The doctor will Zoom you now... how the GP surgery went virtual
Doctors have been forced to adopt telemedicine, fast. But, asks, Lauren Libbert is it as good as face-to-face?
Last week Alex Kremer was out running with her dog when she tripped and fell on to the pavement, cutting both her hands. For two days, she managed the cuts at home with antiseptic cream and plasters but then her hands started to swell and the wounds oozed with pus.
Worried about the infection, she called her GP surgery and within the hour a GP called her back, just as she was parking outside Sainsbury’s.
“She sent me a text message link while we were on the phone in my car so we could transfer over to video and she could look at the state of my hands,” says Alex, 33, a birth and parenting specialist, from Letchworth in Hertfordshire. “It was all very simple and easy and within 10 minutes, she’d sent the prescription through to the pharmacy at Sainsbury’s and I got out of the car and went to pick up the antibiotics.”
Alex, a busy working mother with two children under five, was impressed with the convenience of this new virtual offering. “It certainly beat having to take time off work, sort out childcare and wait in a surgery, with everyone coughing and spluttering around you,” she says.
While convenience is clearly one advantage to “telemedicine”, it is, of course, coronavirus that has propelled primary healthcare into the digital age after years of dragging its feet.
At the beginning of March, the NHS urged Britain’s 7,000 GP surgeries to reduce face-to-face appointments to prevent the transmission of Covid-19.
Matt Hancock, the Health Secretary, reinforced the switch, saying: “Unless there are clinical or practical reasons, all consultations should be done by telemedicine.”
It revolutionised GP surgeries pretty much overnight. Gone were the waiting rooms full of sick patients or those awaiting prescriptions.
Instead, patient consultations were swiftly moved over to phone or video and GPS had to pick up new ways of working – and fast. “We’ve been encouraged to adopt digital technology for years but suddenly laptops and new software were being handed to us and everything changed overnight,” says Dr Debra Libbert, a GP partner in a practice in Prestwich, north Manchester, which serves more than 12,000 patients. “We’ve always done phone consultations but now it is one of our main offerings, and people are only coming in to see us face-to-face for essential services, such as baby checks, childhood immunisations and blood checks.”
But can remote consultations be as effective as face-to-face? What about the visual clues that could be missed?
Scott Dixon, 49, host of the consumer website thegrumpygit.com, developed an itchy rash on his right wrist in the middle of March that turned into flu-like symptoms.
“I deteriorated rapidly and after speaking to two different GPS on the phone within days and trying to ring 111 twice without success, I rang 999 and was admitted to the Edinburgh Royal Infirmary,” he says. “Both GPS missed my coronavirus symptoms despite me saying I had an excruciating headache, hot and cold sweats, loss of appetite and was constantly coughing.
“I was simply told to rest, take paracetamol and drink plenty of water. They thought it was a viral infection, not realising I was developing pneumonia on my lungs. I spent three nights in hospital before being allowed to recuperate at home, where I’m still weak but recovering.”
Dr DJ Hamblin-brown, a former senior A&E doctor at the Maidstone and Tunbridge Wells Hospital, acknowledges that remote consultations have their limitations.
“If a person is acutely unwell, it’s going to be hard to give them a firm diagnosis without doing a traditional physical exam but it’s very useful for the ‘worried well’ who make up 30 per cent of the people coming into A&E and simply need reassurance.”
Over 50 himself and an asthmatic, Dr Hamblin-brown set up doctorinthehouse.net in response to the pandemic – a free, not-for-profit system of virtual doctors supporting the NHS using senior or “vulnerable” medical volunteers, who can’t work during the crisis but are happy to do consultations by phone or video.
“The front door of medicine is about screening patients and ensuring the right patients go to the right place and get the help or reassurance they need,” he says.
With a history of long waiting times and GP surgeries swamped before Covid-19 hit, this online “front door” of expert screening should free up more time for GPS and make practices more efficient in the long run.
“We are going to have a huge backlog of patients from this crisis who are worryingly staying away from hospitals and surgeries now because of Covid,” says Dr Kenny Livingstone, an A&E doctor at the Royal Free Hospital in London and chief medical officer of Zoomdoc, a private service launched in 2017 that allows access to GPS instantly by phone, online or in person. “The new digital solutions that have been put in place means GPS now have a more effective system of triage, which should vastly reduce the number of time-consuming face-to-face consultations needed in the future.”
But, according to Dr Libbert, there is something about face-to-face care that can’t quite be replaced.
“So much about general practice is taking the time to listen to patients, so they can talk and explore how they’re feeling and unburden themselves on you. Patients so often say on their way out, ‘I feel so much better now I’ve seen you.’ There’ll be a lot of less of that if we rely completely on telemedicine.”
‘It’s useful for the “worried well” who make up 30pc of those coming to A&E’