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Digital GP consultations make spotting signs of sepsis 'a challenge', says PHE

Exclusive Digital GP consultations will make detection of sepsis more of 'a challenge’, Public Health England’s antibiotics lead has said.

In an exclusive interview with Pulse, PHE’s Dr Susan Hopkins praised an RCGP toolkit designed to spot the signs of sepsis, but warned it ‘clearly involves seeing the patient’ to examine them.

She said the increasing use of digital technology to carry out consultations would make it more difficult to use the toolkit, which involves taking a set of patient observations - including respiratory rate, temperature, heart rate and blood pressure.

Dr Hopkins said these observations were the 'key variables' predicting the patient's condition in the following 24 hours.

She added that it was both a 'normal' set of observations, alongside the GP's clinical experience, that would reassure a GP that their patient is well.

Dr Hopkins said prescribing antibiotics for patients who may be at risk of sepsis needed to be done in a balanced way, focusing on treating those with the greatest need.

When antibiotics are not prescribed, GPs need to take a 'safety netting' approach by explaining to the patient, or the parents of a child, what the signs are for them to look out for - and where they can seek urgent help if required.

Dr Hopkins told Pulse: 'The RCGP has developed a set of tools for sepsis that are really good, and clearly it involves seeing the patient. So I think that’s going to be a challenge when we’re using more digital technology to do consultations.

‘It also involves doing a set of observations on every patient – knowing what their respiratory rate, temperature, heart rate, blood pressure is. Because they’re the key variables that predict what’s going to happen to the patient in the next 12-24 hours.’

She said: 'If they’re all completely normal and the patient in front of them looks well, with the GP’s clinical experience they can bring those things together, then that’s very reassuring. As long as they document that, then that will help them in any investigations that might subsequently ensue.'

She added: 'Clearly alongside that, there is the safety netting approach, such that when you’re not prescribing, you’re clearly explaining to the patient, or the parents of a child, what the signs are for them to look out for, and where they can get urgent advice 24 hours a day, if anything changes, either through NHS 111, out-of-hours centres, or coming back and calling them again.

'So I think it’s really important that we have the dual approach of examining patients, making sure that our set of observations are taken and recorded on the one side, and then on the other side ensuring that people know what to look out for, and I think that’s the standard approach that we should be taking.'

BMA GP committee chair Dr Richard Vautrey echoed Dr Hopkins' comments, stating that while digital tools can be useful, examining a patient in person 'remains at the heart' of general practice.

He said: ‘Whilst digital tools can provide information to patients and guidance to practitioners, physical examination remains at the heart of good medical practice and it is important to be alert to the risk of missing important clinical signs if the patient is not seen in a consultation.

'GPs are aware of this and will err on the side of caution when responding to a patient’s concerns and this is why it continues to be important to recruit and retain more GPs and practice nurses, and not overly rely on digital solutions as an alternative.’

Digital consultations are set to become an increasing focus for GPs, with the NHS long-term plan promising digital GP appointments for all.

Babylon GP at Hand, a London-based practice that provides video consultations for NHS patients, has recently been given the go-ahead to expand to patients in Birmingham after previous restrictions were lifted.

Meanwhile, the NHS App, which allows patients to book and manage GP appointments, view their medical record and order repeat prescription, was rolled out by NHS England earlier this year following a pilot.

Readers' comments (10)

  • So, actually examining a patient is better than not doing. Who'd have thought it?

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  • Jmd

    The digital consultation is completely a futile process.
    Issues:
    1. how do you obtain vital signs
    2. how can you illicit signs
    3. how reliable is it to consult a child over teh phone, can one rely on parental history!
    4. the time taken for digital consultation is no less than seeing F2F a patient
    5. Ultimately the holy grail- do safety netting and pass the buck back to the patient and the usual GP!!

    Technology is not all and be all . We need to think what we are doing and what the real savings are.

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  • I love the comment that the ‘RCGP’ have developed this ‘toolkit’. Have they? Isn’t that what all normal, competent doctors have done for decades and continue to do in that situation?

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  • perhaps they are planning to 'outsource' OOH care and we will have digital appointments with doctors abroad where our OOH is their office hours. Certainly seems the next step according to their logic.

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  • The digital consult which of which a telephone consult is a subset is only ever a triage tool. Any patient who sounds or looks Ill will need seeing.
    NHSE needs to understand that, while a FaceTime like consult is safer than a telephone call, the overall effect of adding more and easier modes of consultation access will be to drive up demand and ultimately drive up costs.
    There will come a time where you are forced to have a two tier system of charging for ease of access or the system will collapse.

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  • Pfff…… We GPs just love a challenge, and so do the ambulance-chasing lawyers. This should be used to attract Australian GPs to the NHS.

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  • So they are saying it's dangerous? Good enough reason not to do it IMHO

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  • Knowledge is Porridge

    In 5 years your Apple watch type device could monitor temperature, pulse, saturations, BP, maybe even glucose levels.
    Could be 3 years, could be 10, but this technology could be amazing? May help us more than our new paramedics and physios...

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  • There are lots of risks with digital. A common suggestion is that our consultations will be quicker because online screening algorithms will provide us with the history from the patient prior to a consultation. Issue here is the algorithms aren't robust enough to be trusted. A babylon demo I attended asked patients if they had "a fever" and it was a binary yes or no choice. Where's the "don't know" option. What happens when patients don't know what precisely a fever is? They guess. What happens when patients enter incorrect information to game the system? And we're then supposed to rely on that history and therefore make our consultations shorter? Or perhaps we're supposed to go through the entire history again- in which case there's no time saved.... Some of the digital agenda smacks of desperation and leaves GPs walking a minefield. I keep on recalling the famous quote from Jurassic Park "Your scientists were so preoccupied with whether they could, they didn't stop to think if they should".... Some of digital is a combination of desperation and possibility rather than patient safety and proven effectiveness.

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  • Agree with 'Porridge earlier. We now have more reliable wrist BP devices making a comeback (detail withheld to avoid advertising) . People will be able to apply a wrist band, get the basic set of obs and be directed to 111/999 or routine care earlier. More efficient than a triage/visiting service or a Cat 2 ambulance.

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