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‘Improved technical infrastructure’ needed before roll of out video consultations

GPs part of a video consultation pilot have advised not to roll out the scheme until the platform can be integrated with existing NHS IT systems. 

A trial of video consultations implemented in six GP practices in Edinburgh and the Lothian regions found ‘repeated connection problems’, according to a qualitative study by the University of Edinburgh, Exeter, and Warwick.

GPs at these six practices were provided with equipment to use a digital platform called ‘Attend Anywhere’ and were asked to evaluate the performance of video consultations (VC) with patients. According to the study’s authors, the connectivity problems were mainly from the patients’ side.

The study concluded that ‘seamless integration’ was important before rolling out video consultations as a method of routine care.

One of the study’s authors Professor Brian McKinstry said: ‘The clinicians felt that to integrate video-consulting with routine work that the IT systems themselves should be seamlessly integrated with the practices appointment systems.’

Professor McKinstry added: ‘There were some connectivity problems. These were mainly from the patient side. We were unable to use NHS broadband in Lothian because of bandwidth problems but also because of local IT governance concerns around the use of Google Chrome which the system needed. So we went to a great deal of trouble by providing additional hi-speed broadband and Wi-Fi to make sure that the broadband connection in the practices was as good as it could be. Even so, we had problems with Wi-Fi in older thicker walled surgeries.’

Overall participants reported positive experiences and said it was most useful for patients with mobility or mental health problems. But the study concluded that for complex or sensitive problems, face-to-face consultations ‘remain preferable.’

Professor McKinstry continued: ‘I think the overall message was one of positivity. When the technology worked it delivered more than telephone consulting in terms of improved rapport and communication. While such problems were not broached in our study there was a feeling among clinicians and patients that emotionally charged issues such as bad news would be better handled face-to-face.

Some clinicians said it was difficult to maintain rapport with the patient and sometimes there was an issue with time lag which caused ‘a degree of talking over’.

The report, published in the British Journal of General Practice, said: ‘Patients appreciated that VCs differed somewhat from a face-to-face consultation. For example, they mentioned the issue of the time lag that can occur with VC over the internet, which caused a degree of talking over and affected the consultation.’

One clinician in the study said, ‘Because of repeated connection problems you feel it’s breaking down your rapport; you’re saying, “oh I missed that — it cut out.”’

Another participant said: ‘The IT system here needs upgrading. Ideally, I would prefer it [VC] to be integrated into a desktop PC. Simply an image in the corner of your computer you could be looking at the notes and at them at the same time.’

Another study into digital consultations recently reported patients prefer phone consultations over face-to-face appointments, with only 0.1% prefering video consultations.