Can Doctors Work From Home? The NHS is About To Find Out

Is NHS Online the future of hospital medicine?

The pandemic gave us many things: Online quizzes, the hoarding of toilet paper and that weird elbow bump thing we did to greet each other. One of the more consequential impacts of the pandemic was the rise of hybrid working, where workers split their time between the workplace and another remote location, like their home. When you think of professions that utilise the hybrid approach, you may picture a corporate worker, a computer programmer, or even a writer…

A hospital doctor isn’t the first profession that comes to mind when you picture someone working from home. In one of his last acts as health secretary, Wes Streeting spoke about piloting the NHS Online scheme to address the waiting list backlog, which allows hospital doctors to deliver virtual appointments in a similar fashion to how GPs currently deliver some appointments.

Doctors would be able to supplement their income through these virtual appointments in the same way they can with waiting list initiatives. The service is due to take its first patients in 2027.

So the headlines were written: “Doctors could be working from home!”

Telegraph Turmoil

This proposal has not impressed everyone, such as the Telegraph’s Camilla Tominey, who noted in a discussion with fellow journalist Tim Stanley: “Nothing annoys me more as a GP’s daughter than the absolute contempt patients are held in these days. The idea being that the core essence of a clinical exam is going to be eroded.”

Interestingly, a scroll down to the comment section included many former and current patients siding with the former health secretary's proposal. They cite examples of previous appointments where they had to wait months on end before making long commutes to the hospital for information that could have been delivered online.

Now, a slight bit of nuance needs to be added here. This is about clinically appropriate appointments being offered virtually, not replacing all inpatient care. The scheme proposal says it will initially focus on 11 common health conditions such as anaemia, inflammatory bowel disease, endometriosis, prostate enlargement and glaucoma. GPs will refer patients to NHS online, but importantly, patients will still be able to choose in-person hospital appointments if they prefer.

Doctors would review the blood and scans and deliver results remotely over video or over the phone. But this will still require excellent clinical skills and diagnostic reasoning from both the GPs referring patients to NHS online and hospital consultants who end up seeing them. Referral letters sent by GPs will have to be thorough and include a comprehensive clinical examination to avoid the creation of an unsafe system. There is a tendency for hospital specialists to often want to re-examine patients in appointments, so as we said, these new changes mean referral information has to be top-notch.

Judgement will be key for these specialists who should not be afraid to place patients back on in-person clinic waiting lists if they believe there is diagnostic uncertainty mid consultation. The success of NHS Online will ultimately depend on a simple principle: using virtual consultations where they add value, while recognising that some patients still need to be seen in person.

If that balance can be struck, the scheme may prove less radical than its critics fear.

The London Pay Supplement Paradox

The On-Call team have discovered a paradox that surfaces when one begins to discuss the pay of our colleagues down in London. As we know, the full-time London weighting is a measly £2,162, and is an insult to anyone who is attempting to navigate life around the capital. After deductions, it works out as an extra £100 a month, which TFL will kindly take off you in exchange for a central line commute into work where temperatures feel like the carriage is passing through the centre of the earth.

Enter the discussion surrounding the increase of the London weighting, and it is not too long before you hear this argument: “Don’t you know this is simple economics! London’s training posts are already oversubscribed as it is; why should the powers that be try to incentivise by bumping up salary? If anything, it should be undersubscribed areas that see additional pay.”

The paradox is seen when one realises that similar arguments of oversubscription (whether from the external market of IMGs or the internal market of increasing university medical programmes) can also be used against resident doctor full pay restoration to 2008 levels.

Perhaps the argument is less about incentive and more about recognition. No, we don’t need to incentivise doctors to work in the capital. Some have family there, some only know London, and some are drawn in by the bustling city life. It is about recognising that the cost of living is spiralling and many doctors are priced out of living there.

Then the question becomes… okay, you want an additional pay premium to make the city affordable for doctors. I hear you, but what number would actually allow for affordability? Some doctors may be uneasy about answering this question, because they may realise that the number would go from £2,162 to something simply unattainable, especially when all aspects of the NHS funding pie are crying out for money (and that’s before all other expensive parts of the country, like Oxford, Surrey, and Buckinghamshire, begin to make the same argument).

Can You Have an Illness Without a Disease Diagnosis?

Is the difference between disease and illness medicine’s blind spot?

When most people think about medicine, they imagine doctors hunting down diseases. A patient arrives with symptoms, tests are ordered, and eventually a diagnosis is found. The mystery is solved, and we all give ourselves a pat on the back or treat ourselves to the hospital WHSmith.

The scientific method, and by extension, medicine, is incredibly good at this. Modern healthcare has become one of humanity's greatest success stories precisely because it focuses on finding things that have gone wrong inside the body.

But the On-Call question becomes: Is having a disease the same thing as being ill?

You may instinctively think the answer is an obvious yes. Yet the more you think about it, the stranger the relationship becomes.

The Foot of the Athlete

Take athlete's foot. Technically, it's a disease with a defined biological cause and a recognisable diagnosis. But if you bumped into an old friend at the supermarket who asked how you’d been getting on, would you look at them and announce that you're currently "suffering from illness" because of your itchy toes? Probably not.

