 are currently called into their GP surgery every five years for checks on weight, cholesterol, blood sugar and blood pressure. This is to see whether patients are at risk of problems such as diabetes, heart disease, kidney disease and stroke. Now Matt Hancock says we need to be utilising technology and sophisticated data collection to direct help to those most in need. These changes may see in-person checks being reserved only for those deemed high risk, with everyone else expected to rely on predictive online algorithms.

https://www.theguardian.com/commentisfree/2019/aug/20/gp-algorithm-nhs-health-screening


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## TheClockworkDodo (Aug 21, 2019)

Northerner said:


> Those between the age of 40 and 74 are currently called into their GP surgery every five years for checks on weight, cholesterol, blood sugar and blood pressure.



They are? 

I certainly wasn't before I got diabetes - perhaps if I had been they might have spotted the diabetes before I got DKA -  and R has been in once rather than the three times he apparently should have been (and that was only by mistake - he went to see the nurse about something else and she pounced on him and said she might as well do some tests while he was there).


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## Ralph-YK (Aug 21, 2019)

Northerner said:


> Those between the age of 40 and 74 are currently called into their GP surgery every five years for checks on weight, cholesterol, blood sugar and blood pressure.


When is this supposed to come in? And they're already chaining it!?
As far as I know my old practice didn't do this. (I was already diagnosed as diabetic when I joined the new practice.  those my regular BP checks have gone)


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## Northerner (Aug 21, 2019)

TheClockworkDodo said:


> They are?
> 
> I certainly wasn't before I got diabetes - perhaps if I had been they might have spotted the diabetes before I got DKA -  and R has been in once rather than the three times he apparently should have been (and that was only by mistake - he went to see the nurse about something else and she pounced on him and said she might as well do some tests while he was there).


Didn't happen for me either, although not entirely sure they would have spotted anything as I was 49 at diagnosis and (in hindsight) had had symptoms for about 18 months prior so they wouldn't have seen anything at 45 and 50 would be after the horse had bolted. Presumably since diagnosis they check all those things every 6 months so no routine call.


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## Robin (Aug 21, 2019)

Our surgery has never done the checks either. OH read about it, years ago, and asked, and was told 'No, we don’t do that' He’s now checked every year at a medication review, because he eventually had a retinal artery occlusion caused by high blood pressure and furred up arteries, and lost some vision. I always think it could have been prevented.


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## Bruce Stephens (Aug 21, 2019)

Ralph-YK said:


> When is this supposed to come in? And they're already chaining it!?



More cynical people might suspect they're trying to kill it without officially doing so (because killing it would produce negative headlines, even though killing it's probably the right thing to do).

It was always thought (by those experts we don't trust) that it was a dubious idea which would likely cost much more than it could ever be worth, and I think research on the outcomes have supported that.

So change it to what's presumably going to be an invitation to take an online survey and investigate people who report feeling chest pain or something and you can claim you're using "new technology" and AI and "focusing", "building on the success of the existing policy", while getting rid of the costly stuff that was largely a waste of money.


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## Docb (Aug 21, 2019)

Not with you on your headline Northerner.  Bring on the AI I say and get rid of the post code lottery and variability in diagnosis and treatment found when you rely on people of varied competence and experience.  Read the posts on this forum and you will see what I am getting at!   

Could be some benefits in introducing AI into politics. Maybe there would be fewer promisies and more results.


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## mikeyB (Aug 21, 2019)

Mind you, one of my patients told me her dad had dropped dead at Manchester Airport. Two days before, he’d had a full BUPA health screening and been given a clean bill of health. 

When your number is up, it’s up. No checks or algorithms will stop that.


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## silentsquirrel (Aug 21, 2019)

Docb said:


> Not with you on your headline Northerner.



Actually the headline of the Guardian reporter, not Northerner!!


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## Docb (Aug 21, 2019)

silentsquirrel said:


> Actually the headline of the Guardian reporter, not Northerner!!



OK, but Northerner should have known better than to repeat a newspaper headline, even if it was from the guardian!


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## everydayupsanddowns (Aug 21, 2019)

I can sort of see healthcare (and a lot of other things actually) going this way eventually - doctors / solicitors / barristers who know all the latest research / case law and are never hungover, and haven't just broken up from their partner... who don't have ingrained prejudices and preconceptions and who are never under massive stress and feeling undervalued or just about to go on holiday and winding down.

Of course that presupposes that the AIs themselves won't have errors and prejudices of the people that built them ingrained.

And it will be a long and tricky transition, we are only just beginning to consider as a reality.

Apparently pigeons (with a little training and some grain encouragement) can be taught to review and diagnose problematic areas on scans for some cancers with extremely high levels of accuracy, particularly if you pool the results from more than one pigeon - presumably to make sure you don't get one in their 'off day'


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## Drummer (Aug 21, 2019)

I was told that I'd had annual health checks since 40 - but they could not tell me when - they insisted they had been done - but I keep a diary - some time around your birthday they said at first.
When I said that I would check up they decided that it could have been done at any time of year. Maybe with my thyroid checks which I had done around St Crispins day, I suggested. They brightened up at that. But of course I never saw a nurse for that - I went to the hospital for the blood to be taken and never heard anything more. 
Oh. 
I suggested that when in a hole it is best to stop digging, and that I probably had not had the checks at all. 
They went all tight lipped. I said don't worry my memory was badly affected by the Metformin and Atorvastatin so I tell people what I think it is important they know these days, just in case I never get the chance in future, but it might be useful for them to know. It would save you time looking for the twenty eight years of checks which were never done, I said. 
Bright young things with delusions of adequacy and a computer need to learn to take the on screen information with a pinch of salt.


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## Northerner (Aug 21, 2019)

Docb said:


> OK, but Northerner should have known better than to repeat a newspaper headline, even if it was from the guardian!


Don't shoot the messenger!   

Maybe it's my 30+ years as a programmer/software designer that makes me sceptical about the claims for AI. I've known some dreadful programmers in my time - even the really good ones can get things wrong - and nothing in recent years has led me to believe there has been much improvement. Yes, there's a place for it, just as long as it doesn't become a substitute. Bear in mind that 'AI' is already used by NHS Direct, in the form of the questionnaires they use, and that is far from flawless. I'm particularly sceptical when it's  someone like Matt Hancock promoting it - again, I have met many 'managers' who make claims for things that they actually know nothing about and he would definitely fall into that category


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## Ralph-YK (Aug 21, 2019)

While b>1 do
   add 1 to count
Repeat

Me: When will this loop end?
Programmer: ????????


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## Ralph-YK (Aug 21, 2019)

Northerner said:


> Presumably since diagnosis they check all those things every 6 months so no routine call.


Nope. There's supposed to be a urine test.  My old practice never did it.  New practice only did it cause I took them on. Last time my old practice did weight was 2011. BP tests were sperate, and already being done cause of high BP and being on medication. I'm not aware of ever having a cholesterol test before I joined my new practice.

New practice do BP tests just whenever. Did weight once.

I was diagnosed diabetic while at my old practice, and was still there well over a year later.


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