How do GPs really feel about the digital transformation sweeping through their surgeries? Dr Anne Connolly shares her perspective.
The world has changed in so many ways since February 2020 and as we move into the next phase, we have to make sure that some of the improved ways of working remain while rebalancing them with those that are tried and tested.
Over the years, general practice has changed the ways of working, with many previously established efficient telephone triage systems and remote consulting. Often, this has been met with resistance from patients and from healthcare professionals (HCPs), who have preferred the reassurance of seeing someone in person for a ‘proper’ consultation and examination.
But the Covid-19 pandemic forced us rapidly into new ways of working to protect patients from coming to what was deemed a high-risk environment and to prevent staff from contracting infection. Remote consultation has become the norm and using digital solutions to share self-help resources, fit notes as message attachments and send electronic prescription directly to the pharmacy has reduced unnecessary travel requirements.
Being a GP with many years of experience and understanding the mantra that ‘common things happen commonly’, dealing with patient’s concerns via telephone has been relatively straightforward. Using video consultations where appropriate and providing face-to-face contact if requested or required has allowed us to balance the risks and benefits on an individual case basis. The first telephone consultation – allowing time to document as much of the patient concern as possible and providing online patient information prior to the face-to-face consultation – has reduced unnecessary time in clinic and often streamlined care.
Remote consultations offer advantages to many patients who are balancing work commitments or caring for family and children. These patients have embraced the ease of accessing healthcare advice and will continue to want this way of working, not having to take leave to access basic care. Specialist care has also developed to deliver remote consulting, reducing hours waiting for follow up appointments and has been appreciated by many.
“For those who are less empowered or able to use remote consulting or online digital solutions, there is a risk of increasing inequity of healthcare provision”
However, there are many concerns about how care has been accessed and provided, which we do need to address. For those who are less empowered or able to use remote consulting or online digital solutions, there is a risk of increasing inequity of healthcare provision. Some people do not have sufficient phone data or funds to wait in the morning telephone queue trying to book an appointment, some are unable to complete the triage forms they are asked to so the appropriate healthcare professional appointment can be allocated, and some feel their problem is not sufficiently concerning or do not realise there may be help available to address their issue. There needs to be a variety of ways of accessing the care people need with some requiring drop-in provision as soon as it is possible to organise safely again.
Women’s health is a particular example where the current way of working may cause barriers to care. Many women tolerate symptoms for a long time thinking they are normal or not concerning enough to ‘bother the busy doctor with’. Period or menopausal concerns have often been mentioned at the end of an appointment for some other issue, the typical “while I’m here Doc…”, or tested out during a nurse appointment to see if they are deemed sufficiently concerning. Issues that might warrant urgent investigations to exclude a cancer diagnosis have also been neglected during this time by the elderly or those shielding themselves or their partners for fear of bringing Covid-19 infection into the home.
New models of care must also be accessible and appropriate for those with mental health concerns who may not feel sufficiently empowered or able to cope with the morning booking process or, once in the system, unable to share their concerns via a remote consultation. Likewise, for those with complex health needs as a result of frailty or multi-morbidity.
There is also a concern about where people get their healthcare information from and ‘Dr Google’ is not always a friend. A negative experience or frustration is more likely to be shared via social media than when something has gone well or produced beneficial results, as witnessed recently with the way the media shared the AstraZeneca vaccine concerns forgetting the massive benefits and success this has offered to so many.
There is so much work to catch up on by healthcare, with much frustration resulting from delayed operations and access to specialist care. Much long-term condition management is a great example of how care has been improved by streamlining appointments, with HCPs learning new skills and sharing best practice in an attempt to reduce the numbers of attendances. The Primary Care Networks have worked hard to develop efficient services across a bigger footprint by delivering vaccination clinics and shared responsibility for providing care for nursing homes. This has opened up opportunities for future possibilities of delivering enhanced care services locally.
Finding a balance
I have to admit that I have appreciated seeing more patients again as the infection rates and risks have reduced. In the midst of the pandemic, some days in clinic I felt that I was becoming a ‘call handler’ working down a phone list, managing most remotely but missing the ‘buzz’ of human contact. I really don’t know how the clinicians newer to practice have functioned, with minimal opportunities to enjoy the satisfaction of teasing sensitive information out of a complex issue and witnessing the satisfaction of improving the quality of life that we as healthcare professionals can bring.
So, what does the future look like? We have to continue to develop remote and digital provision of care in a variety of ways, allowing people the choice of where and how to access it without leaving those with complex needs or ‘hidden concerns’ behind.