The pandemic has been a “game changer” for the way clinicians conduct their consultations. Prior to the outbreak, 90% of GP consultations were face to face, and in the space of two months since lockdown, 90% are now done remotely.
Having to try out digital technology for consultations as a necessity for social isolation purposes has made GPs realise that by using digital tools, including email and video, patients can be diagnosed and treated effectively without the need for face-to-face contact.
As a result of Covid-19, GP practices are increasingly taking up digital solutions that encompass three main systems that enable practitioners to manage patient care remotely. The most basic means of remote consultation is simply the telephone.
Remote systems used by primary care practitioners
“When this approach was first taken clinicians were nervous about their ability to triage or consult with patients without seeing them, but it’s become the norm over the last 20 years,” says Dr Mark Harmon, strategic and brand director of online consultation platform eConsult, and a junior A&E doctor practising in south east London.
Then there is the video consultation “which has come to the fore during the last few months”, says Dr Harmon. “Video is suitable if you want to have look at a patient in care home, are working in a remote practice or the patient is bed bound." However, he points out that this digital tool also has its limitations, such as a video consultation takes the same amount of time as a face-to-face one, and this approach doesn’t provide information about the patient upfront.
The third approach is through online consultation where patients can either use an NHS App or their practice website to give a history online. An advantage of this approach is that “the GP doesn’t need to be ‘with’ the patient at the same time, and they can fill in the information in their own time in the comfort of their own home,” says Dr Harmon.
Patients are required to give a “robust history”, responding to standardised questions – “and unlike a busy GP surgery, no questions can be missed, so GPs and practice nurses are able to make very accurate, informed and safe decisions about their patients”, says Dr Harmon.
Raising remote consultation awareness
While a technological revolution may be taking place during the pandemic, patients need to be aware that such approaches to consultations exist. Those that are aware, welcome this new way of working, says Dr Tim Ringrose, chief executive officer of the Cognitant Group, which provides interactive and visual health information in 3D, who also works part time in the intensive care unit at Oxford University Hospitals NHS Trust.
“Once patients find out about these services, often via recorded or websites messages from the GP practice, they are very receptive about new ways of contacting primary care practitioners. In fact, I believe a lot of the population had been frustrated that primary care was so reliant on face-to-face appointments – this archaic system was no longer fit for purpose,” Dr Ringrose says.
Resistance to change lies largely with the medical profession, some of whom were reluctant to embrace change and lose face-to-face contact with the patients. Covid-19 has changed all that. But to ensure patients understand these changes, Dr Harmon recommends that GP management educate and train all practice staff about the benefits of these new ways of working, and to use different channels, such as answering machines and websites, to raise patient awareness.
Benefits of new GP technology
“The more we embrace the technology the more benefits we will see,” says Dr Harmon. Benefits, he says, include saving patients an unnecessary trip to the practice, having time freed up to see the sickest patients first, and a more rapid response to patient requests – often within the next working day rather than a wait of two weeks.
With the short-staffed NHS under increasing pressure through a growing ageing population and a growing prevalence of long-term conditions, digital systems “help the NHS maximise the way it delivers care and ensures we can deal with the increase in demand on services,” says Dr Ringrose.
Dr Chris Whittle is founder and CEO of Q Doctor, which provides a digital general practitioner workforce, and a video consultation platform for NHS organisations, says the benefits of video consultations are that they can upgrade what would have been a telephone call by allowing practitioners to “visually assess patients, build a greater rapport and enable total triage, including effective routing of clinical problems”.
“Digital systems also allow you to bring in extra GP capacity, which we provide to many practices, such as locums working evening shifts or weekends remotely via a video consultation platform,” Dr Whittle says.
Will primary care return to face-to-face appointments?
But as the UK gradually enters a ‘new normal’ is it likely that consultations will return to normal face-to-face appointments? Doctors believe that digital services will continue to transform primary healthcare.
“Early on in the pandemic people thought things would possibly return back to normal but now we know we can’t go back to the way they were.
“The pandemic isn’t going to disappear and we need to plan ways of delivering healthcare services that take into account the need for continued social distancing,” he says.
Dr Ringrose says where once patients sat in crowded waiting rooms, “now people know it doesn’t have to be that way. It’s time our health service was more flexible and user oriented. And digital services offer solutions and give practitioners a chance to provide value and contribute to the health of the nation”.
Post lockdown the landscape of primary care will continue to be transformed by digital services Dr Whittle believes. “Awareness of online access to GP practices will change how people interact with them. As with banking ten years ago, now people will be checking their Apps for appointments and booking online,” he says.
For Dr Harmon, digital primary care services “are the new norm”. He says services “can only get more exciting going forward”, as systems become more intelligent and add more functionality to help standardise and speed up clinical decision making so that the process is faster and safer.
“We’ve moved forward four years in the last four months in terms of digital adoption. There’s a digital revolution going on in healthcare - and we can’t go back.”
For more news and articles on digital consultations visit our health technology section.