Remote appointments and getting back to a new normal for routine care

In Dr Andy, our in-house GP’s latest blog, he talks about the measures his GP surgery has in place to protect staff and patients, and what the ‘new normal’ of routine care could look like.

Before the pandemic, some parts of the NHS had already been using telephone, email, and text more often as a way of communicating between doctors, nurses, and their patients. My GP practice was doing this because there were always more people wanting an appointment than there were appointments available, which was then causing long waits. We also knew that for a lot of appointments, there wasn’t always a need for a physical examination, such as prescription requests, discussing results, and follow-up appointments to see if people’s symptoms were better. These slots could be used by people who needed a physical examination.

This approach also helped many patients who couldn’t get time off work, found it difficult to attend the surgery, or thought it unnecessary to disrupt their lives when they felt well. This included a lot of our patients with asthma.

At medical school, we’re taught that most of the time, talking to the patient is the most important part of a diagnosis or deciding on a treatment. This is definitely true, though there are times when I need to see someone in the flesh. This includes when I need to listen to a chest, see someone’s effort when breathing, or to carry out tests.

Remote appointments

Telephone reviews are useful for when we need to work out what help someone might need, and how urgently. In one case, a brief assessment on the phone led to someone getting urgent treatment on the same day, when they would have usually waited 4 weeks for a routine appointment. In another case, one of my patients would’ve waited weeks for an appointment to ask for some tests that they needed, and another few weeks to get the results. Instead, it took a few days from an initial telephone appointment to me explaining the results and doing a referral.

Don’t delay getting help if you need it. For people with new or worsening asthma symptoms, it’s crucial to see your doctor early, so that you can get the right tests and treatment. If you’ve been given treatment for a condition but it isn’t improving, it’s important to get reassessed by your doctor.

What GP surgeries look like now

As restrictions are easing, the focus on the safety of our most vulnerable patients has continued in GP surgeries by:

• all staff regularly washing their hands, with sanitiser provided for everyone visiting the surgery

• regular COVID-19 tests for staff

• reducing the number of people coming into the surgery (by using telephone or email as the first point of contact and encouraging online prescriptions)

• asking patients whether they have any COVID-19 symptoms before they attend appointments

• using different buildings or rooms for patients who were presenting with symptoms that could be COVID-19

• face coverings being used by those who are able to wear one

• maintaining space between people as much as possible

• using perspex barriers in places like reception

• additional cleaning of rooms and equipment between patients.

Looking ahead

With the effectiveness of the vaccination programme and the lower levels of COVID-19 infection in our communities, I think we’ll move back towards normal - but it’ll be a new normal. We’ll continue to see the NHS use remote appointments to provide support for more people in a way that is more convenient for many of our patients.

Hopefully, we’ll see a blend of remote and face-to-face appointments, so that the right people get the right care, at the right time.

Routine care

Routine care is also getting back to a ‘new normal’. GP surgeries have been given guidance on restarting tests such as spirometry and FeNO for our patients where the results will affect the care they need. Asthma reviews are now often carried out remotely, at least in part (symptom questionnaires, for example, might be done remotely). Some doctors and nurses are also comfortable doing inhaler technique checks and asthma action plans over video.

In summary, there are some great benefits to remote appointments, although they don’t suit everyone or every condition. Using them more often will help keep patients and staff safe, and allow the NHS to deal with more people more quickly. However, there’s still a significant role for face-to-face appointments, so that the right people can be assessed in the right way, to get the right treatment.

One of our Respiratory Nurse Specialists put together this blog about how to get the most out of your telephone or video appointment, which you might find useful.

Asthma research is severely underfunded

DID YOU KNOW: Research into respiratory diseases like asthma accounts for just 2% of all the medical research funding in the UK.

This underfunding is exactly why we launched the 2021 Research Appeal...