The switch to digital care – a GP’s perspective

Dr Kevan Ritchie is a GP partner at the Bloomsbury Surgery in the heart of Camden. He qualified as a GP in 2007 and has worked in Camden ever since. Dr Ritchie is a GP Trainer and is an elected Governing Body Member and Clinical Representative for Camden on the North Central London Clinical Commissioning Group.

Dr Ritchie has been at the frontline during the Covid-19 pandemic, supporting patients at his surgery as well as playing a strategic role in healthcare planning across Camden and north-central London.

Back in June, Healthwatch Camden published a blog titled ‘Changing the ways we access health and care services’ which outlined resident experiences with the sudden switch to digital caused by Covid-19. Dr Kevan Ritchie comments on this switch to digital from a GP’s perspective.

Covid-19 has changed the delivery of health care in many ways and at an unprecedented pace. The initial phases of the pandemic were very confusing and uncertain as we were dealing with an unpredictable foe.

When the government announced lockdown at the end of March, our practice was already engaged in the Covid-19 response. We quickly realised we needed to ensure a safe environment for staff and patients. Per the initial advice, we were double-checking whether someone had travelled before allowing them into the practice. Once it was clear Covid-19 was spreading rapidly in London, ahead of the national advice we started operating a ‘virtual first’ triage model of care.

We knew full well that as a small practice we were vulnerable if a few of us became unwell at the same time, and how we would then struggle to provide a service to our patients. Some of our staff are categorised as vulnerable. Therefore, we created a safe ‘bubble’, and ensured that anyone entering the practice from outside the ‘bubble’ did so in a safe and controlled manner.

In late March I faced a very difficult dilemma when I became unwell. It was a terrible weekend trying to decide if I should I go in to work and risk infecting others or stay away and let my colleagues and patients down. As with many people, the initial Covid-19 symptoms can be very vague and I had no cough, so even as a doctor I was unsure if it was Covid-19. However, I became so unwell the decision was taken from me. It later turned out that I did have the virus. Fortunately, because of our safe and cautious approach in the practice, I hadn’t made anyone else unwell.

I didn’t need to go to the hospital and have since fully recovered. Not everyone was so lucky. Though it varied practice by practice, we at the Bloomsbury Surgery were surprised by the high numbers of patients with Covid-19 symptoms and the information we got from the hospitals about our own patients who were very unwell, some of whom didn’t make it. It was heart-breaking. From a clinical perspective, we became aware of the unpredictable course of the Covid-19 infection. It also become clear the virus had landed significantly in London.

Everyone is aware of the challenges in tackling the Covid-19 outbreak, and the way primary care was catapulted into making fast changes to answer those challenges. It has been a major adjustment for clinicians as well as patients in dealing with a ‘virtual first’ model of care that minimises face-to-face contact. We certainly, by necessity, rushed into this change, and it possibly saved the service during trying times, as well as saved lives through avoiding unnecessary contacts.

As GPs, we do love the personal contact with patients. Much of our job satisfaction is derived from this, and our diagnostic and clinical management skills utilise all aspects of communication, both verbal and non-verbal. During the pandemic we found making safe virtual assessments very challenging as people seemed okay but would suddenly deteriorate. Fortunately, ‘hot hubs’ (clinical assessment centres set up so clinicians could safely see patients with suspected Covid-19 symptoms if they needed to be seen) allowed safe physical assessments, but every day we found ourselves holding risk and uncertainty.

We understand the new model of clinical provision but we miss the old one too. We also understand the limitations of this new model. It makes many things more difficult including making subtle diagnosis and picking up safeguarding risks, amongst others. GP services being accessible and sustainable is of course crucial during this time, and the online model undoubtedly supports this. However, there are aspects of the model we are still learning about, for example how to manage the workload and flow, and exactly how to utilise it optimally. At times patients just need to be seen physically.

Clinically, we have noted both advantages and disadvantages. Patient responses to the new model have varied. Many are very happy with convenience, but others find it frustrating and annoying. We of course need to adapt access and assessment for those with limited digital skills, and sensory or other impairments. We need to engage with our patients on this, and we need to understand and modify systems accordingly, and messaging is a big part of this. But likewise patients also need to go on a journey to help us sustain the NHS. We all need to understand our own roles in how we utilise the NHS services and what we expect from the NHS to ensure efficiency and sustainability.

Many patients are hoping things will go ‘back to normal’ when the pandemic is ‘over’. What they don’t realise is that the NHS was already moving towards increasing use of digital health and this has been a long-term objective of NHSE for sustainability. The acceleration caused by the Covid-19 response has meant that some obstacles have been rapidly overcome out of necessity. Still, much work needs to be done to ensure that digital solutions, e.g. online triage systems meet all requirements in terms of patient experience, equality and clinical safety and efficiency.

I am a firm believer in NHS GP services moving with the times to better serve the population and remain sustainable with increasing demand and more constrained resources. Extraordinary times require extraordinary solutions which include rapid decisions and rapid launches. Expediency is key. There are many challenges, but I have seen people in health working together collaboratively from different organisations like never before, and I think that bodes well for the future of the NHS.

A final word on GP services: we are open. If you have health needs, please contact us. If you are able to, please provide us with all relevant information on the online forms. It really helps us give you rapid appropriate assistance. But if you have problems doing this, call us and we will ensure your health needs are met.

Stay safe and well,

Truly yours,

Dr Kevan Ritchie