It’s been more than a year since general practice introduced remote triage to keep patients and staff safe from Covid-19. I say ‘introduced’, but we’ve all been doing some form of triage for many years, whether remotely or face to face. Triage originated in the Napoleonic wars as a way to determine the gravity of wounds and prioritise treatment – today we use it to help patients quickly access the right treatment from the many healthcare professionals who now make up the general practice workforce.
Technology has supercharged the potential to do this. Online consultation tools enable patients to send a digital contact describing their symptoms, allowing the practice to triage the patient to the right person or service.
In January, we saw more than two million online consultation requests and 155,000 video consultations, as well as big increases in the use of electronic prescribing services. This shift hasn’t just offered safer care for patients and staff – it has allowed us all to work in different ways. Balancing home schooling or caring duties with work has become more manageable – if no easier – and for some, being able to offer an early telephone surgery before the school run has brought a new flexibility. These experiences will help us decide what to adopt more permanently and where to return to more traditional ways.
None of this takes away the importance of seeing patients in person; during the pandemic more than half of appointments have still been face to face. However, a recent Healthwatch report highlighted that the changes in access have been challenging for some, and we must ensure no one is excluded along the way. The Covid vaccination campaign has underlined the need to reach into our communities in a variety of ways; the experiences gained should
help us adapt access to local primary care, reflecting on what have we learned and what can we build on in partnership with patients and communities.
Last summer, a separate Healthwatch report – in conjunction with healthcare charity coalition National Voices – shed light on the patient experience of remote and virtual consultations. They heard that this is a convenient option for many people, who appreciate quicker and more efficient access and the ability to fit the appointment around their lives. Most respondents felt they received appropriate care and a majority said they would be happy with remote consultations and a blended approach in the future.
In-person collaboration is critical for staff too. Learning, development and teambuilding is hard to replicate remotely. A recent Kings Fund survey showed many GP trainees like the flexibility of remote working but want to be at the practice most of the time to ensure they feel part of the primary care team.
Recognising the different skills needed for remote working, our national clinical director for digital first primary care Dr Minal Bakhai worked with the RCGP to produce guidance on remote vs face to face. While general practice has proved its ability to transform, as our models evolve we must recognise one size does not fit all. Crucially, we must use the past year’s experiences to increase access and help close the health inequality gap. As a practising GP, supporting patients will always be at the heart of what I do – technology offers options but that connection between clinician and patient will remain a priority.
Dr Nikki Kanani is medical director for primary care at NHS England, and a GP in South London