When I co-created the eHub for the Hurley Group in 2017 it was to create a centralised workforce that would become highly skilled in remote, online consultations and help more patients. It has proven true - our team have now done over 80,000 online consultations.
Now, practices across the UK are having to move to triage-first primary care and rely on online consultation tools - some for the first time. Here are some of the key things I have learned about online consultations.
Pick the right consultation tool
With triage-first consultation, you need as much clinically relevant information as possible. You need this in front of you, and with online consultations all the relevant information can be collected in the patient’s own time - you don’t want to be calling patients to understand what the one sentence of history you may have really means.
Access is difficult because of lack of capacity, not because of the mode of access. Video consultations will not solve capacity issues. It still needs 10 minutes of a clinician and a patient at the same time (assuming the internet can cope). Use video tactically, to target the cases that you might have called in but now can’t because of coronavirus. Think of it like a diagnostic tool, like a stethoscope.
Rethink what you have been taught
Depending on the type of online consultation solution you have available, you might already have a patient history in front of you. If this is the case, at first, no matter how experienced you are, you will inevitably want to 'retake' the patient’s history and start with an open question when you call or video them. That’s what you’ve been trained to do, since the day you started medical school. Try and resist this – it isn’t easy.
Dealing with and processing online consultations is a new skill set for us all and takes time and practice to develop. As experienced online clinicians we now use the history received through our eConsult platform to formulate a management plan, or set of questions we need to ask, before we contact the patient (if needed).
This means a quick check that nothing has changed and then straight into the plan or focussed questions. This means you operate efficiently with time and can do more with less, without cutting corners.
You will find yourself beginning to think more like a radiologist - how will your actions change your management of the patient? Do I really need to see this patient, or can I get the information I need through a phone call or video appointment or even the medical record? Do I have enough information to know they need an investigation before an examination - if yes, I can save us both some time.
The more you do the better you get
Most GPs will transition from wanting to see the majority, to then telephone and, finally, remotely messaging most patients. Once you build up confidence you will find that you naturally end up closing more encounters remotely. We have found that 85-90% can be closed without an appointment.
Use the history alongside the record
With online consultations, especially where you have a history up front, you will learn to read and extract the most relevant information quickly. Alongside access to the patient’s record, this powerful combination will help you decide on next steps. All without a patient sat in front of you. This means you create head space to consider difficult cases more carefully, check online resources or message a colleague If you're unsure how to proceed.
While physical cues can be lost in online interactions, cues exist in written language just as much as physical language - a single word can change your management. I always remember a case of routine knee pain, which indicated no concerns. 'Why are they consulting?' I thought. Tucked away in the consultation was a comment that their father had osteosarcoma of the knee...cue phone call.
You’re still human
Be empathetic - when you don’t see someone physically it’s easy to forget empathy. Everyone should do an online consultation for themselves and go through the process from a patient's perspective. Always think 'How would I feel if I got this response?' before you respond to your patient.
- Dr Ross Dyer-Smith is a GP partner of the Hurley Group, and specialises in online consultations. He created the first 'eHub' in the UK delivering online consultations at scale across multiple practices. He is also a graduate of the newly-created NHS Digital Academy and a former GP federation director.
- The RCGP has produced new guidance in light of the COVID-19 outbreak on undertaking video consultations in general practice here.
- The BMA has advice on remote consultations and homeworking here.