You’re frustrated. I’m frustrated. Tweets, columns and Facebook posts have been claiming that GPs are closed. But my practice has been open – and has been all the way through the pandemic. GPs worked fast at the start of the pandemic to dramatically change our work, to meet demand and make surgeries safer. Covid “hot hubs”, video kit, flu vaccination season – we have been pulling together.
How are GPs working? There are variations, but basically it’s like this. In non-pandemic times, people could make an appointment to come in, by phoning or booking online. Now, patients call the surgery and speak to a doctor, and are either advised on the phone or a face-to-face appointment is arranged. Or, of course, a virtual video consultation. Matt Hancock, a patient of Babylon Healthcare (an online app and video-based GP service), is a fan.
“All consultations should be tele-consultations unless there’s a compelling reason not to,” he said in July. In September, Nicola Sturgeon said that, while she recognised that sometimes video consultation would not be appropriate, the intention was to make them the “default option for patient consultations”.
There is some logic to this. The waiting room has limited space; vulnerable patients should not be unduly exposed to infection; cleaning rooms and PPE between patients takes much time; and many things can be dealt with without both parties in the same room.
But the rush to make GPs video-first is a cause for great concern. Matt Hancock told the Tory party conference that 99 per cent of GPs were using video. Certainly, doctors have the kit, but it is only used for a tiny percentage of consultations. Why? I did lots of video consultations early in the pandemic but quickly cut back. It was inefficient. I was spending time fixing technology, not medical problems – bad sound, bad pictures, difficulty with connecting our rickety PCs.
Ten per cent of the population don’t use, or have never used, the internet. Even people with internet access may struggle. And examinations, injections, blood pressures and blood tests can’t be done remotely.
Certainly, some people may prefer video – especially for a one-off smaller problem, with no need for follow-up. But general practice deals with people over long periods of time – chronic conditions where symptoms come and go, mental illness whose symptoms relapse and remit, and symptoms that could mean something or nothing and need careful consideration.
There is a huge difference between people who already know each other, trying to do their best in a crisis, and doctors and patients who only meet remotely to deal with a problem not yet diagnosed or revealed.
Can a trustworthy relationship be built, satisfactorily, online? The truth is, we don’t know. Certain things – a pensive look, or a hesitation at the door, a hint of weight loss, an uneasy walk from the waiting room – add up. Continuity of care, an ongoing relationship with a doctor, are associated with better health (and lower cost to the NHS). We know that relationships in healthcare matter.
General practice should never be about ticking boxes for efficiency savings. Having “difficult conversations” about death, dying, and serious illness feels much easier when each knows the other – and much harder with strangers. Can we do this over a video? We don’t know.
Meantime, the phones are furiously busy, the waiting room is quieter, and I have an odd sort of loneliness. I don’t want to practice call-centre medicine. Unexpected turns of conversations, or even just chat with a patient on the way from the waiting room, and opening the door on the way out, are not minor things. They build a relationship that aids all sorts of future decisions.
It is knowing people over long periods of time that makes my work rewarding and worth investing myself in. The stress of the work is paid back by job satisfaction. Technology should never be adopted because it seems sexy, or is the personal preference of the current Secretary of State.
We need careful, individual judgments about what kind of consultation is safest and best to have – not missives from on high, capable of making huge inefficiencies, broadening digital inequalities, or threatening the relationships on which we depend. If general practice goes under, so does the rest of the NHS.