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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.