After having left a traditional salaried GP role a few months back, I have been adjusting to working completely remotely. Whilst there are advantages to working remotely there are also several drawbacks which should be considered by anyone working in a purely remote role.
What do I actually do?
My main responsibility is reviewing eConsults that patients submit via the practice website. My role is more of a supportive one to the GPs on site at the surgery.
An eConsult is essentially an online form completed by the patient which can be general or more specific, depending on the patient’s presenting complaint or problem. There are several standardised questions that the patient should complete, ideally as fully as possible, which make it easier for the clinician to understand the problem and therefore better help the patient.
The clinician receives the form and then decides how to best manage the patient. This could be in the form of an email with some self help advice and further reading and resources, or it could be with a phone call to help elucidate the issue or issues.
Regardless of the presenting problem, there are two main types of consults; administrative and clinical.
The former includes things like issuing new medical certificates or private letters. The latter encompasses clinical issues such as coughs and colds or musculoskeletal pain.
The role is very flexible and I can usually start at a time that suits me and complete the consults throughout the day or in one session. There is a set number that should be completed per hour. However, the amount that can be achieved in that time varies depending on what the issues are.
For example, eight consults could be completed within an hour very quickly because they are mainly administrative or simple clinical issues. However, there can be complex cases, such as severe mental health issues, which means the patient needs to be called. Referrals may need to be completed, or private letters, which could take some time to construct.
If a patient needs to be seen face-to-face or needs to be seen relatively urgently then I arrange this with the practice by sending a task to the relevant staff member or booking the patient in directly to the appropriate clinic.
Usually face-to-face appointments are for physical examinations, more complex cases such as those patients with multiple co-morbidities, or because it is the patient’s preference.
Advantages and disadvantages
One of the biggest drawbacks to working remotely is not having the patient physically in front of you; you lose a lot of non-verbal body language cues and of course you cannot conduct physical examinations. This in some ways means that the consultation can be harder and take longer to complete.
However, in my experience, the majority of cases seen remotely can be completed satisfactorily for both patient and GP and, as mentioned above, the patient can always been seen face-to-face if either party feels it is necessary.
Working remotely using eConsults can save a lot of time, especially when there are difficulties across the board with appointment availability. A medical certificate does not always need an appointment with a GP, this appointment could be reserved instead for an elderly patient with a complex medical history.
However, the system could disadvantage some patients. Some people may feel digitally excluded, especially if they have visual or hearing impairments, or if they are unable to communicate well in English. While there are tools to support this (such as translator services) some patients may still find remote consultations more difficult.
There is also the concern that socioeconomic disadvantages mean that some patients may not have access to smart phones, tablets or computers.
On the other hand, patients with physical or mobility issues, or carers and relatives, may prefer remote consulting as it saves them time, effort and the need to leave loved ones at home. Moreover, some patients struggle with being able to take time away from work and therefore submitting an eConsult and receiving an email or a telephone consultation can work well.
As a remote GP I do sometimes miss the interaction with staff and patients alike that is part of working in a GP surgery. However, there are still many ways to stay connected and this helps with feeling a part of a team.
Working completely remotely is not for everyone, but I believe it can help with pre-existing recruitment and retention issues.
More GP surgeries should consider creating completely remote roles, e-hubs (for completely remote staff) or a rota for staff to work remotely. The latter especially helps with issues around room availability that occur in practices, both large and small.
There seems to be a consensus that while remote consulting works well for certain groups of patients and staff it can never completely replace the need for patients to be seen face-to-face. Rather it should be used as an adjunct; to enhance and improve the existing way we work.
- Dr Patrice Baptiste is a GP in London. She has a YouTube channel aimed at supporting doctors and aspiring doctors during their careers.