So much about the way our treatment is delivered, has changed in the last year or so. As always, some for the better and some for the worse. I’m very fortunate that I rarely have to visit my GP, as he says I’m “too technical” for him now! But for many, the visit to the GP which we all have taken for granted, is changing dramatically! At times like these I always like to invite my great friend Dr Simon Hodes (@DrSimonHodes) to keep us up to date with the facts.
“Over the last 13 months we have all been glued to the health news, and the Covid-19 pandemic has dominated our lives. Never before have we needed and appreciated the NHS so much. 90% of healthcare is delivered in the community, so we all rely on our GP practices for help and support.
On 10th March 2020 Matt Hancock instructed a digital first approach to access the NHS. This meant that all consultations where possible (in GP or hospital settings) should be performed by phone or video to try and maintain services while reducing the chances of infection for staff and patients. Despite an enforced shift towards delivering consultations remotely, and some very critical narrative in the media, (in some cases even leading to abuse ), GP practices have continued to deliver large numbers of face-to-face consultations throughout the pandemic, with recent data suggesting that over 50% of consultations in general practice are currently face-to-face .
For many, the move to digital consultations has advantages: it is very convenient, saves you hanging on the phone lines and you can submit queries 24/7 via the NHS APP or secure web forms (eConsults). However there are recognised down sides. Many patients may perceive that their GP is ‘not open’ or accessible , there may be a loss on continuity of care, and some patients simply do not have the technology or skills to use online and digital services.
This may be more of a problem depending on finances, medical problems or disabilities. As such GP teams are concerned about “ digital exclusion ” which may once again further widen health inequalities. Many patients simply prefer face to face reviews. Many staff find virtual consultations more tiring to perform, with a perceived sense of increased risk. Virtual consulting reduces human interaction and non-verbal communication. It might reduce the chances of picking up other medical problems mentioned by a patient or picked up by a GP ‘while I’m here doctor’.
On 25.3.2021, a document published by NHS England talks about ‘total triage’ – stating that NHS systems will be expected to ‘support practices to increase significantly the use of online consultations, as part of embedding total triage’ . NHS England defines ‘total triage’ as a model in which ‘every patient contacting the practice first provides some information on the reasons for contact and is triaged before making an appointment’ .
I understand the term ‘ triage ’ here to mean getting the right care for the right patient in the right timeframe by the right service . So it is clear that triage – and remote consultations – have become embedded, and will have a role to play in general practice beyond the COVID- 19 pandemic. However, it is very unclear how, or if, patient groups have been involved in a ‘total triage policy’. Given that each patient and each GP practice is unique, perhaps it should be up to individual GP practices, in consultation with their patient groups, to decide locally what works for their population?
Given the known workforce crisis in general practice, and the increasing demands being placed upon the NHS, some form of digital triage in future will be essential to manage workload.
Summary
● Covid-19 has forced the NHS to adapt drastically to offer ‘digital first’ solutions
● More than half of consultations in general practice are now face to face again
● Not all patients have the correct digital knowledge or equipment to ensure fair and equal access for all. This risks ‘digital exclusion’ within the NHS and can exacerbate ‘ health inequalities ’
● NHS policy is now currently suggesting a ‘total triage’ approach ( where triage = getting the right care for the right patient in the right timeframe by the right service)
● Minor A&E problems are already meant to be triage / 111 first
● There are expanded numbers of clinical staff in GP teams now, and often the best person to help you is not your GP.
● There are new ways to access your GP now (especially if it is not an emergency) and many patients are still probably unaware of how to make best use of their appointment . This blog from 6.12.2020 has some (hopefully) useful pointers.
● There was a GP workforce crisis before Covid, which is now deepening, with many senior GPs reducing their hours, retiring early or leaving the profession altogether
● Some form of triage will be necessary moving forwards, to try and make best use of the services available and direct patients to the best care available. This is a ‘hot topic’ in the GP community – some interesting discussion here
● Some of the digital improvements brought in response to the pandemic (video consultations, secure sms exchanges for photos, web enquiries / eConsults ) have certainly improved care for many, been very popular with patients, have actually improved access and speed of access for many patients – and should be embraced, retained and used more widely moving forwards
We learn from history that war (in this case viral) forces many changes to society, and also technological advancement. Perhaps as we see light at the end of tunnel, the NHS is now at a watershed moment, where we should take positive advances forwards, driven by patient engagement and consultation, to try and harness new technology and provide the best care we can within the limited resources available.”
Now days it is always crucial to get the facts from a trusted source and I would like to thank Simon for taking the time to keep us up to date with the facts!
Hi, Chris – last year my husband had heart problems; he was treated fast and efficiently and came home from hospital with a couple of stents and some new medication. Since then, he has had phone consultations, blood pressure checks from the practice nurse and a couple of face to face appointments with his gp when necessary. It felt weird at first, but now that we know how the system is operating, we can manage it quite well. (Hubby’s record keeping for blood pressure checks is second to none!) If working like this reduces the risk of covid infections for us and for the medics, then that’s fine by us. Changes like this take some getting used to – but we’re really grateful for the care and attention he has received from the doctors.
Hi Margaret, great to hear from you! Really good to hear that your husband has been looked after so well during these difficult times. For sure the NHS have received a lot of negative press since the pandemic hit, but there is certainly a lot they should be praised for.
Of course like many things, the way we receive service will change permanently, and not all in a bad way. I believe our systems have needed to be more efficient for the staff and patients for a long time. This seems to be a good start.
Thank you for taking the time to share your own positive experiences of the changes happening, I know Simon will be thrilled to hear this!
Very best to you both, Chris
Dear Margaret – many thanks for posting this comment, and hope your husband is doing well.
It is good to hear your story – of when things go well – and totally agree that it’s getting used to the changes that’s the challenge.
So many new ways of working have been imposed by the pandemic that have made things so ‘different’ – and while we often look back with ‘rose tinted specs’ new ways of doing things can work better for many patients / carers.
eg just today was talking to a patient today who finds online ordering of stoma appliances so much better and they feel in ‘control’, another patient has emailed in an enquiry we swapped messages, she sent photos, I called her with a likely diagnosis and is being seen face to face later today – so am convinced we need to harness the potential of new tech and try to make it accessible / work well for patients.
Take care and keep well
Simon