A few years ago, when I was a university student in Southampton from Newcastle Upon Tyne, I was awaiting results from a biopsy I had a month before. I was given a follow up appointment date, which was to discuss the results from the procedure. This wasn't my first biopsy and I had been with the same urologist/consultant for two years; I believe we had managed to build a good rapport. Unfortunately, I had to travel home (Newcastle) tqo days before my appointment. This meant I could not attend the follow up appointment as planned. If you think getting a GP appointment is hard, getting an appointment with the urologist (at the time) was even harder! I called the urologist's secretary and asked if the face to face appointment could be changed to a telephone appointment. She wasn't sure if this was possible so I left the message with her, to hear back later that day. I got a call from the urologist (on the same day); he too informed me that he wasn't sure if it was 'allowed' to do the review over the phone and he would get back to me after confirming this. The next day, he called me and to my delight, whoever he had to confirm with had agreed to a telephone appointment.
I wonder how many students travel between their university homes back to their homes for an appointment? Yes, there are GP surgeries and hospitals with well trained staff across the country, but what about the students who have long-term conditions and have been seeing the same consultant/GP for years and are not comfortable changing their GP or consultant? However, that's a topic I'll discuss in my next piece.
Fast forward a few years, the most recent phenomenon in healthcare is the use of virtual consultations. Almost all of my urology department follow up appointments have now been over the phone and if I have a non-urgent concern which I need my GP to answer, I send a message on the GP surgery's online 'chat' platform. Most GPs now have an online chat system where patients can message a GP and get a response from one of the GPs at the surgery (within 24-48 hours). Although face to face appointments are still the most popular appointments, telephone appointments and video consultations are now also popular options, as highlighted in the "NHS Digital (2019) Appointments in General Practice, February 2019." This is all part of 'Disruptive (Health) Innovation'—a phrase I was introduced to at the Tech Expo Humber, during a talk by Rob Lewis (Edenic Group and 54degrees North). NHS organisations are constantly looking for ways to meet the rising demand for services (KPIs) and achieve savings. It'll be interesting to find out how the usage of the GP online services compares to the use of 'private platforms' and factors which influence the differences (if there are any). Private healthcare platforms such as Babylon health, Push Doctor etc, take long waiting times for appointments with GPs out of the patient pathway/patient journey, utilise smartphones and the internet, which a lot of people now have access to, to put 'healthcare in the hands' of the patient', promote patient autonomy - allowing the patient to manage their own health and choose when to speak to a doctor depending on their schedule, no more waiting around in the surgery waiting rooms even if you're early for your appointment! However, all of this comes at a fee (this varies with the provider/platform you use) for the patient, potential financial savings for the NHS as non-urgent appointments are sometimes filtered out, reduced GP workload and contribute to the overall transformation of outpatient care.
I've recently worked as a Patient Care advisor in a company which provided telephone assessments for non-urgent patients. There were mixed reactions to a telephone assessment, when I offered these to patients. Some were thrilled to be able to speak to a trained professional on the same day or in a couple of days. However, common concerns I got from patients were; "How are they going to be able to tell what's wrong with me over the phone?", "Is it another admin person I'm going to be speaking to?", "Why can't I go to see someone face to face?", "I prefer face to face appointments.", "Will I speak to the same person again?", "Will they be able to see my records?", and "Is this all privatisation of the NHS?" These questions are similar to the findings from my literature review on "The primary bottlenecks and opportunities for use of self-logged data for differential diagnosis and care planning during patient visits to primary care providers," as part of a Health informatics university module in 2017. 'The 'patient' has evolved and this is important because patients are the consumers of care and influence the delivery of care too. Some healthcare platforms have successfully recognised and responded to; the patient's need to be able to control their appointments around their busy schedules, challenges in the healthcare system including; increase in demand for services and staff shortages, to 'put healthcare in the hands of the patient'. Others are still working on presenting their Value and justifying why it is better to pay for a virtual consultation than to wait weeks (sometimes) for a face to face appointment with any GP. Healthcare app platforms should be aware of the 'Healthcare trends' in their target regions/patient groups, maintain 'Personalisation—tailored care' and high quality of care received in face to face appointments, familiarise themselves with and meet 'Patient expectations' especially because their service comes at an additional cost, seek and promote opportunities for 'Collaborative working' with GP clinics/the NHS to reduce duplication of the patient record (the patient won't have to share their story twice) and the NHS is also on the drive to develop similar apps, and go beyond just providing a virtual consultation service but also participate in 'Health Engagement/Public Health promotion' activities.
If you or your organisation require a literature review of current policies, strategies related to your healthcare project/organisation or a review of your current healthcare project please email me on [email protected]
Bharadwaj V Chada Virtual consultations in general practice: embracing innovation, carefully https://bjgp.org/content/67/659/264
Babylon Health https://www.babylonhealth.com/
Push Doctor https://www.pushdoctor.co.uk/
54degrees North https://www.54degreesnorth.co.uk/
David Gilbert—The Patient Revolution: How we can heal the healthcare system (book)
Dr Stephen Black, Insights from NHS Digital GP appointment (2019) data https://public.tableau.com/profile/matt.black#!/vizhome/gpapptanalysisv1_2pub/insightsfromGPappointmentdata
NHS Digital (2019) Appointments in General Practice, February 2019 https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice/february-2019
Lisa Hollins, Transforming outpatient care, https://www.england.nhs.uk/blog/transforming-outpatient-care/
NHSEngland, General Practice Forward View https://www.england.nhs.uk/gp/gpfv/
NHS Innovation Accelerator, Understanding how and why the NHS adopts innovation https://nhsaccelerator.com/wp-content/uploads/2018/11/NHS-Innovation-Accelerator-Understanding-how-and-why-the-NHS-adopts-innovation.pdf
Nicola Merrifield, How technology is changing the GP consultation http://www.pulsetoday.co.uk/news/gp-topics/it/how-technology-is-changing-the-gp-consultation/20037389.article
NHS, Start using GP online services https://www.nhs.uk/using-the-nhs/nhs-services/gps/gp-online-services/
About the Creator
ltc_stu
24, Lived experience of a long-term health condition (ltc), passionate about healthcare improvement.
MSc Human Factors and Patient Safety student
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