Posted by: beyondtheheadlines17 April 2014
The details of the Health Secretary’s latest plans for primary care are about to be unveiled, but the all-too familiar themes hit the front page of the Sunday Telegraph a day early, bringing the usual ‘lazy-9-to-5-GPs-finally-told-to-do-some-work-and-care-for-their-patients’ headlines, but no great surprises.
There are three main thrusts to the Government’s primary care policy, and it would be easy to write several blogs about each one of them, but I will constrain myself to two one-liners before moving swiftly on to the third: the use of technology.
The first of Jeremy Hunt’s big ideas is that every person aged over 75 will have a named family doctor – any such patient who thought they knew who their doctor was has clearly been living under an illusion up until now, but not to worry, as of this April all will be revealed and they will finally find out the name of their GP – well done Jeremy, fantastic work!
The second is to get GPs in England to open 8am til 8pm, seven days a week, for £50m. The band aid the health secretary stuck over Accident and Emergency was to the tune of £500m, and he hopes to increase access to primary care by over 30% for a tenth of this? Enough said.
Hunt’s third big idea? Using Skype to consult with patients. Technology, of course, is to be the saviour, and the Health Secretary won’t have to spend more on primary care because he is going to use technology to free up so much of our time that we might even get back on the golf course.
The online video call application might be a good way to keep in touch with the grandchildren in Australia, but few of us use it for anything more than personal use. Video consultations would be limited to GP opening hours, as inconvenient to arrange as a mutual telephone call, and the video adds little or nothing over talking to the patient by phone. The plan to give iPads to thousands of elderly patients to Skype us with has ‘white elephant’ written all over it - most devices will become expensive coasters, while patients continue to consult in the traditional way.
But I must not be too cynical – GPs need to move with the times, and just as computerised records have transformed the care we give, so there are newer technologies that we need to embrace emailing our patients.
The contrast between Skype and email could not be more stark. It is convenient: you can send emails 24/7, don’t have a two-week wait to send one or have to call a surgery at 8am to book one in. The line is never engaged, which is just as much a boon for the GP trying to call back the patient as it is for the patient trying to get through in the first place – and it works just as well even when you are abroad. The advantages are too compelling to ignore, and the profession is going to have to take this bull firmly by the horns, tame it and make it work, because it is not going to go away.
Of course the concept of emailing patients produces anxieties: will it open a Pandora’s Box of demand? Will patients contact us out of simple medical curiosity, and leave our inboxes resembling the ridiculous Twitter feed of TV’s Dr Christian?
What about the ‘I’m about to kill myself’ e mail that we receive the morning after the night before, or questions like, ‘Is it normal to vomit blood/have central crushing chest pain/be covered in a purple non-blanching rash’?
We will have to learn what to do with these, and so will our patients. They will have to discover that sending a long, rambling email with a multitude of symptoms is going to result in the standard reply - ‘better make an appointment’ - while we will soon find out that sending a terse one-liner that doesn’t properly answer the question will only lead to a second email, so better to get it right first time.
There are many times when it could work well, though. Take delivering test results, for example, or reducing review appointments, sending reminders for blood pressure checks, or resolving non-clinical queries regarding medications, hospital visits or claim forms. I have to agree with the Government – we could save ourselves, and our patients, a lot of time.
However, before this can take place, secure emails must become integral to all GP IT systems. Emails from patients cannot become enmeshed with the endless stream of information flowing from the CCG or the spam that clogs a GP’s inbox.
The email consultation must also be part of the patient record, and cutting and pasting from nhs.net will not be practical – and nor is printing off endless emails and scanning them in. Writing an email to a patient needs to become as seamless as filing their pathology results, or reading electronic documents.
And the whole conversation needs to fall into the consultation record, and checking emails to doctors on leave needs a simple solution.
If anyone from Government or the DH is listening: please start talking to the techy people who design GP computer systems because, once they get the technology to really work, it won’t be hard to persuade GPs to fall into line.
Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.