Dr A – Technology and remote working

Dr A is the senior partner in a GP practice, which employs three part-time salaried GPs.

He has a strong personal interest in technology. His practice had been triaging patients via telephone calls or online forms for 12-18 months before the pandemic. Patients were then directed to self-care, the pharmacist, a nurse or, where appropriate, a GP. The practice was also already booking in video consultations between 6-8.30pm for those who could only attend in the evening.

During the pandemic, Dr A was able to tweak this system to adapt to the changing scenario. He explained, ‘it was a very, very easy switch because it was effectively business as usual, but with a slightly different [focus]’

In the first wave of the pandemic, GP consultations were mostly carried out via telephone, but some were by video. There were very few face-to-face appointments. Nurses were taking detailed histories and sometimes asking for photos of, for example, rashes. The doctor was then able to give advice on the condition, without actually having to contact the patient. Even physiotherapy was delivered digitally.

Dr A said, ‘COVID has catalysed everything for me. It's just brought everything forward. It's made everything quicker. It's made everything more acceptable.’

He appreciates that for other practices, the transformation may have been more challenging. But 2020 has allowed GPs to see how technology can be safely used.

He described, ‘The silver lining of this particularly dark cloud is that it's enabled us to transform the delivery of patient care that was planned to take months and years in a matter of days and weeks and months. It's made us realise that it is ultimately safe to deliver consultations via video, via telephone. We can triage very effectively. Actually, not that many people really do need a face-to-face appointment.’

However, there have been some resulting demand issues – doing things more quickly by phone or digitally can subsequently generate more work. He said, ‘if I see 40 patients in a morning rather than 20, suddenly I've got 40 blood results rather than 20 to look at the next day. Efficiency breeds more work.’

Also, while there has been huge digital uptake, at the same time many potential patients have stayed away, leading to a build-up of demand. ‘It's [the pandemic] massively polarised. By that I mean that COVID has made people stay away because of fear and necessity and all those negative things associated with that. There's suddenly significant unmet demand.’

While it’s been slightly less busy, it has still been busy. Catching up with things they couldn’t normally do, doctors had the opportunity to go through reports, review Quality Outcomes Framework1  populations, make sure chronic diseases are being monitored correctly, and carry out Primary Care Network (PCN) work. ‘I wouldn't say there is huge amounts of slack, but there was some slack there. General practice was probably running at 125%, so even that 25% reduction just still felt like a normal day,’ he says, ‘It's enabled them [GPs] maybe to get out of the trenches a little bit and see that life doesn't have to be as quite as hard and arduous as life has been in the past.’

Technology also enabled staff to keep in touch and attend meetings while homeworking or isolating. But this was one area where digital was not as effective  team working was ‘difficult’ as relationships and interactions were more ‘transactional,’ losing the usual conversations over coffee.

Going forward, Dr A would like to extend primary care triage into ‘smart triage’ using artificial intelligence, with people triaged initially electronically and in an automated way. ‘It's a balance between making people's journey far too complicated and needing to have 52 touchpoints before you see the right person, versus getting somebody in at the right place at the right time.’

He thinks video consultations should be kept too as they benefit both patients and doctors. By mixing them in with usual practice, they make working life less monotonous and therefore less stressful than continual face-to-face appointments. They also give doctors a new challenge.

Dr A said, ‘It's much better to use than the telephone, because of course we've now just got an interaction, which feels entirely different. I can see you, which for a human interaction is massively important. But to bridge how you're interacting, what you look like, are you well-kept, etc it adds a real richness.’ For the patients, he described, ‘Your day isn't interrupted at all, other than the 20 minutes we're having a conversation.’ Video is better than telephone, he feels, because patients feel less short changed, having an ‘in the flesh’ doctor in front of them.

The ‘new normal’ for him would ideally be a hybrid between, ‘the good stuff pre-pandemic and the good stuff from now, [delivering] a service that is flexible for all, enabling digital, enabling triage, enabling people to be seen by the right person at the right time.’

1 The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results.