Primary Care needs evolution, not a revolution

Dr Jay Verma

by Dr Jay Verma

GP Parner and Medloop Clinical Advisor

Patients have always had a right to see their GP. Even during the pandemic, this has never changed and I doubt any practising GP will say that they were unable to see patients who needed a face to face appointment for proper clinical diagnosis.

What has changed is the increased levels of administrative and clinical workload in primary care.

Everyone deserves access to care – not just the select few.

As a GP I want to help as many patients as I can and digital triage might help with this. Might. If it is done properly and not as a tick box exercise to meet a government target.

Many patients are receiving prompt advice through digital triage and, if needed, they are being called into the practice for a face to face appointment. This was, and still is, a mutual agreement between the patient and the doctor. The very essence of the symbiotic relationship we are trying to preserve. But it is clearly not working in all cases.

So the climb down on trying to implement digital methods is not the answer to either the problem of patients not being able to see their GP or the tragic failures during the pandemic of ill people getting face to face appointments and diagnostic referrals.

Because what no one seems to have pointed out so far is that the many bulk purchased methods used in primary care were not even digitising legacy methods – they were actually adding a new level of work and in many cases resulted in such a large increase of paperwork that non clinical staff were making triage decisions.

This is the practice which needs to stop.

In an open letter to its patients one practice, Ivy Grove, tried to explain the rationale behind the steps it had taken in using one particular online triaging product which they used as a way to try to manage their patient workload and due to Covid-19 NHS England implemented a policy of a digital front door to primary care.

‘Our experience,’ they wrote, ‘is that it has been like opening up a brand new lane on a full motorway that was already littered with roadworks and having an instant traffic jam as a result.’

Digital triage does have a role but it should not be viewed as a barbed wire fence between patients and GPs.  We need to stop perceiving it and treating it as such but rather improve the system.

Filling out incessant questions might not be the right method but it has helped to reduce telephone call queuing. All online systems must state clearly that they are not suitable for emergencies. But apart from some red flag filters the sorts of machine learning algorithms which have been developed are not implemented within the currently used software. What we need to get to is a system where urgent cases can call the practice and be booked in for an appointment. But for that to happen, patients need to be happy with the alternative. And clearly, they aren’t.

Ivy Grove, for example, has 16 telephone lines for incoming and outgoing calls, yet these were constantly engaged.

What we should therefore look at is a less burdensome digital triage system which patients have faith in.

As a GP I have always believed patients have the right to the best care and that is not always an appointment with their GP. Sometimes they need self care, sometimes to see a nurse or a first contact physio. We won’t do anyone any favours if we become so scared to say no to patients that we give appointments to anyone who has asked instead of having a system where the most urgent cases are seen first. If you have a cold, I cannot suggest anything more than your local pharmacist would suggest. Patients need to be confident they are not being fobbed off and there are a variety of ways for doing this but they all involve communication and education.

Administrative staff now have more capacity and we can look at training them to become health and wellbeing coaches. They are NOT clinicians and cannot replace clinicians but they do have experiences which are useful and can be trained to provide further signposting. But never should anyone in primary care deny a patient in pain or worry about an appointment with their GP.

With the increase in nurse numbers and the move towards shared resources via primary care networks, we really can develop new ways of working which will benefit everyone.

My practice uses digital triage and we were able to increase our capacity as a practice to dealing with five more patients per day per clinician. It also lowered the time receptionists were spending on the phone by 26 hours in a month. That number signifies a significant drop in people having to wait on hold to the practice.

It’s not the perfect solution and I personally would love to talk to senior figures in the NHS and Department of Health to explain the opportunities proper tech can bring. Because a survey resulting in pages of notes for someone to read is not digital.

We don’t need a revolution, we need evolution. We cannot replace clinicians with machines and we must not have any more repeats of the tragic case of Joy Stokes and the many others who over the past year have been unable to get a quick diagnosis.

We need to work together if we are to make the NHS more resilient. That starts from people taking responsibility for their own health and an understanding that GPs cannot just magic appointments or treatments from thin air to deal with day to day minor illnesses and ailments. And from our side, it means implementing a system which patients have faith in, where people can see a GP or suitable clinician and they do not feel like the system they pay for is working against them.

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