Covid19, healthcare and general practice?

As a GP I know all too well how busy life can be in general practice with patients saying they ‘can’t get an appointment’ while we keep expanding our skill mix and employing more locum doctors to help manage increasing demand and workload.

I have been working remotely with patients using VitruCare for many years to manage chronic diseases and care home patients using video calls to transform care and manage patient demand,  however, with Covid-19 this way of working has been brought into sharp focus across the NHS and the world by this pandemic!

Covid 19 and the lockdown dramatically reduced the number of patients coming to the practice, we have had to change all our systems and processes for social distancing, isolation and ensure personal protective equipment was in place – this has been a shock to the whole NHS, patients and everyone. Patients remain worried about coming to the practice or going to the hospital in case they became infected with Covid-19. So, in one ‘fell swoop’ Covid-19 has leapfrogged the NHS to use digital services like never before despite previous attempts through national policy objectives!

Several weeks into the lockdown I continue to manage patients using remote consultations by phone, video, and email messaging, which many patients have accepted given the situation and the daily number of consultations are now rising. There are instances where face to-face consultations are needed, and these patients are seen with protective measures in place as appropriate. 

I get the sense from my daily conversations with patients that there is much anxiety about the crisis which is impacting the mental health of many patients. People are still not coming forward when they have problems and what happened to all the acute patients we used to see or the medical and surgical emergencies we referred into hospital? Also, the feedback from care homes show they are finding it difficult to cope with the crisis and there is the potential for Covid-19 to get worse before it improves in care homes. People generally cannot wait for this crisis to settle so some normality returns.

But what next?

I can imagine that once the lockdown is lifted, we will have long queues of patients outside the practice wanting appointments. In some cases, this will be justified, but in a large majority they will not need a face-to-face appointment and could be managed remotely.  Our own triage figures before the Covid-19 crises shows that up to 60% of patients do not need a face-to-face appointment and 75% of patients in a care home setting can be managed by video consultation using VitruCare services.

With the change in mindset and cultural shift resulting from the Covid-19 crisis in patients and NHS staff remote working is getting embedded in NHS and healthcare systems around the world ( evidence shows remote working is becoming more acceptable for both clinicians and patient, McKinseys Covid-19 Consumer Surveys 2020)  and we must ensure that we don’t return to the unmanageable situation before Covid-19.  Whilst manpower, and skill mix are important the opportunity to embed the use of digital health now firmly into routine working must be consolidated. VitruCare services developed by Dynamic Health Systems can understand patient requirements remotely using Ai and direct patients to interact with the practice so that their needs can be addressed in the most appropriate and streamlined way reducing the need for face-to-face consultations. These types of services can help manage the return to normality for patient benefit, help provider organisations manage demand, yield greater productivity, and enable the NHS to thrive.

Prof Shahid Ali

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