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Has COVID forever changed the delivery of primary care?

by in COVID-19, IT & Technology, Surveys

It would seem that we in the UK are in the midst of a paradigm shift when it comes to delivering primary care appointments. COVID-19 has demanded that technology plays a full part in the tackling of our patients’ diseases and ailments, and the traditional 10-minute face-to-face (F2F) consultation between clinician and patient at the surgery should no longer be the first option.

Back in those darkest of the COVID-19 months, to maintain a semblance of a ‘normal’ service and to ensure that patients could get their much-needed appointments, phrases like ‘Digital First’ and ‘Total Triage’ became commonplace. In short, we all needed to embrace the ‘technological revolution’ that the pandemic has brought about.

So, clinical-system appointment screens up and down the land have had additional colours added to denote the different types of appointment on offer, such as Ask NHS / 111 or telemedicine, rather than the previous F2F or telephone appointments.

Patients’ demands

By default, our patients have been exposed to more of these kinds of new appointments. But as the table below from the latest 2019 Ipsos MORI Patient Survey shows, some of these appointments would have been received reluctantly (see Q20 which asks “What type of appointment did you get?”).

Typically, and consistent with 2018’s answers, overwhelmingly patients wanted to see a clinician during a F2F appointment at the practice.

So, whilst technology in the form of telemedicine and phone call appointments have become more prevalent over the past few years, statistically they’ve continued to be unpopular.

In my experience, when questioning patients on this topic, often their responses have been:

• I prefer to see my GP; it’s what I’ve always done
• It’s the only social outing I have all week
• I’m not too technologically savvy or I have no computer
• I simply don’t have any trust in technology
• I can get my medication straight away
• I do my weekly shopping on the way home from the surgery

The future

As we’re starting, hopefully, to see the status quo returning in the post-COVID era, will these alternative kinds of appointments be accepted and will they remain on the clinical system?

Different demographics will have different needs and some older patients may not feel as confident with new technology. All the same, we do need to make our friends in the CQC feel confident when they visit and ask the following question:

“How do you know your patients’ needs when it comes to the requesting of different types of appointments?” – or something similar to that.

To help you pinpoint your response, here at Practice Index we’ve put together a patient survey so that you can ask your patients what they want moving forward. The survey poses a range of questions, including whether they’ve used technology for an appointment in the past, what their experience was of this, and would they be happy to use it in the future. By carrying out this survey, you should be able to discern what your patients prefer and adjust your clinics accordingly – plus, of course, you should achieve a ‘great big lovely CQC tick’! Download now: Patient survey – Telephone and online appointments [PLUS]

There’s a great deal of research and many publications covering this topic, including speculations that “50% of appointments should be made online after the pandemic” – GPOnline . But, having talked to GPs, there really is a mix of those who are quite content to continue with the Digital First approach and those traditionalists who state that actually, as a clinician, it’s really important to see the patient in a F2F setting as so much can be gauged from that meeting, be it the patient’s appearance, smell or gait.

But has this technological revolution already started? During the COVID-19 pandemic, sales have boomed for the UK’s largest electrical retailer, Currys PC World. And many more thousands of households have greater online access, having taken receipt of a new PC or tablet, plus an obligatory crash course in Zoom, FaceTime, Teams, etc., to enable them to have contact with family and friends. So, is there no stopping this trend?

Now, armed with a new and altogether different sort of tablet, even the group who on average need to use GP services more times annually than any others may have become tech-savvy too! As such, maybe we’ll see an increase in our post-war baby boomers readily accepting and embracing Digital First? We’ll see…

How Practice Index can help

Whilst I can only surmise, Professor Chris Whitty (CMO for NHS England) has already stated that “the NHS will never go back to what it was, and changes already made so far, will form part of new norm going forward”.

Therefore, we’ve needed to bolster our policy library to ensure that all are fit for the post-COVID techno-savvy world, and in recent weeks the following policies have been raised or significantly updated:

1. Firstly, we have the new Virtual by Default Policy [PLUS] that details the need for practices to manage footfall within their practice as a response to the COVID-19 pandemic.

It outlines the need for the practice to remain responsive to governmental COVID-19 initiatives as the pandemic continues to apply exceptional demands upon all healthcare resources across the UK.

This document is supported by NHS E Guidance on general practice in the context of COVID-19 v3 dated 8th June 2020.

2. Latterly, it was felt that there was a need to revamp the Audio-Visual and Photography Policy [PLUS} and to move away from what was a resource for a GP trainee in their use of AV recording equipment to support the more modern requirement of these alternative forms of consultations, plus what is needed to be done with digital media, such as the email and attached image of a child’s stomach once received.

3. Additionally, and as detailed above, the CQC-friendly Patient survey – Telephone and online appointments [PLUS] will support a better understanding of your patients’ particular needs.

It’s hoped that this will provide the invaluable support that you require.

As always, good luck.


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Mat Phillips

Mat Phillips

Mat Phillips is a Practice Manager and clinical governance specialist, facilitator and trainer. A primary care career spanning 30+ years within the NHS, in the UK Oil and Gas Industry and Royal Navy. Mat now provides specialist consultancy support to Practice Index and the wider primary care community.

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