by Dr Murray Ellender

video consultation

Is anybody there?

Why video consultations are not the answer for general practice (yet)

When I talk to other clinicians about online consultation, they often think I mean video – perhaps because there’s been a lot of media interest in this form of consultation where, for a fee, you can speak to a doctor via a video call instead of visiting the surgery.

Video works well for private patients and, in a perfect world, it would be great for the NHS too.  Free for patients, who could talk to their doctor face-to-face from the comfort of their own home, or while they’re at work; easier for GPs, who could still ‘see’ patients without asking them to travel to the surgery.  But if we’re talking about saving time for GPs and giving patients better healthcare options, and if we’re looking at doing this across the NHS, I believe we’re still a long way from being able to offer video consultations as a workable solution in NHS general practice.

There are several reasons for this.  The first is that the NHS IT infrastructure is not able to support video consultation at scale.  The broadband service to most GP practices is pretty slow, which is fine for email and other basic requirements, but it won’t support several GPs doing video consultations simultaneously.  We carried out an extensive trial of video consultation in our Lewisham surgery about three years ago, but found that there were connection difficulties, or calls dropped out a lot, which often resulted in the GP just picking up the phone and resorting to a consultation by telephone.

The next issue is that a video consultation doesn’t actually save any time

We also found we had to spend quite a lot of time talking to the patients about the practicalities of a video call to ensure the technology was working properly at both ends, and that everybody understood how to use it.  Sometimes you can’t connect for various reasons, or you get through but it’s a bad signal.  So the consultation would focus on the technical issues, rather than the actual patient problem. You still only have a precious ten-minute slot and you don’t want to waste it.  In our trial, trying to conduct video consultations almost became a barrier rather than an enabler.

Another concern, while we’re on the subject of infrastructure, is that you need to have a webcam in every consulting room, and very few GP surgeries are currently set up for this.

The next issue is that a video consultation doesn’t actually save any time.  To make it work, you still need ten minutes of GP time and ten minutes of patient time in front of the camera.  It’s still necessary to take the patient history, just as you would if they were sitting in front of you in your consulting room.  The difference with our version of online consultation is that it’s asynchronous – you can get the information you need when the patient isn’t there, and decide how to address their health issues before you respond.

If video calls became another part of a GP’s patient contact schedule, it could actually add to the problem of time management, rather than helping solve it.  In a busy GP surgery in the morning, you may have 20 to 30 contacts.  It’s a real skill to run to time with that, and many GPs struggle.  Some patients take 20 minutes while others take five, and it’s very difficult to stick rigorously to time.  If you add video consultation, it could mean quite a lot of extra pressure.  For example, if you’ve scheduled a call with someone, you have to be there when you say you will be.  So that call needs to take place at 11am even if you’re running late.  It adds more stress to the GP’s day, rather than helping alleviate it, and in the reality of the NHS you could be doing several of these scheduled video consultations a day.

We were keen to try video consultation when we were shaping the eConsult offering, and maybe we will come back to it when the technology is slicker.  But the results of our research led us to come up with a better idea – to gather information asynchronously, up-front and push it to the GP in a format that helps give them the details they need before they contact the patient.  Done in this way, electronic consultation really does save time and it’s much more efficient.

Niche applications

I do think video consultation should be used wherever it adds value, and there are certain scenarios where it works very well.  For example, video consultation is great in situations where getting to the surgery is very difficult, such as in rural Scotland where there’s an hour’s drive to the surgery.  In our trial we had some patients who were quite young, very digitally adept but housebound, and it was ideal for them too.

Like AI, video consultation has a place, and we need to keep considering ways in which these technologies can help us improve patient access

At eConsult, we’re currently revisiting video as we evolve into an urgent care platform.  If you are a parent with a sick child at 2am on a Saturday night and you ring the GP out-of-hours service, invariably you will be invited to bring the child in.  But I can take a history over the phone, and there might be value in my seeing the child before deciding whether they need to come in.  This is where a video consult could be really useful.

Like AI, video consultation has a place, and we need to keep considering ways in which these technologies can help us improve patient access and make GPs’ jobs less stressful and more productive.  As the NHS evolves, there may be a time when video consultation could be another option for general practice, but I don’t think we’re quite there yet.