3 Considerations for the Future of GP Remote Consultations
Just under a year ago we wrote a blog that considered the UK-wide implementation of GP remote consultations, and its impact on the experience of patients. Since writing that we’ve had two further ‘lockdown’ periods and are currently coping with the Delta Variant. As the COVID-19 restrictions are lifted, the LDA Research team thought it an appropriate moment to revisit the use of technology for patient consultations.
We asked a range of patients how they have coped with GP remote consultations over the past few months. Based on their responses, we’ve come up 3 considerations that are likely to be key to their ongoing application for local GP surgeries.
The Rapid Implementation of Remote Consultations
In 2020 the avoidance of face-to-face contact between patients and HCPs became an integral part of the UK’s attempt to contain coronavirus. The implementation of technology-facilitated consultations was one of the most extensive and rapid reforms undertaken by the NHS since its inception. The success of the operation was even more impressive given that it involved a significant change in the relationship between doctors and their patients.
Technologies Used by NHS Patients During 1st Lockdown.
YouGov research carried out in October 2020 showed that the most common experience of remote consultations was by phone. The use of video consultations occurred via askmyGP software which was being trialled in a number of GP practices prior to the outbreak of the pandemic. Where the software was originally in use, adoption of video consultations dipped in March 2020, before returning to 2019 averages. Telephone consultations, however, increased by 12% as did online messaging.
Patient Responses to Tech-Based GP Consultations
For the public, the rapid roll-out of tech solutions in the NHS represented emergency measures taken in a national crisis situation. The fact that medical services were maintained under these conditions garnered widespread approval. Younger people in particular reported a positive experience:
22-year-old, no serious health conditions
“I don’t frequently attend the doctors, and as I have no serious illnesses/concerns I don’t have a problem with having a virtual consultation, for the most part. If I think back to when I did used to go to the doctors pre-covid it’s only ever been a quick chat that could’ve been done over the phone, so I think it’s convenient. Especially if it’s during the week when you’re working, you can just wait for the phone call instead of having to make the trip and then enduring the waiting times. I think it’s more time convenient.
However, I think I would like the option, depending on the nature of the issue. If it’s something that I would physically want them to see or check I would want to go in but if it’s something where I can just talk about my symptoms, I would happily do that over the phone/video.
For example, I recently had a change with a mole and wanted to get it checked but I was just asked to send a picture of it. I had a slight worry that it may not be the most effective method and I thought is sending across a picture enough?”
Where patients had an ongoing relationship with a GP practice, perhaps due to health problems over a period of time, responses tended to be positive. Trusting relationships with HCPs are difficult to nurture via a video screen or telephone, so relationships developed in person, and then maintained in a hybrid form (where restrictions allow), are considered a productive use of technology.
48-year-old woman with long-standing, complex and serious health problem
“I’m lucky with my GP and my consultants – I think that the fact that they know me well and that I have a healthcare background helps a lot with communication. I find our current system with my GP very easy to use and it allows me to fit medical consultations around work.
At my practice, you fill in an online form outlining what you need and that is then reviewed by the doctor. You can request an appointment also through the portal. Recently I had a lump on my hand that I was worried about as I am at high risk of skin cancer because of previous ciclosporin use. I was able to describe the problem and upload a picture. The GP called me back the next day and invited me to pop down to see him. So I got a face-to-face appointment within 30 minutes and also a referral to my dermatologist.
However, I appreciate that this system works best for people who are happy to use an online portal.”
Half of patients over 55 who accessed GP services via telephone or video felt that their experience offered a reduction in value when compared with pre-COVID-19 healthcare. This could be to do with older patients feeling less confident when using a smartphone, or laptop. Alternatively, patients over 55 are likely to have a number of health concerns they want to deal with, and a phone call may not be the appropriate way to manage them.
80 year old patient with multiple co-morbidities
“It has been really hard to access GP services over the last year and I feel a bit like I’ve been left to struggle on my own. Its almost impossible to get an appointment with a doctor and when I do get one it’s a phone call. It’s really hard to get the right help over the phone. I find it easy to forget what the doctor has said, also its hard for me to be prepared with what I want to say because they can phone at any time, this can be quite stressful. Sometimes I can be waiting for hours to receive a call.
If I am in pain or worried about something happening to me its hard to deal with. I would prefer to see the same doctor face to face, I have a mixture of health problems and they all effect each other, when we talk over the phone they only look at one thing, they also can’t really see how I am, which I think is important.
I need someone to see me and talk to me as a whole person and address these problems more holistically, which really can only be done face to face. I would also like to have a set appointment so I can bring someone with me and they can listen to what the doctor says also in case I forget something, I can’t do this if it’s a phone call.”
3 Considerations for the Future of GP Remote Consultations
Throughout the first UK lock-down, demands for appointments dropped and then rose again in the summer 2020. A year on, society is ‘learning to live with COVID’ and the demand for appointments is threatening to overwhelm GP practices.
In the context of COVID-19 vaccines, NHS England has recently offered new guidance to to GPs. It requires them to provide face-to-face appointments if patients state a preference. Remote consultations should be maintained and recommended “where patients find benefit in them”. Given that we are currently negotiating a new relationship with our GP practices, it may be helpful to consider:
1. Patients and HCPs need to collaborate in identifying the ‘benefits’ of remote consultations
Introducing technology as an emergency measure is very different from embedding it in communities as a standard way of accessing your GP. Consultation between GPs and patients would help to shift the cultural acceptance of this new form of access.
2. Not everyone has access to digital technology, or a safe space at home
We currently know very little about the impact a tech-first approach to healthcare has had upon poor and vulnerable communities with no access to the equipment or space needed for a remote consultation.
3. Think about the shift from crisis to ‘the new normal’.
As the national emergency starts to recede, surgeries have a cultural job to do in persuading patients that tech is good for normal life as well as lock-down life. This may require conversations about the best mix of online and face-to-face experiences for patients who will need to access GP services regularly.
About LDA Research
LDA Research is an international qualitative research provider. Set up in 2011 by Lucy Doorbar, we specialise in providing global intelligence in the pharmaceutical industry and medical device sector. We have dedicated healthcare panels in the UK and US, as well as a network of international associate. The LDA team can be your eyes and ears wherever you need to be. From local culture to regulation and reimbursement, we can be relied upon to find the appropriate specialists for your requirements.