Scottish GPs will be doing all patient consultations via video link in future, the Goverment has announced, although GPs expressed concern for the future of the doctor-patient relationship.
Going a lot further than health secretary Matt Hancock, who earlier this summer suggested all GP consultations could be done remotely in the future, the Scottish Government intends to roll out an existing video consultation platform as the ‘default option’ for all patients consultations across general practice and secondary care.
The ‘Near Me’ consultation platform, which is accessed by patients via a website, is already available to all GP practices in Scotland although its usage has been voluntary to date.
But setting out her Programme for Government for 2020/21 earlier this week, First Minister Nicola Sturgeon said: ‘Crucially, in the months ahead we will build on the rapid expansion of digital access to care that was achieved in response to Covid.’
She said this comes as ‘early on in the pandemic’ the Scottish NHS ‘quickly upscaled the use of the “Near Me” video consultation service’, from just over 300 video consultations per week to 17,000 a week by the end of June.
Ms Sturgeon added: ‘Patient satisfaction with the service was also high. That shows how quickly progress can be made.
‘So while we recognise that video consultations will not be appropriate for every patient or situation, I can confirm that we intend to move to the position where “Near Me” is the default option for patient consultations.’
But RCGP Scotland, which has contributed to GP guidance on using Near Me, warned against using remote consultation as a ‘silver bullet to the challenges facing general practice’.
RCGP Scotland chair Dr Carey Lunan said: ‘These options can work well for patients who have access to technology and are confident in using it. It may also be a more convenient option for those who live in remote areas and may struggle to access transport. However, for many patients speaking to their GP by phone or video does not work as well because their problems are more complex, more difficult to describe or more personal in nature.
‘Certain groups of patients particularly struggle with this type of consultation, for instance those living with sensory impairment, those who have English as a second language, those with cognitive difficulties, the frail or elderly and also those who have less readily available access to technology.’
Calling for a full evaluation of the impact of switching to digital cosnultation, Dr Lunan added that ‘digital consulting is still in its infancy’ and said there are ‘still many unanswered questions in terms of its impact on potential worsening of existing health inequalities and the longer-term impact on patient care and health outcomes’.
And she warned that patients and GPs alike report that they ‘miss the face-to-face contact’ when using video consulting.
‘Building relationships with patients and their families is why many have chosen a career in general practice,’ said Dr Lunan.
And Dr Iain Kennedy, secretary at Highland LMC, said: ‘Very few GPs and patients are finding Near Me that useful. Often phone consultations are just as good. Patients struggle to use the technology and the demand from both patients and GPs is low.
‘There are huge concerns from GPs and patients about failure to examine patients and also the loss of the human connection. GPs are concerned that hospitals are using Near Me as an excuse not to see patients and consequently a lot of work is being transferred to general practice.’
And he went on to warn video consulting was merely being rolled out in response to financial constraints.
He said: ‘Overall there is a feeling that Near Me is being pushed by government and NHS Boards to save money. And the benefits to patients are over stated and the risks brushed under the carpet. Patients seem very relieved when a doctor actually wants to see them face to face.’
Dr Robert Baunsbak Coull, a partner in Argyll and Bute, said: ‘We are signed up but we have almost never used it. We have been fortunate in that our small size has allowed us to continue to see people face to face when needed, and we have found that telephone supplemented with emailed photos have worked well for us.
‘One area where it might be useful to us in the future is for mental health patients where being able to see the person you are talking to is especially important.’
The news comes as Mr Hancock suggested in July that all GP consultations in England should be carried out remotely going forward unless there is a ‘compelling clinical reason’ to see a patient face to face.
At the time, GP leaders warned that a predominantly remote GP service ‘wouldn’t be in anybody’s best interests long-term’ and should be ‘approached with caution’.
