THE DOCTOR WON’T SEE YOU NOW - GPs AND THE PANDEMIC

How audio trumps video for remote GP appointments

“We’ve seen two years’ worth of digital transformation in two months.” That was  Microsoft’s Satya Nadella speaking in April 2020 - but it could have been any of the UK’s General Practitioners. 

Faced with unprecedented demand from patients but unable to have their waiting-rooms filled with people who might infect each other with Covid, they had to do what many had put off for years - go digital.

Nearly two years on from the start of the pandemic, I’ve been speaking to one doctor who was prepared because he has long been an evangelist for better use of technology in healthcare. Dr Hussain Gandhi is a GP based in Nottingham - he also has a YouTube channel, runs a platform providing tech training and is active on social media as @drgandalf52. 

Some headlines from our conversation;

• Right now, as Omicron brings staff shortages not just to surgeries but to health visitor services and pharmacies “many general practices are as close to breaking point as we’ve been.”

• Remote consultations have been an essential tool in the pandemic and they’re here to stay -  “it's not a great use of my clinical time just to see someone to give them a prescription.  It's not a great use of the patient's time.”

• Patients want more use of tech, not less - “often I get patients saying, well, why can't you just WhatsApp me?”

• Simple phone appointments have proved more effective than video consultations which are overhyped - “telephone is a really good technology, you can convey quite a lot of information fairly quickly.”

• His message to newspapers demanding a return to exclusively face-to-face appointments - “Well, let's be honest, they're stuck in the past, and they need to get with it.”

Dr Gandhi is the first guest in a regular series of Always On interviews with  interesting people in the healthtech world. You can watch our full conversation here:

When the pandemic arrived, Dr Gandhi and his colleagues were better placed than many to introduce remote consultations. They already had a system of telephone triage so that before fixing an appointment a patient’s needs could be assessed. That was quickly adapted so that more online or telephone consultations could be offered, with face-to-face appointments only where there was a real need, for instance for patients with learning difficulties.

What made things easier was that the practice was furnished with good modern IT systems, partly because Hussain Gandhi had arrived nearly a decade earlier as a geeky young doctor eager for change:

“I was always frustrated about trying to share information with patients and how difficult it was to do that. We were very reliant on printing off stuff for patients.”

He set about creating an online dashboard for patients, giving them links to useful information. But whereas some patients have always wanted faster progress with tech - hence the requests to message via WhatsApp which is not approved for use by GPs - the pandemic brought a different challenge.

Now, everyone had to adapt to this digital era, whether they liked it or not. And Dr Gandhi quickly found that what was supposed to be the most modern solution - video consultations - did not work for many people:

“You need to have the infrastructure, you need to have the right equipments, you need to have the right systems to enable that to happen. Most people don’t have 5G, many don’t have 4G. A lot of practices don't actually have the internet capacity to even do video consultations.”

So the good old fashioned telephone has been the main method for the surgery’s remote appointments during the pandemic - “most people know how to use a telephone.”

But will we ever go back to a situation where face-to-face appointments are the norm? While patients were understanding at the beginning of the pandemic about the need to stay away from the surgery, Dr Gandhi says that has changed as the world has opened up again. He says a lot of people are now saying, “I can go out to the shop, and it's not a problem, why can't I just come down to my GP?”

So will that ever happen? “Hopefully we’ll end up going back to a system where yes, it's easier to see your GP. I think many practices will probably still stick to the method of having some form of remote contact first, just because it can be so much more effective in terms of delivering health care, in particular, when you're trying to deliver health care on a shoestring budget.”

So, whatever the Daily Mail may say, this GP is not going back to the world before Covid, even after the almost intolerable pressure of recent weeks eases. Dr Gandhi told me that the day before we spoke he had seen 10 patients face to face and spoken to 30 on the phone, and on one day when he had been in charge of telephone triage he’d had 78 “patient interactions’.

Digital transformation of general practice has been painful for some patients, and the pace of change is now likely to slow. But given the huge backlog of people waiting to be seen, it seems impractical to return to a time when waiting rooms were packed with patients just wanting a chat or a prescription.

What do you think of the move to remote consultations by GPs? Patient or doctor, I’m eager to hear your views.