Using digital technology to ease the burden on general practice has been heavily underlined by the Royal College of General Practitioners and its members. One NHS England policy response has been to promote the use of online and video consultations. However, the current approach needs to look at what works if it is to genuinely make a difference on the practice front line.
The use of technology to help make general practice Fit for the Future is a central part of the RCGP’s vision for sustainable primary care. GPs are positive about using technology, as are their peers in secondary care.
Research from the Royal College of Physicians has shown that 70% of doctors think that outpatient consultations could be carried out using video, for example.
In turn, the new GP contract says all practices should be offering online consultations by April 2020, and video consultations by April 2021.
But the rush to the digitised doctor-patient relationship misses two important points.
Firstly, most people still use the phone to speak to their GP.
Secondly, whilst new technology is being deployed effectively in some places, the evidence base for using such innovations is still being developed.
The risk is that, while video and online tools are becoming increasingly relevant for some patients and doctors, we do not focus enough attention on making improvements that can address current wants and needs for practices and patients alike.
Understanding healthcare users
NHS England is enthusiastic about potential channel shift, and is supporting practices willing to make the change. Its 190-plus page implementation toolkit sets out how practices could implement online consultation.
It’s very useful, if you are going down that route. However, it seems to forget an inconvenient truth – very few people are currently using online and video consultation tools to communicate with their GP.
For the majority of people, the phone is still their first, and preferred communication channel.
Pulse Today has reported, for example, that twice as many patients prefer phone to face-to-face consultations. Only 0.1% wanted to be contacted via video.
According to the 2019 GP Patient Survey, 78% of people use the phone to book an appointment with their GP.
In addition, the age and socio-economic groups that make the most use of NHS services are still using traditional communications channels.
Almost half of those over 75, for example, have not used the internet in the last three months. Those of lower socio-economic status are also less likely to go online, but these are the groups who have greater healthcare needs.
And it is not just some patient groups that depend on the phone; professionals do too.
Data from thousands of interactions analysed by online consultation provider askmyGP shows that, when there is a free choice of all available channels, 43% of those patients who used an online service to contact their GP wanted a phone call in response.
This data showed that clinicians actually resolve such requests face-to-face 38% of the time, and over the phone 35% of the time. The doctor chose which was the best channel to answer the request; sometimes it meant seeing someone in person, sometimes it was over the phone.
Our own research shows that video is highly suitable in some circumstances. For example, a GP talking to a parent of a child with a skin complaint can use ‘video-on-demand’ to see first hand what the problem is.
Much of the time, the doctor can recognise the problem and make the appropriate recommendation, removing the need for both the patient and professional to go through the inconvenience, or even the impossibility of a face-to-face meeting.
The underlying message is that technology needs to ‘understand users, their needs and the context’; coincidentally, this is the first principle of the government’s code of conduct for health and care technology.
Failing to meet real needs
That is not to say that new communication channels should be avoided. Online consultation tools are showing some promise, helping GPs to manage demand and patients to get answers.
Similarly, video communication technology is an important part of the communication mix. It can also benefit collaboration between GP and hospital consultant, or members of primary care networks.
Undoubtedly, these will form an important part of communication going forward, and we are actively involved in supporting and providing such services ourselves.
For certain groups, such tools can be highly valuable; as academic studies note, patients with mobility or mental health issues can benefit from video consultations.
The right communication channels can make a huge difference to access and continuity of care.
Robust and reliable phone systems should be one of those channels.
Yet the number saying it was easy to get through on phone is falling – from 81% to 2012 to 68% according to the 2019 GP patient survey.
Many practices are struggling with ageing phone systems so only people with the fastest fingers get through.
Doctors feel the impact too; the collaboration that is vital in helping practices come together as part of primary care networks is made all the more challenging if the phone system is down.
Many of us can benefit from the move to digital forms of communication. One of the most obvious forms – digital, cloud-based telephony – appears to be somewhat off the radar of some in primary care.
Meeting immediate needs
What benefits can digitally-driven VOIP telephone systems bring?
They can provide multiple lines for a practice, quickly and with minimal downtime. Patients can get through more easily, or be called back if they are held in a queue.
Power outages can be less disruptive, as doctors and practice staff can re-route phone lines to mobile devices if disaster strikes.
Telephone enhancements such as interactive voice response can signpost patients to other services, when demand is at a peak. Ultimately, this could use natural language processing to provide even more detailed information to patients.
Modern telephony can provide video-on-demand, so doctors can switch to a virtual consultation with ease. This can also bring people together, such as other members of the primary care network in online meetings. Hard to reach consultants can become part of the consultation – and all at the click of a link.
Integrating telephony with the clinical system is easing the admin burden on staff. Telephone triage is helping GPs work more flexibly. Having more phone lines and call-back functionality is providing a better patient experience, and addressing access issues.
Many of these positive impacts are not isolated to the telephone; online consultation, for example, can help signpost patients in a highly cost-effective manner.
However, to get to these benefits, practices might have to transform the processes they use to interact with patients, to get close to providing what can already be achieved with existing technology.
With the phone, behaviour and process change is minimal. It is simple, powerful technology that can rapidly deliver significant benefits to general practice, and the population each surgery serves.
Where do we go next
With GPs facing huge demands on their time, what we need is quick-win solutions that can meet multiple needs for patients and professionals alike.
However, the current policy drive appears to be translating digital innovation in patient communication as online and video consultation.
This might look impressive to those who are comfortable with what technology can provide; for those who use the NHS the most, it can be an obstacle to accessing care.
We need to take the time to understand the right communications channels, and what will work, for patients and professionals.
Let’s look at the evidence, working with the academic community, and take the same approach to technology as we do for clinical practice.
In the meantime, let’s recognise that phone systems have evolved, and ensure that general practice sees digital telephony as part of the solution for technology-driven, sustainable care.