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Should remote consulting remain the default option post-Covid 19?



simon hodes photo

 

YES – They are popular and convenient

For many years, my brother-in-law Ben has teased me that the NHS is the only place left on Earth that uses fax machines and that he still can’t email his GP practice. He insists the occasional visit he has had to make could have been conducted via video.

Coronavirus has sorted all this out for him. The pandemic has rapidly brought sweeping changes to the NHS, triggering, it would be fair to say, a digital revolution. A phone call is the first point of contact now, augmented either by photos via SMS or email, or by conversion to a video consultation. My own rough audit over the past few weeks shows around 64% of my contacts were dealt with by phone alone. Some 18% needed video, around 10% a photo, 2% video and photo, and 6% face-to-face review.

We’re also doing weekly ‘ward rounds’ by video in our nursing homes to review the patients and support staff at this time. Patients are emailing us more than ever, for example with blood pressure readings, using our website for chronic disease monitoring and contraceptive checks, and taking advantage of software solutions like AccuRx.

Video consultations look likely to be a legacy of Covid-19

On becoming health secretary in 2018, Matt Hancock signalled his passion for digitising the NHS. The growth of the video consultation service GP at Hand suggests this is popular with patients, although its rapidly growing list size – as the BMA and others have noted – consists mostly of younger patients, leaving more complex cases for regular practices.

Video consultations look likely to be a legacy of Covid-19. They feel much safer and can give far more information than a phone call. Of course, we must note that our hospital colleagues are adapting too, with some clinic letters now referring to ‘remote review’; antenatal care is just one area where this has been embraced.

Maybe in future, patients calling their practice will be offered a telephone, video or face-to-face consultation. In essence, we’re all GP at Hand now, which is clearly popular with our regular patients. If anything, this might just improve continuity and access for the younger ‘digital’ cohort that the BMA mentioned.

And by the way, the fax machines have gone at last. Ben – you win.

Dr Simon Hodes is a GP partner, trainer and appraiser based in a large group GP practice in Watford

katie new

 

NO – They will simply increase demand

‘We need to encourage people to book more appointments’, as no GP ever said.

Demand and rates of consultation have been on the rise for decades. So what do we expect to happen when a GP consultation is available at the touch of a smartphone? GP services are not like online shopping – ever-easier access is not the priority. As doctors who care for the health and wellbeing of whole populations, we know it is essential for our services to be available for those most in need.

Coronavirus has given the Government, and those in big business, the opportunity to capitalise on the need to consult remotely. The cynic in me was not hugely surprised to be told we could sign a death certificate only if we had seen a patient in person, or via video consultation. Why not via a phone consultation? Perhaps some are eager to ensure we all move to video, and hope we won’t look back.

Video consultation is likely to be another Government fad

Make no mistake, there is a lot of money at stake. GP at Hand parent company Babylon Health is now valued at $2bn (£1.65bn) and many other video consulting apps are emerging. Many very rich and very powerful people would like GPs to roll over and accept a move to online consulting en masse.

Video consultation is likely to be another Government fad, much like seven-day access, that will do little to improve general practice. Until independent research shows it eases demand on GPs, we should reject wholesale moves to this model. Video consultations are likely to increase demand for our services, discriminate in favour of younger, fitter people and even increase consultation length.

The indemnity risks also need to be considered. E-consults frequently contain reams of text, which I may not have time to read as carefully as I might like. A video consult could also be covertly filmed or watched by a third party. Should an already overstretched workforce really accept a model that will put us at greater risk of being sued?

We must not be blinded by tech firms who have not done our job and do not share our priorities. I’m sorry, but neither they nor the health secretary know what they are talking about.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West of England