I have recently purchased a new iPad "pen" as I wanted to have a spare and the one I was using previously was an ultra basic one with a very big writing tip.
The new pen I bought is the dimples excel model shown above which actually comes as a set of 2 pens, each with a chunky end like my old pen and a fine writing tip. 6 replacement tips also come in the set. The fact that it comes with so many replacement tips worried me a little that they may be very fragile but currently I am pleasantly surprised with the build quality so I am hoping they will last quite a while. I chose the standard black pens but there are lots of other colours available.
The fine writing tips are a bit funky. Rather than a pen style tip like on the Apple Pencil, it has a clear disc to increase the contact area on the touchscreen and make it more responsive, but because it is clear you can still see what you are doing. It can definitely be used more accurately than my old chunky pen and the few patients I have handed it to seemed to be able to use it just fine too.
If you do a lot of arty drawing on your iPad then you may want the added features built into the Apple Pencil (pressure sensitivity, adjusting angle changes brush width etc), however if you just want a pen for signing consent forms and maybe annotating photos this could work very well for you and it is 1/7th of the price of the Apple Pencil.
I got mine here:
Dr Chris Harper