NHS Technology During Lockdown
The way appointments are now booked has dramatically changed. The normal state of visiting your GP practice for a face to face appointment has been transformed in a way that we will never go back to consulting in the same way. At the height of COVID, face to face consultations in primary care had plummeted to <2% and telephone calls had soared in its place. Once we are through lockdown (eventually) we will probably settle to half of all appointments (at least) being done on the phone. Add on to this the fact that all patient contact is now being triaged first before an appointment is given, will ensure that patients will be seen by the right clinician at the right time. The other knock on effect from all of this is that waiting times have dramatically reduced, in part also due to online consultations (see below).
One of the other dramatic technological changes has been around video consultations – who’d have thought we’d be communicating via video to check out a rash or to assess respiration a few months ago. The beauty of how this has been rolled out is that it is very highly clinician led in that a clinician will decide during a telephone call whether a video consultation is required and this in turn has meant that even fewer patients have needed to attend for a face to face consultation.
It’s not just the patients that have been staying away from healthcare settings! Primary care specifically has mobilised remote working like never before. The amount of increased investment in remote working has been phenomenal and in part healthcare has contributed to the worldwide shortage of headsets and webcams as well as laptops. There’s been lots of infrastructural change that has had to be mindful of governance with the roll out of VPN tokens to enable connection to the NHS network as well as IT support to provide appropriate software to be installed on PCs and configurations to allow access to restricted websites and functionality such as file access previously only reserved for within the NHS network. This has brought flexible working to the fore and has also had the knock-on effect of staff being able to offer more flexible time to work from home due to other prior commitments. Tie in the fact that more hours are available to offer from the standard workforce and you can see one of the reasons for why locums are now not in as high demand as they were previously.
Often, it’s the simplest forms of communication that have been transformational. The humble text message has been a fantastic tool that means that we have moved away from requiring a postal letter to be required to send communication to patients and is more readily read than emails are. Add together the savings from printing, envelope stuffing and postage and compare this to the fact that patients can also instantly be sent an SMS that includes documents such as fit notes or clinical letters and you can see the impact it has had.
Along with the ability to have SMS access to patients, patients have also now been able to text back to the practice and have information coded into the clinical system. This has been a revelation in monitoring patients e.g suspected of having COVID and has led to a more focused approach to dealing with patients by priority. This along with video consultations have resulted in the tool AccuRx now being used in over 90% of GP practices up and down the country.
Another aspect that has been revolutionised in the way that patients communicate with practices is that there is now 24/7 access to the practice through online consultation tools. They have been (and are still) a challenge to implement, but over the last few weeks we have seen system change that would normally take years to embed in one practice, never mind across the nation. The functionality to allow patients to consult first through an online form that could give appropriate advice or direct appropriately for 999 advice at one end and to pharmacy or social support at the other, can really help support primary care to deal with issues that they are set up to support. Linked to this, the ability for practices to prioritise workload based on this form of communication, has led to response times plummeting to a few hours which is absolutely transformational.
The NHS App has a functionality that allows appointments to be booked and repeat medication to be ordered without visiting the GP practice. With a self-approval and identification process requiring photo ID, everyone can now download the NHS App and order medication through the app and then collect the medication from a pharmacy of their choice – all without going to or contacting their GP practice directly. Add to this the ability (with practice approval), to view the whole of the GP record, patients now have all their health information from their GP at their fingertips.
What about in secondary care? Hospitals up and down the country have had similar transformational change with outpatient clinics being cancelled and appointments now being converted to a digital form – whether that be through the good old fashioned telephone to video consultations to provide an alternative to face to face. The worry, which is also felt in primary care, is that of delays to diagnosis and treatment of other conditions such as cancers and strokes. This is a valid concern, that the pressures of COVID have brought to us, the standstill of other diagnostic and treatment services which may take a considerable time to catch up on. Therefore, there are pathways being developed and improved to keep patients moving through the healthcare system by improving communication channels through secure methods to discuss patients and identify those that need to be seen face to face or those that could go straight for a test to be reviewed.
As an educator for a local GP VTS (Vocational Training Scheme) I have also been at the forefront of seeing the impact on local education for our future workforce. Not only are our trainees now having to learn new ways of working and consulting, but their educational requirements have been dramatically changed from a vocational training scheme with regular face to face educational sessions to one where we are remotely meeting for not only educational elements but for peer and pastoral support. We will see how the path to CCT will pan out with face to face exams and clinical skills examinations being replaced with alternative assessments.
One of the key changes to education delivery has been through webinars which are increasing in number and becoming increasingly attended. There is now the worry of information overload more than ever with webinars available left, right and centre on anything and everything, live or recorded which on one hand provides a rich range of education but on the other has the potential to cause confusion, especially if it is not localised. In our locality we have looked closely at establishing this early on as locally focused webinars provided and supported by local staff so that there is some consistency in our delivery. We have also rolled out webinars for our GP trainees in the form of educational sessions provided through Red Whale as an offer to VTS schemes.
As we move towards a world where we are going to need to collaborate more widely with different members of the healthcare team, collaborative working has become a buzz word that is also being realised through acceleration of the integration of Microsoft Teams to NHSMail allowing not only meetings to occur securely, but also chats between individuals and teams to be organised – fondly referred to locally as the professional WhatsApp! There are also developments for collaborative working and discussion with Teams using it’s full potential as a professional portal for discussion which in the not too distant future will replace email!
Dr Osman Bhatti is a GP in East London with a specialist interest in IT and is the CCIO (Chief Clinical Information Officer) for the East London Health And Care Partnership that is the STP that covers 7 CCGs across North East London. He also works for HEE as a Programme Director for a London GP VTS and is a presenter for the Red Whale GP Update team. He has produced material to support primary care and IT across the NHS on his website www.DrBhatti.com and often tweets about IT in the NHS @OsmanBhatti