The rapid scaling of IT within general practice

5 June 2020

Continuing with the theme of silver linings during COVID-19 this week, I am keen to reflect on the rapid upscaling of IT in general practice and update you on a couple of pieces of work that I hope you will find of interest.

Advances in IT

The speed at which general practice has adopted virtual consulting options (telephone triage and consulting, video consulting) to minimise unnecessary face to face consulting, while maintaining safe, efficient and accessible primary care has been phenomenal.

Normally, this scale of change would take years in the NHS, and once again, general practice has adapted and risen to the challenge.

Every practice in Scotland now has NHSNearMe installed.

More than 100,000 NearMe consultations have taken place in NHS Scotland from March to May, with more than a third of these taking place in general practice. Although this change in our way of working has been a necessity, it has brought with it many benefits:

  • it helps us retain our home-working workforce
  • it avoids unnecessary travel for patients (conferring environmental benefit)
  • it offers more flexibility for clinicians and patients
  • it works well for those patients who find attending the practice an anxiety-provoking experience
  • it’s easy to use, even for someone like me who is not naturally technology inclined! 

There is work underway to explore the potential for this new technology to support our vulnerable residents in care homes and our community nursing colleagues.

The opportunities for improving interface working between primary and secondary care through enhanced availability of clinical decision support and three-way consulting with patients (being trialled by paediatrics) are also exciting. 

Support where it's needed

But there are of course important caveats. The basics need supporting. As a colleague said to me last week, "Tech-enabled is not the same as tech-embedded."

For this to work well, we need:

  • adequate broadband speed
  • reliable remote access
  • rapidly accessible eHealth support
  • training issues identified and addressed.

There is still the potential to upscale the amount of video consulting equipment available in each practice, although our smart phones can also be used (and the data usage is not high).

I am also acutely aware that there are certain groups of patients who risk being disadvantaged by this type of access to healthcare - those with:

  • digital poverty
  • literacy issues
  • learning disabilities
  • mental health issues
  • visual or hearing impairments
  • English as a second language
  • cognitive impairments
  • frailty.

These challenges are not insurmountable, but require careful thought, and I have been in regular communication with the evaluation teams who are actively considering how all these groups can be specifically supported to avoid health inequalities developing or worsening.

Although digital healthcare confers many benefits, as GPs we are also acutely aware of what can be 'missing' when we are not able to see our patients face to face.

Ours is a speciality built on long term relationships of trust and continuity of care.

While virtual consulting can support this to a certain extent, we all know the clinical scenarios where face to face care remains an essential part of what we are able to do in terms of opportunistic care, understanding the hidden agenda or casting an eye over the vulnerable family.

Virtual care at scale will be part of our professional lives for the foreseeable future, so what we need to consider is how it can release face to face time in clinical practice for the patients who most need it and benefit from it.

It is so important that we own this narrative as a profession and offer leadership on what we think ‘good’ looks like for the future of general practice, and not let it be unduly influenced by simplistic arguments of cost-effectiveness and access. 

The future of general practice and COVID

This is just one aspect of the future of general practice in the COVID landscape that I’m sure will be discussed when RCGP Scottish Council meet (virtually) next week, along with our RCGP Scotland Faculty Board colleagues.

Our Council meetings are always a great opportunity to come together and discuss the big issues of the day.

We have kept in touch throughout the pandemic by creating an email list server for discussion and holding update meetings, but this will be our first formal Council meeting since the COVID-19 pandemic altered our ways of working and priorities so drastically. I am really looking forward to catching up with colleagues.

On the same evening, I will be delivering a (pre-recorded) webinar for the Royal College of Physicians of Glasgow (RCPSG) on digital health care in general practice as part of its COVID-19 series.

Next week’s theme is How We Remobilise the Health Service and I will be presenting alongside colleagues from surgical and cancer specialities.

Details of how to view this can be found on the RCPSG website.

Tackling inequalities

This week’s news has rightfully been dominated by the scenes coming from the US following the appalling death of George Floyd in police custody.

This is yet another reminder of the stark inequality that exists in the world, which requires, not only recognition, but urgent action to be taken to ensure that it is tackled.

I was pleased to have the opportunity to share my views on tackling divisions around race in Scotland and a range of other current issues when I appeared on BBC Scotland’s Debate Night programme on Wednesday night.

The panel, made up of myself, Cabinet Secretary for Justice Humza Yousef MSP, Jamie Greene MSP and broadcaster Ayesha Hazaraki,answered questions from the remote audience on a diverse range of topics, such as:

  • the Black Lives Matter protests
  • how we ensure equitable healthcare systems
  • regional variation in approaches to easing lockdown
  • the mental health implications of the pandemic.

The full programme is still available to watch and you can catch up on snippets via the Debate Night Twitter feed.

Health inequalities questions and answers

Finally, I’m delighted to let you know that you can access my interview with Professor Sir Michael Marmot, which went live over the weekend. As I discussed in last week’s blog, Michael is a personal hero of mine and I felt honoured to be able to speak at length with him about:

  • the many different aspects of health inequalities
  • how COVID-19 has shone a spotlight on the challenges that many people face in their daily lives
  • what we, as individual GPs, and our College, can practically do for our most socially vulnerable patients.

Please remember, you can always get in touch with me through scottishc@rcgp.org.uk.


Post written by

Dr Carey Lunan, Chair RCGP Scotland

Dr Carey Lunan is a GP partner in one of Edinburgh's Deep End practices and is the current Chair of RCGP Scotland.

Prior to this, she held the role of Executive Officer for Patients and Public and Interface working. She also sits on the RCGP Ethics Committee.

Her priorities during her time as Chair include a focus on practitioner wellbeing, improving the interface between primary and secondary care, and growing and retaining the GP workforce.

She has made tackling health inequalities a high priority and has consistently called for the need to engage the public in a national conversation about the realistic role of the modern NHS and the importance of collective social responsibility.

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