The arrival of Covid-19 has prompted a dramatic but fundamental change in the practice of primary care within the UK.
Like many prospective medical students my age, I was unable to carry out any hands-on medical work experience as a result of Covid-19. Therefore I decided to get in contact with several different doctors to broaden my understanding of different medical professions, and to learn how the pandemic had impacted them and their work. I spoke over Zoom with a general practitioner in Nottingham who told me about the rapid changes that had taken place in general practice across England, and the remarkable shift from face-to-face appointments to online and telephone appointments that had occurred.
In this article, I am going to explore the impact that Covid-19 has already had on general practice and how it will affect the running of GP surgeries in the future.
The key change that has occurred is the increased use of technology in primary care to ensure doctors and patients can comply with social distancing measures. As a result, practices have seen a large rise in remote consultations by telephone and video since last year. For example, in 2019 fewer than 1% of appointments were done via video link with 80% being in person. However as of April this year, this figure has been turned on its head, with only 8% of appointments being carried out face-to-face. Technology has also been incorporated to allow for practice meetings to be moved to digital video platforms such as Zoom and Skype, which allowed for extended members of the team to be invited to meetings, irrespective of their geographical location. Software has also been used to support text exchanges with patients. In addition to this, before the Covid-19 outbreak, not every patient was triaged before a planned GP consultation, yet now 100% of patients are triaged. This means every patient should be clinically assessed either online, by phone or by video, before any face-to-face contact with a doctor. This helps to reduce avoidable footfall in practices and protect patients and staff from the risks of infection.
One of the companies that has been providing the platform to enable video consultations is AccuRx, a health tech start-up that already has an SMS tool used by GPs. The week that GPs were told that face-to-face appointments needed to be replaced, AccuRx built a new video consultation service that weekend. The solution was tested on the Monday morning then enabled for 3,600 practices across the country that afternoon. Since then, the number of practices using it has gone from 3,600 to 5,700, which is over 80% of practices in the country.
There are, however, challenges with the increased use of technology. For example, whilst working from home GPs have reported frustrations with IT problems such as slow NHS laptops. Personal laptops often cannot be used for consultations because they do not allow access to the Electronic Patient Record. This ultimately has cost implications for surgeries as they must fund compatible computers. In response to this, some practices are already using systems like Away From My Desk, which enables remote secure working from home.
Furthermore, only 54 % of patients over the age of 74 have internet access in their homes, and whether patients can receive a digitally enabled service depends on where they live. There is therefore a risk of creating inequalities through digital health care. Those without a smartphone or digital skills, or those without money for data or a private space to talk, will struggle with remote consultations and experience worse access. Consequently, there was significant variability in take-up of and access to online services.
Despite these, there are many positives to the changes that have occurred. Martin Marshall, Chairman of the Royal College of General Practitioners, said in a recent article that it has taken ‘two and bit weeks (during Lockdown) to achieve more than we have achieved in 20 years’ in adopting new technology.
But what do these changes mean for the future of general practice and which technological elements will be embedded permanently? Martin Marshall has said: ‘I don’t see us doing all of our consultations over the phone or online, but certainly up to 50% is possible.’ There are still occasions where patients need to attend a practice in person, such as where blood pressures or oxygen saturation needs to be read, he said.
The next stage in developing the technology used in primary care will be to use Artificial Intelligence to direct the online consultation to the right clinician through the right modality (SMS, online message, phone, video, or face-to-face). AI technology is also being used to transform healthcare in a variety of other settings. For example, capturing the history, observations, and pre-ordering of investigations using self-check-in arrival screens in Emergency Departments and the use of predictive technologies in detecting health conditions before symptoms become apparent.
It is clear that whenever this crisis finally passes, the landscape of how GPs function will have changed forever. Yet to embed the positive work that has been done during the pandemic and ensure that it is sustainable in the future, it needs to be underpinned by adequate funding, infrastructure, and the necessary workforce.
Fenella, Head Girl
Photo Credit – GOMBERT, SIGRID/SCIENCE PHOTO LIBRARY
