The use of online and video consultations during the COVID-19 pandemic - delivering the best care to patients

Dr Minal Bakhai, Deputy Director and Clinical Lead for Digital First Primary Care at NHS England and NHS Improvement and a GP in London, set outs the extraordinary way general practice has adopted online and video consultations in response to COVID-19. 

There has been some amazing innovation happening in General Practice. As a GP I’m proud of the agility and incredible change that has been led locally at pace. We have rapidly moved towards delivering a ‘total triage’ model of care enabled by online, video and telephone consultations. Safe, secure and flexible, these solutions provide choice, and are helping to minimise the spread of COVID-19 by supporting patients to stay at home, while still enabling them to receive the care they need.

Online consultations are now available in 85% of practices, covering 86% of the population with a further 10% of practices soon to go live. Video consultations are now available in 99% of practices, covering 99% of the population.

Practices are embracing a service improvement mindset to successfully adapt and embed new ways of working into their own setting. The next step is optimisation, realising full benefits will require an investment of effort which should not be underestimated. To help practices there is nationally funded support, with access to technical and QI expertise, providing personalised hands-on capacity to develop your digital offer.

Top tips on delivering an effective remote consultation

There is growing confidence in online and video consulting. We have produced guidance, e-learning and other free resources which can be found on our FutureNHS platform to support clinicians and practice staff.

Here are a few top tips when consulting with a patient online:

• Try to enable continuity with a clinician already known to the patient. Online consultations have been shown to work best as part of an ongoing clinician-patient relationship.
• Be clear about the rules of engagement, how the online consultation process works, service hours and response times. Patients are more satisfied if it feels personal and meets expectations.
• Write in the tone you would normally use to communicate with patients. Don’t worry about composing messages to make them ‘sound right’. Avoid ‘essays’.
• Extract the most relevant information from the history provided in the online form, combining this with information in the patient’s record to decide on next steps. Don’t re-take the history, do check your understanding and the patient’s expectation.
• Provide clear safety-netting instructions, this is particularly important when you have not been able to see or speak to the patient
• Regularly debrief with colleagues, take peer reviewed decisions for difficult cases and consider a shared working space to avoid isolation
• Use feedback from patients and staff and use routine data reports from your supplier to understand impact and monitor demand patterns to flex capacity
• Use pre-set messages or questions which can then be personalised to save time

Encouraging people to seek help when they need it and supporting patients with new ways to access services

It is important that during this pandemic, patients still feel empowered to seek help and care when they need it and understand the different ways to access our services (including making them aware of routes for non-digital users), letting them know general practice is still open.

Recently the NHS launched a new drive to persuade the public to seek urgent care and treatment as well as the Health at Home campaign to help patients to understand the different ways in which they can access non-emergency NHS digital services from home. The campaign includes information and videos for patients about how to access GP services, how to have an online and video consultation, and how to order repeat prescriptions online. This toolkit from Public Health England contains information that can be used by practices and patients.

Moving forward beyond COVID-19

Patients are embracing new ways of accessing healthcare and clinicians have been overwhelmingly positive about their experience of using online and video consultations. There’s certainly a view that this will now become a core part of the general practice offer and should be used synergistically with face to face consultations to enhance traditional models of care.

To inform how we build on the strengths and shape services going forwards, we are undertaking a deep dive evaluation with patients and practices to rapidly learn more about the benefits and unintended consequences, while also working on standardising the data collected to support practices, PCNs and commissioners to obtain robust and timely evidence about the impact of these technologies and support service and solution development.

The Long Term Plan provides a clear commitment that every patient in England will have the right to digital first primary care. Coronavirus has forever changed the way healthcare will be delivered, and in doing so, has helped to accelerate us to a digital first future. By embracing a culture of collaborative improvement, we have proved we can rapidly adopt innovation and bring about dramatic and sustainable change.