I love it, I hate it. No, I find my emotions don’t go that deep in general practice. I like it, I dislike it. In a world of increasing binaries – Brexit, Covid – I am going straight for the middle ground.
Our total triage has been live for two months and I loved the novelty and the upskilling of the early days. Every day was a COBRA Covid briefing followed by the next new IT change. The sense of achievement when you have attached an electronically signed sick note to an AccuRx text message cannot be underestimated. Show me a twisted ankle via video link during the depths of lockdown and the sense of gratitude between patient and doctor was palpable. The responsiveness and convenience increased satisfaction and wellbeing for all of us.
Then came the second phase, which was beset by IT outages at exactly the time that demand was increasing as fears eased and people were still stuck at home dwelling on every ache and pain. The depths of frustration and stress engendered by problems that are entirely technical, surpass any heavy duty day pre-corona.
We are now hard on the third phase, which seems to be entirely normal demand with no secondary care outlet. Add to that staggering number of administrative tasks being heaped upon us by hospitals and we seem to be right back at breaking point.
I still like it for the control over my list. The lack of a full waiting room decreases stress. I bring down as many patients as I think is necessary and I have space to do that. Some doctors who work more days are doing regular home working, there is flexibility for mothers and fathers who do need to do drop offs and pick-ups. I still think it is more responsive and leads to quicker, more appropriate consultations leading to better patient satisfaction overall. We are all better at managing the IT knowing how to avoid the duplication of the early days.
On the other hand, it is a long day staring at a screen. It is bad for the back and bad for our sense of humanity. We cannot dismiss the idea of the therapeutic consultation and the notion of healing which has nothing to do with medication or paperwork.
As a colleague said, it can lead to ‘bad medicine’, undoubtedly true; that twisted ankle for example, she got an X-ray. Then of course there are the potentially missed visual cues, the hand on the door comment, you have to very good on the phone to elicit that.
Like it or not, it is here to stay. We will do it better and add more value than any private contractor offering the same service so we just have to get with the programme. So, it is two cheers for footfall.
Dr Charlotte Alexander is a GP in Surrey