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Primary Care

Primary care has leapt forward during COVID19 — we can’t go back

Riccardo Garavani  | 12th June 2020

In this period of increasing alarm with Coronavirus a global problem, adding to existing NHS pressure, we highlight the ways in which accessing primary care in the UK has changed. Digital solutions are available and in use across the NHS that are allowing GP surgeries to triage their patients quickly and safely, gathering a patient’s history in their own time. This leads to a better patient experience, more appropriate and timely care for those that need it, and improved work-life balance for otherwise overwhelmed NHS staff. Remote triage is saving lives by protecting staff and patients from spreading the virus, as well as by allowing sick patients to get the most appropriate help quickly.

It’s Monday morning and you have 100 calls in the phone queue already — it’s only 08:15. Most of your patients won’t get the help they need. Your routine appointment slots are booked out for the next four weeks; half of them have the bare minimum information, some might only have a full stop. First come, first served. That’s the way it’s always been.

In many ways, the NHS has been torn between processes from 70 years ago, when it was created for all the right reasons, and the demands and needs of the 21st-century patient population. An ageing, complex patient population — increasingly digitally savvy.

Key to note is that this is a population that for the last 30 to 40 years has become accustomed to fast-paced innovation in technology. We are undeniably entering, if we haven’t already, the Fourth Industrial Revolution. The speed of change and the development of new innovations is immense. Societal norms now are almost unimaginable to someone that might have time-travelled from 1948, when the NHS was founded.

The NHS has always fostered innovation, with many pioneering surgeries and drug discoveries under its belt. All in the name of improving patient safety and outcomes, with technology as the enabler. It’s impossible to imagine doing heart surgery without a heart-lung machine, and without all the drugs provided to sedate and avoid infection.

We can see now that Coronavirus has accelerated the use of digital and the NHS is now relying on it as its front door. A safety barrier between a virus that could, and is certainly threatening to, cripple health services around the world. It, however, is an intelligent door that allows those that still need help to get the help they need.

The NHS is increasingly raising awareness of online services to save lives during Coronavirus

Other industries have innovated digitally

Pre-Coronavirus, digital was slowly creeping into healthcare, and if done for the right reasons with safety at the forefront, it’s proving to be a game-changer. Banking and retail are prime examples of technology changing established routines. Many newer ‘challenger’ bank providers have no physical branch to visit. Same have online-only presences or there exist online exclusives for those that also have brick and mortar shops.

Everything you can do in person can be done online. When was the last time you went into a branch of your bank? Whoever thought you could get your food delivered to your house without having to physically select and pay for items in a supermarket? You can buy, try on, and return an item without ever leaving the house if you so wish. Except now we have no choice. We leave the house only for essential reasons. Thanks to digital innovation, we’ve realised it is possible to live in these conditions.

Let me be clear, that’s not to say that digital-only is the right or only way. Many people will still feel more comfortable with what they know, what they have experienced for most of their lives. Going to the bank might be a social event, a reason to get out of the house and see a familiar face. It’s something that might even sound more appealing in this mid-lockdown mentality.

Ultimately, healthcare is still underpinned by the experience of a trained clinician doing the best for a patient in need. But we are also a population open to change. Especially when convenience is king and the safety of millions of people is paramount.

Digital-first healthcare is sorely needed — and it’s working

This brings us back to our phone queue. Another 40 people are now on hold, and will inevitably be frustrated by the time they get a chance to speak to someone. The reception team will likely bear the brunt of this.

Online booking of appointments was supposed to help: open slots up to patients so they don’t have to call the practice. Self-service, like in retail or banking. However, this led to patients booking appointments ‘just in case’ they still feel that way in a few weeks. When they don’t, that appointment will likely be wasted. Did Not Attend rates across GP practices are unbelievably high considering the difficulties in getting appointments.

Telephone triage — a brilliant principle — is too reliant on someone (most likely a highly experienced and very expensive General Practitioner) calling them back to find out what they need and how they can be helped.

Online interactions with your GP are becoming more common

Enter digital triage through online consultations. Collect your patient history upfront in a structured and consistent way. Let your experienced clinicians understand the demand and allocate it to the most appropriate staff based on the resources available (resources that might change day to day). Spend your time looking after patients, providing advice and treatment, not on the phone trying to work out just how sick your patient is based on the one line they gave to your receptionist.

Primary care has been forced to move to patient history upfront because of Coronavirus. Triage before they walk through the door with an appointment booked with a full stop. Triage because your patients are putting themselves and your staff at risk by walking through the door.

We need to explain WHY to patients and now more than ever they will understand the value for themselves and for our stretched NHS staff. We need to reinforce the fact that the NHS is still there for them, but much like other elements of the world during Coronavirus, it’s a little bit different. Different — but also the future.

Through necessity, we have moved forward two years in the space of two weeks. We can’t go back to 140 patients waiting on the phone by 9 am. It doesn’t work for anyone.