The pandemic has cost us dearly, but we can use the learning to build a more efficient and accessible health service, writes Dr Omobolaji Iji, GP and co-founder of Tekihealth Solutions
There have always been strong arguments for using digital solutions to enhance patient care, but it has taken a pandemic to break through some of the biggest barriers to change. So, what does that mean for our future, beyond Covid-19?
A drive for digitisation has been present in the NHS for well over a decade, with primary care often leading the way. Electronic clinical systems have been in widespread use in general practice since the 1990s[1], followed by a series of other advances, most recently including patients being able to access some parts of their clinical record via their personal electronic devices.
But these changes have rarely been adopted swiftly and, despite the benefits it can bring, we’ve often resisted replacing direct patient contact with a virtual alternative.
It comes as no surprise that digital solutions can help to increase access to primary care in remote locations or community settings such as care homes. But prior to Covid-19, there were concerns about whether patients would be willing to engage with different methods – and whether we as GPs would feel able to offer the same quality of service.
The pandemic removed that choice. When it became clear that visiting care home residents or having waiting rooms full of people could increase their risk of catching or spreading coronavirus, we had to find alternatives. And in my experience, the response from patients and fellow clinicians has been extremely positive.
When the Royal College of General Practitioners (RCGP) surveyed its members during the pandemic in July 2020[2], 67% said video or e-consultations increase efficiency, rising to 70% in relation to telephone consultations. Over three quarters of respondents said that GP-led telephone triage increases efficiency, with the majority also saying non-GP triage and online triage increased efficiency (66% and 65% respectively). Achieving greater efficiency in primary care is crucial – particularly as we emerge from the pandemic. But there is more to be gained than simply making our resources go further.
As well as being an efficient use of time, telephone consultations have enabled patients to seek medical support from the safety of their own homes during lockdown. For some, this will have been a real bonus – instead of spending time travelling to a practice to sit in a waiting room, people can carry on with their normal routines until the phone rings.
Many care homes – and their residents – have also willingly adopted digital solutions in recent months. Traditionally, lack of diagnostics has limited what can be achieved remotely, but video conferencing and diagnostics systems containing tools such as digital stethoscopes, digital otoscopes and high definition cameras, as well as tests to remotely assess heart and lung function, are now starting to enable GPs to conduct a full consultation with their patients virtually.
Remote patient monitoring solutions have also been more readily adopted in care homes, as well as by those recovering from Covid-19 at home. By combining medical technology, such as digital thermometers and pulse oximeters, with app-based questionnaires, these systems detect deterioration in health, triggering early clinical intervention.
Through necessity, we have made big strides in our use of technology and now need to consider how best to harness what we have learned to enhance care in the longer term. For example, telephone appointments may continue to be more convenient for some, and with the recent growth in people becoming used to using video communication for home, school and work purposes, there is an opportunity to enhance use of video GP consultations post pandemic.
According to the RGCP survey, 88% of respondents said their surgery was equipped to deliver video or e-consultations – up from 5% before the pandemic. While video won’t suit every person or circumstance, it can be part of the solution to improving access to care in remote areas or community settings – particularly when combined with more reliable satellite connectivity.
Although face-to-face consultations with patients will always be an essential part of general practice, the pandemic has also shown us that digital doesn’t have to be about compromise. As we move beyond the worst of the pandemic, we need to learn from our fellow clinicians, patients and carers and challenge some long held misperceptions about different ways of working.
Covid-19 has cost us all dearly – but we can use the learning we’ve gained to build a more flexible, efficient and accessible health service for the future.
[1] Primary Care Patient Records in the United Kingdom: Past, Present, and Future Research Priorities: Brian McMillan, Robert Eastham, Benjamin Brown, Richard Fitton, David Dickinson. J Med Internet Res. 2018 Dec; 20(12): e11293. Published online 2018 Dec 19. doi: 10.2196/11293
[2] https://www.rcgp.org.uk/about-us/news/2020/july/rcgp-survey-provides-snapshot-of-how-gp-care-is-accessed-in-latest-stages-of-pandemic.aspx RCGP, 30 July 2020.
