GP educator Dr Ben Gooch offers his advice on how practices should incorporate technology and remote consulting in the post-COVID-19 era
GP partners and their primary care colleagues are facing a set of monumentally important decisions. As the nation reels in the aftershocks of the pandemic, we must lay the foundations of an evolved, uniquely modern service. We must use the lessons of the past few months and our own professional experience to select and employ new digital tools. But making this choice will require some practice-specific soul searching: how do we emerge from this crisis, and what tools do we need to navigate the changed healthscape that awaits?
Remote consultation technology is currently invaluable to GPs to an extent no one would have predicted just six months ago. However, the time has come to move away from immediate crisis management and settle on a permanent structure for our practices. Choosing the wrong tools risks undermining the innovations we have already adopted, with a real risk of exacerbating pressure on overstretched clinicians. Making the right decision at this key moment could plot a course for transformative and far reaching innovation. The stakes could hardly be higher, and actions taken now will shape the legacy of primary care provision for years to come.
As an early adopter of digital triaging technology and remote consultation software, I have learnt a number of important lessons when it comes to understanding what works for patients and doctors on the ground. If you too are considering how best to equip your practice for today’s primary care landscape, the below should provide some valuable food for thought.
Leave no patient behind
Over recent months, many GPs will have been able to explore video consulting for the first time. Clearly there is no substitute for face to face but, when applied to the right situation, video is a tremendously powerful tool as an alternative to telephone triage.
For the most vulnerable or frail patients, the window into their home environment enabled by a video call can be invaluable, as can the ability to visually assess a range of clinical signs which would otherwise be impossible on the phone.
However, many of these same patients lack the fine motor or technical skills to download and log in to a smartphone app, (and many simply aren’t comfortable with video calls) and so it’s important that doctors employ tools which don’t require the patient to download any software or create a personal account on their device. Clinicians should be able to initiate the video call if preferred by the patient and, in turn, the patient should be met with a user-friendly interface requiring minimal interaction.
Your demographic matters
Now more than ever, an up-to-date understanding of your patient demographic is invaluable.
This is because the age distribution and geographical spread of your patients are just two factors which should influence not only your target ratio of in-person to virtual appointments, but also how you intend to deliver these virtual appointments.
For example, urban practices with more diverse populations might look to select a tool which integrates translation technology such as LanguageLine.
Rural practices with large catchment areas ought to be encouraging patients to consider virtual appointments whenever possible, as this will save a good deal of travel time for patients and clinicians. If your demographic is young and more comfortable with navigating apps, you might consider partnering with a service such as askmyGP or eConsult to enable app-based appointment booking and video consulting.
However, if your patient base is skewed towards an elderly demographic, be wary of adopting a platform-based video-first consultation model.
Poor rural internet connectivity and tech unfamiliarity amongst older patients will make WiFi-dependent technology impractical and appointments difficult in this scenario. However, this does not mean that remote consultation is impossible.
In these situations practices should look to adopting a tech agnostic solution – one which enables GPs to reach landlines as well as mobile phones. The humble telephone is often overshadowed by flashier app-based solutions, but in reality it remains the backbone of general practice up and down the country.
Choosing a tool – such as the Nye Phone that my practice employs – that can switch between mobile, video and landline calls whilst simultaneously allowing GPs to avail of hands-free desktop or mobile calling, will help doctors to seamlessly bridge the access-to-health gap.
Be wary of sales reps who want you to believe that their product is a one-size-fits-all solution, and instead think carefully about what your patients really need.
Compliance is key
Infant-stage remote consultation and triaging technology is flooding the primary care market, but there’s no guarantee that every option you are presented with can be trusted to safeguard your patients and doctors.
You must investigate the compliance credentials of any new technology you intend to use – remember it should be compliant with GDPR, registered with the Information Commissioner’s Office, and meet NHS Digital standards of security and patient confidentiality. All organisations that have access to NHS patient data and systems must use the Data Safety Protection Toolkit (DSPT) to provide assurance that they are practising good data security and that personal information is handled correctly.
In addition, the contact details of doctors should be automatically masked when they call a patient from their device.
Will it stand the test of time?
New products can hit a market fast – this has never been more true than during the last three months. However, keep in mind that software can date quickly and not all solutions will boast the future-proofed longevity of traditional communication platforms.
Look to solutions which marry old and new technology to enhance the usability of familiar tried-and-tested tools.
A good example of this is the Chain SMS feature from accuRx, which effectively harnesses the simple power of the text message. The tool allows doctors to send SMS messages from their desktops to the mobile phone of patients, attaching documents or notifying them of normal test results if required. These messages are then automatically uploaded to patient notes.
Look for evidence of success, case studies, talk to colleagues who’ve used it
New technologies can promise enticing savings and remarkable successes, but it’s up to you to evaluate the credibility of such claims. Look for case study reports and published research which backs up the promised outcomes, and if possible arrange to speak to a fellow practice who has been using the tool for some time already, or who can caution you against certain routes.
Can you afford it? What are you actually getting for your money?
To support GPs in adapting to remote consulting, participating solution providers from an assured list are available to be selected by practices and CCGs from the NHS Digital Care Services Framework (GPIT Futures). Costs for selected services are covered via a central Call Off contract with each participating supplier.
In addition, Digital First Primary Care funding is being made available to NHS England regional teams. This will be used to support health systems with the implementation and delivery of remote consultations.
However, this central funding is unlikely to last forever, and soon practices may be required to make an investment themselves.
There’s nothing wrong with making an informed investment, but be aware of the risk of future prices hikes or budget cuts. Is the added spend really worth the added functionality? Do those attractive add-ons truly drive better patient outcomes?
In addition, ask if you will be tied in to particular hardware, or whether the solution will be tech-agnostic. Will you need to budget for regular upgrades to computer systems, compatible devices for your GPs, or speakers, cameras and headphones?
Listen to your colleagues
Naturally, there will be clinicians in your practice who are wary of change. However, ultimately it’s the practice staff who’ll be expected to use the new digital tools on a daily basis, so it’s essential that they are involved in the decision making process.
Consult with nurses and GPs to find out if they really want an all-singing, all-dancing tech platform, or whether they just want simpler tools that streamline their tasks and save time.
Once you’ve established their priorities – whether this be the ability to work securely from home or the ability to upload call transcripts to patient notes – you can refine your search criteria accordingly.
Do we really need to reinvent the wheel?
I’ll conclude by reiterating a key theme. In responding to the pandemic we have proven to be a resourceful and resilient profession. We have weathered unprecedented challenges and shared the most difficult of times with our patients. As we begin to see signs of recovery we are curiously presented with a rare and exciting opportunity to drive positive change, and the tools to achieve this await our selection. We must now look to building a bridge between traditional consultation methods – in person and on the telephone – and the video and app-based platforms to create a kind, community based, and patient centric model of care.
Every practice wants to operate in a safer and more efficient manner, accessible to all patients equally. Let’s embrace the tools which enhance and supplement the power of teleconsultation, building on its popularity and proven success to achieve the very best outcomes for doctors and patients.
Dr Benn Gooch is a GP partner and Health Education England Primary Care Fellow
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