Online access and triage must become the norm across Scottish general practice

Kris McLaughlin joined in Aberdeenshire in 2012 and has a special interest in respiratory medicine. He is the Clinical Lead for the Grampian Respiratory Managed Clinical Network and is Hospital Medical Director for Kincardine Community Hospital.

In March 2020 NHS England advised primary care to go digital-first to protect patients, clinicians and staff from COVID-19. Surgeries were to assess patients online, over telephone and video appointments wherever possible.

Funding for online consultation (OLC) services varies across the UK. The 2016 Five Year Forward View offered English practices funding for online improvements. Wales and Northern Ireland received no funding. Scottish funding focused on appointment booking and video consultations so practices have primarily self-funded these services, with NHS Grampian delivering OLCs at scale through local Primary Care Improvement Plans (PCIP).

OLCs must become the norm in general practice, with appropriate national funding. The needs and challenges of patients and professionals don’t differ because of our location. A triage-first approach is necessary to continue delivering care.

Patient management and preference

Our phone lines have remained largely manageable, with many patients understanding the need to try OLCs to ensure they can access the practice. The ability to review and read structured and consistent patient histories has enabled us to triage patients quickly and decide on the best care. Those with the greatest clinical need must be the priority, not those who happen to have secured appointment weeks in advance. We cannot continue with long waits for routine appointments that might not be needed. This pandemic has highlighted the weakness of such outdated practices. Responsive, agile services that can provide rapid advice and action within appropriate time frames are what is needed now.

A supported patient education campaign is also needed to explain the rationale for this new way to access healthcare and to support the population in taking more responsibility for their care. Why are we asking patients to spend time queuing on the phone, travelling to the practice, and interacting with other potentially sick people in the waiting room, when many can be helped remotely? Why aren’t we keeping GP practices as a safe space for patients requiring dedicated care or physical consultations? These are the questions that COVID-19 has forced us to consider.

Innovation can lead to improved care

General Practice has lagged behind other industries in terms of providing online access. Banking, shopping, booking holidays, and a large amount of social interaction are all conducted virtually by much of the population. The recent rise and success of virtual FinTech banks are evidence of this. The numbers of people ‘living online’ continues to increase exponentially. This must be mirrored by our primary care patient interface so that services remain relevant and accessible to most of our patients. Interconnectivity between data and services will strengthen the care we can provide across sectors.

In my experience access for all patients has improved, not just the young or digitally savvy. By shifting most patients to consult online, telephone access has improved for complex patients or those unwilling or unable to go online. These are the patients most in need of our expertise and whose experience of primary care is least likely to change through the introduction of digital services and remote consultations. For others, their experience will better with improved access, faster responses and appropriate advice and information about the next steps. Patients with long term conditions can now update clinicians on their condition online, with telephone calls to support management, leaving only those needing physical tests coming into the practice.

A better way to sustain primary care

For clinicians and practice staff, our experience has improved. The day is still full but demand is predictable and manageable. Work can be more appropriately assigned by the scope of practice, and administrative requests quickly identified and allocated. Care navigators/receptionists can direct patients to the OLC process, support others via telephone, or arrange appointments for patients that clinicians need to bring in. Triage hubs have allowed the pooling of clinicians’ sub-specialities and experiences, improving teamwork and better supporting patients. This has mainly been borne from the ability to better manage our workload. Pressured days can be broken up by reviewing and responding to OLCs. We can even leave the practice on time or work from home.

Has this not proven that online access and triage are critical during this health and professional crisis, and should be recognised with national funding for Scotland?

 

Featured photo by Marissa Demuner on Unsplash