What are Consultation Credits?




  • Dr Lucy Marshall

    Please can you explain your rationale behind using Consultation Credits?

    I had a great first impression of the FourteenFish platform, however I am most disappointed to see this Credit system.

    For those sitting the August RCA, there is a two week period between booking and the submission deadline. Two weeks is not a sufficient time frame in which to make the most out of 600 credits.

    In addition, those who are LTFT, or who require extra time (such as on disability grounds), will be further disadvantaged.

    If the purpose of credits is limit the amount of storage used be a candidate, why not simply put a storage limit in place? I am unsatisfied with your explanation as to why credits cannot be refunded if a recording is deleted - there are so many reasons out of the candidates control that a recording may fall short of the RCA requirements and cannot be used, so why still charge the candidate for this?

    I am also dismayed that candidates can pay for extra credits. This disadvantages those on lower incomes (most likely female) and gives an advantage to those who can afford to pay for extra credits.

    Have you considered the indirect discrimination your credit system will create?

    Dr Marshall

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  • Dr Duncan Walling

    Dear Lucy,

    Thank you very much for your comments as I recognise you are not the only one feeling like this.

    I can understand your concern. We tried to build a system that could be a smooth experience for both doctors and patients, whilst being secure and robust in its recording. This unfortunately attracts a cost.

    For phone consultations we are phoning the patient on your behalf, then consenting them using an automated system that includes voice recognition. This means we incur costs for the outgoing call to the patient, as well as a smaller cost for the incoming call from the doctor.

    For video consultations there isn’t a phone call but to record these in the cloud means we incur similar costs to a recorded phone call, in addition to sending the patient and the doctor an SMS, as well as a followup SMS to the patient.

    We charge just less than 10p per minute per consultation – as a comparison, a standard rate to call to a mobile (e.g. using BT) is 21p per minute. About 6p goes on the costs I have described. This doesn’t leave much for us to cover our business costs including the significant costs of providing a support service as well as the fees for storage space and bandwidth. In the July RCA candidates submitted a total of 4,500 Gb of files.

    I hope this helps explain why we cannot provide a refund if a consultation is not used, since the majority of the costs have already been incurred. 

    We are constantly reviewing this – for example we have reversed the decision to include the patient consent time in the minutes counted as used and will absorb these costs ourselves. We are trying to balance out giving doctors plenty of time to do their recordings with the costs we incur ourselves.

    (I haven't commented on the two week window as this is more of a RCGP matter and this has been conveyed to them)

    I hope that goes someway into explaining our position.

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