4 May 2020

Blog by Dr Sian Stokes

Dr Sian Stokes,
GP, The Village Medical Centre, Wallasey

My worry is, where are the patients with suspected heart attacks and cancer – those with breast lumps or suspicious skin blemishes; I am worried that there are a lot of people out there who should be coming to us for help, but are staying away.

I am only seeing a few patients face to face; we triage patients over the phone first and then consider whether we need to see them.

In the past, a patient would call reception to request an appointment or else book online; or an appointment could be booked as a follow up.

Now, a GP or nurse carries out the triage call and we are finding that for most people, a phone call is enough. We offered phone consultations before Covid-19, but we now have a lower threshold for managing things over the phone – for instance we may prescribe antibiotics for chest infections if appropriate and we don’t always see the patients first; and we are issuing more repeat prescriptions.

This has been our biggest change and it has been massive; we are seeing relatively few patients face to face but only after triage and only if their condition cannot be managed by a telephone or video consultation. We didn’t have the capability to do this before COVID-19. The company which provides our AccuRx secure text messaging service is only small, yet over a weekend they developed an extension to the app so we can clink on a link and have a video call.

It is very simple to use and it happened so quickly! If it wasn’t for Covid-19 there would have been 20 hoops to jump through and a lot of paperwork. It is safe to use, it can’t be hacked and it is perfect.

So I can be having a phone conversation with a patient and if he mentions a rash for instance, we can immediately switch to a video consultation.

We are seeing care home residents in the same way; care home staff are using their own mobile phones so that we can talk to them and the residents. It is quite safe on the app as nothing is recorded or stored. We are doing lots of video consultations, which is great.

Issuing prescriptions has changed. We have been working hard over the last few years to get people to use the online system to order prescriptions, but even when they do, some people still like to come to the surgery to collect their prescription rather than it going directly to the pharmacy.

Some patients attend the practice fairly regularly, either for appointments or a blood test or to collect a prescription. It will be a big change for some patients that they are no longer coming on such a regular basis.

We have been using e-Consult for the last nine months; people answer a series of questions online which can end by providing some advice, eg on dealing with back pain or hay fever. Before COVID, we didn’t have many patients using it but uptake has really increased. We still often have to contact the patient by telephone or video, but the app ensures that patients are dealt with by the correct person and only when required.

My worry is, where are the patients with suspected heart attacks and cancer – those with breast lumps or suspicious skin blemishes; I am worried that there are a lot of people out there who should be coming to us for help, but are staying away.

The pace of change has been good; I get really frustrated by the length of time it takes to implement any change – and Covid-19 has been a massive unblocker.

Before, we were probably seeing lots of people we didn’t need to see, though the other side of that is the large number of people who we should be seeing, but aren’t. There is definitely a large cohort of patients who aren’t coming forward.

When we started remote working I was off for a fortnight self-isolating, while another of our GPs was at home shielding a vulnerable person. Four of our eight GPs have had to self-isolate for a fortnight but have not become ill so have been trying to work from home. But it is a bit frustrating because we only have two laptops in the practice set up with the NHS N3 special connection, which we need to get into our system.

It means that only two of us can work from home at the same time; we have been promised more laptops but they haven’t arrived yet.

I think we will continue to use telephone triage and video consultations but I suspect e-Consult will fall away as it is too cumbersome and I’m not convinced patients like it, they prefer a phone call.

Video consultations with a secure app are being used throughout the country now and it would be very difficult to go back – there is no way I want to go back.

Story told on 16 April 2020

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