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Coronavirus should change GP practices’ long-term approach to digital

This week, the vast majority of UK GP consultations won’t be for treating patients with actual or suspected coronavirus (Covid-19).

While that may change, policy moves are afoot to adapt how practices work.

Dr Nikki Kanani’s letter advising GPs to use online bookings for triage rather than for face-to-face appointments is an important step in the right direction.

But in 2019, only around 4% of GP appointments were booked online, meaning 96% of patients spoke to a receptionist first. We know from countless conversations with receptionists and GPs that with appointments in short supply, patients will say whatever it takes to get in front of a doctor.

It therefore makes little difference whether a face-to-face appointment is booked online or by phone. Current fears mean patients will avoid saying whatever might deny them a slot – is it fair to expect receptionists to add to their duties a COVID-19 quiz?

While we have little idea how much the virus will impact the NHS, it’s bound to increase workload, and much of that burden will fall on primary care. However policy is changed, it must reduce normal work, and herein lie both opportunities and risks.

At askmyGP, we’re not alone in saying that all patient requests should be triaged by a clinician, not as a last resort, but as normal practice. What’s changed recently is the huge efficiency boost from digital, rather than telephone triage. It’s crucial that practices looking at different ways of working don’t go back to a less efficient model.

Practices looking at different ways of working shouldn’t go back to a less efficient model after coronavirus

A key change for the practices we work with has been in the language they use for communicating with patients. No patients were offered an appointment booking. Instead, all were invited to put in their request, and while 67% did so online, the remaining 33% had a receptionist enter it for them.

The problem with a half-way house where triage appointments are bookable online is that they’re a finite quantity at a pre-defined time. Operationally, they’re not always an effective use of a doctor’s time, but once committed that time is irretrievable. We can’t afford to waste GP time.

Video is even more problematic than pre-booked telephone appointments – the very few, very small studies published have shown no efficiency benefit for GPs. Despite the hype, video will play a very small part in the GP response to Covid-19. Even if our figures multiply 100 times, and there’s no reason to suggest they will, video would represent 0.8% of demand while online secure messaging is at 31% and growing. It saves GP time.

The fundamentals are the same with or without COVID-19: digital can help change the currency from appointments to requests, make it easy for patients to request help online and make it easy for GPs to decide how to help each one.

The virus has simply added to the advantage of resolving two out of three requests remotely, which empties the waiting room, while focusing minds on what needs to change. The repeatable outcome is a lower stress, more efficient, more patient friendly service.

Harry Longman is founder and chief executive of the online consultation and workflow system askmyGP