The RCGP report, Fit For The Future, believes that GP practices will need to evolve into “wellbeing hubs” to meet our primary healthcare needs. I’ve been thinking about what this means for our surgeries, and what needs to change.
Walk into any typical GP building this morning, and you’ll see a familiar picture. A reception desk, where a solid team are booking appointments and spending a lot of time firefighting, answering the questions of worried parents, anxious elderly folk and many poorly people. You’ll see a waiting room, never empty, where patients sit, concerned about their own health, and mindful of what other illnesses may be sat beside them. You’ll see screens repeating helpful surgery information, notice boards, and maybe, a steady queue of people collecting prescriptions from the pharmacy. GP surgeries are already hubs, of community, of activity. But they are hubs with no spokes – wheels without propulsion.
The RCGP report, proposes a scenario where, when needing their GP surgery, patients are seen by a team of health professionals, with access increasingly being by digital and video means. Here, I see the formation of the spokes – solid pillars of better, more appropriate healthcare support reaching out to the community. As clinicians, we have to evolve how we offer our help to patients, it needs to be far more appropriate to the way they live their lives.
Video appointments create channels of communication between clinician and patient that we are all familiar. At Refero, where I am a Clinical Safety Officer, we believe that care should be devolved directly into the home, the university hall, the care home, and even the school using video appointments with clinicians for a wide range of mental and physical health issues.
Let’s look at that typical morning surgery again and see how those spokes would benefit the people sitting within. The receptionist shouldn’t be the person who decides how the patient sees the doctor, that should be the choice of the patient. Using an app-based booking and triage process, the spokes supporting the patients of the wellbeing hub can be created.
The worried parent, with the baby with suspected chickenpox, could have spoken to a pharmacist that morning by video appointment, where the spots could have been examined and advice given on making the baby comfortable. The anxious elderly lady, with a history of swollen legs could have been referred to a consultant by her GP following a quick teleconsultation, meaning she didn’t have to get the bus to the surgery. The electrician, missing a paid job because of waiting times at the practice, could have exchanged instant messages with a GP on his break regarding care for his hamstring injury. The student, late for their first appointment at a new surgery in their college town, would get to speak to a GP about their breathlessness and exam stress from the privacy of a special corner of their halls of residence.
Those solid spokes to the healthcare hub fit our modern expectations of communication with everybody – friends, family, work and wellbeing. Teleconsultation’s benefits are simple – more patients will be seen, in an appropriate way, giving better chances of health to them, and better chances of job satisfaction to every person working in the primary care environment. Most of all, it doesn’t threaten an end to being able to see a doctor in their surgery. It actually means one has more chance of being able to do just that, if you want to.
We believe a more secure, more reliable Skype alternative could be at the centre of the creation of the health hubs the RCGP suggests. Skype isn’t fit for this purpose, there are issues with patient confidentiality and governance, as well as not providing a secure and easy enough connection between healthcare and patient. Dedicated telemedicine solutions, which are as easy to use and familiar to people, providing a platform of engagement which builds the solid spokes for our healthcare hubs, will work.
I’m wholeheartedly in agreement with the Fit for The Future Report. Any GP practice can be transformed by telemedicine. It’s as applicable to the rural, two-GP surgery as it is to the inner-city partnership. The cost to the patient of video conferencing is of course, nothing, similar to those apps we all use for messaging and sharing photos and calls. However, the cost of not having access to clinicians can be, as we all know, immeasurable. We need to enable our patients to make that call.
Dr Ian Jackson is Medical Director and Clinical Safety Officer at Refero.