Now consider the opposite situation. Many people live with chronic fatigue, chronic pain, or symptoms that leave them exhausted and unable to function normally. Their lives may be profoundly affected, yet scans and blood tests sometimes struggle to provide a clear explanation. They feel unwell, but the evidence medicine has access to in 2026 may return with no answers.

This is where it helps to separate disease from illness.

Define Illness For Me

Disease is what doctors are trained to identify. It can include abnormalities in organs or bodily systems. Illness can be best defined using the words of Consultant Neurologist and rehabilitation doctor, Dr Christopher Ward. He calls illness the experience of being unwell. It is the disruption of everyday life. It's cancelling plans because you're too tired to leave the house. It's losing confidence in your body. It's waking up with the nagging sense that something just isn't right.

Most of us have experienced that feeling. It’s a fascinating part of being human when one wakes up in the middle of the night, or perhaps on a Monday morning, and immediately knows something is off. You don’t need a medical degree or a blood test to know that something is ‘just off’. Long before any doctor becomes involved, you already know that you've drifted away from your usual state of health.

That awareness comes from lived experience rather than laboratory results.

Of course, diagnoses remain important. A diagnosis gives names to problems, guides treatment, and helps people access care. A diagnosis can be reassuring for our patient's body because it provides an explanation for what is happening.

Yet diagnoses also simplify. They take a messy, deeply personal experience and shove it into a clinical category like a toddler forcing that spherical-shaped toy into the triangular hole. Now, sometimes that categorisation works beautifully and the patient thanks you for the Dr House level of diagnostic excellence. Sometimes it captures an abbreviated part of the story.

The challenge for doctors, then, is not to abandon science in favour of feelings. It’s to remember that medicine deals with both disease and illness. One can often be measured on a scan or a blood test; the other must be understood through something much more, using those tools we learned right at the beginning of this journey: empathy and good communication.

So here is the On-Call takeaway: illness exists where biology meets experience. We thought that sounded quite cool (and accurate).

“There can be little doubt that Streeting’s self-proclaimed achievement of reduced waiting lists that he brandished as health secretary can be put down to patients being removed from waiting lists rather than, say, being operated on. But why do some pretend this is necessarily a bad thing? Once again, we can circle back to the foundational maxim of ‘do no harm’. If those patients didn’t need to be on waiting lists in the first place, then their removal should be seen as a success.”

“Big congratulations to everyone who passed their MRCS Part A exam recently, you are just one fairly large exam away from having the doctor title taken away from you that you worked so hard to get.”

“Look out for the 3.5% DDRB pay rise, which will be hitting payslips in June and will be backdated to last April.”

“The BMA knows amongst core members, some argue that the messaging for strike action has become diluted by incorporating the jobs crisis into the pay dispute. However, they also know that the public and perhaps the government are far more sympathetic when the jobs crisis is emphasised. A tricky one for them.”

“Had my first leg-lengthening patient admitted today with nerve damage and a blood clot. Not sure who the surgeon was, but this kid’s right leg was left about 2.5cm longer than his left. Scary thing was he was above average height before the procedure and still flew out to get it done.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

The latest YouGov poll on the 28th of May shows only 37% of respondents strongly support or somewhat support the ongoing resident doctor strikes. Another poll from YouGov showed that 52% of respondents believe that doctors shouldn’t be allowed to go on strike.

Keen On-Call readers know how passionate we are about the limits of medical knowledge. Sometimes “I don’t know” is the best response. Here’s a great Harvard Medicine article from Sachin Jain on clinical humility that we enjoyed reading.

Weekly Poll

Last week’s poll:

Do you think hospitals and the NHS would benefit from Consultants offering more on-site out-of-hours cover?

…and whilst you’re here, can we please take a quick history from you?

Something you’d like to know in our next poll? Let us know!

The Single Patient Record Is Here! Wait, Why Isn't Anyone Cheering?

Consensus is rare in British politics these days. Everywhere you look, there is further evidence of the polarisation that has weakened the century-old two-party system. If there is one thing most politicians can still agree on, however, it is the NHS. How to stop it deteriorating further is, therefore, a question of great importance…

For years, a single database record was the dream of NHS doctors, who were often left without vital pieces of information when seeing patients. Patients, meanwhile, would turn up to appointments expecting doctors to have their full medical history, only to discover outdated or inaccurate records.

The government's answer is a Single Patient Record (SPR), accessible through the NHS App by 2028. Patients would be able to read, share and update their information through the app, while doctors could view a person's medical history, whether they originally lived in Torbay or Scarborough.

The grand vision has not received the reception many expected. The main concern is data control and regulation, particularly given the potential value of health data to private companies in developing medicines and new technologies. Ministers insist that data sharing will remain subject to existing safeguards, but that has done little to quieten concerns.

We are also living through an era of centralisation. With NHS England being abolished, direct control of daily NHS functioning is moving to the Department of Health and Social Care (made up of politicians and ministers). The government is assuring us this is a good thing as it will reduce duplication of work and improve accountability.

Whilst it may do this, it also concentrates greater authority over health data in the hands of ministers. And if there is one institution or body trusted less than a multinational corporation in the UK, it may well be where the politicians reside.