Covid-19 has been a driver of innovative practice at speed across the healthcare system which should be celebrated. In all sectors there has been a shift to remote care and primary care has adopted a proliferation of new tools, at pace, to enable online triage, delivery of care and video consultations. However, the pandemic and the pre-existing digital divide made it particularly difficult for some sectors of our communities to access primary care. This has become a more significant problem, one year into the pandemic and when the short-term digital solutions to manage shielding and infection control are becoming embedded practice.
Some primary care practices had been operating an eConsulting model, which means many of their patients interact digitally with the practice prior to the Covid-19 pandemic. Others moved very swiftly, in just a few weeks, to adopt technology and rollout a virtual service to patients that would also enable staff to work in a safe and effective fashion. From a survey* we undertook in May 2020 with primary care staff in Suffolk there was a broad endorsement of the rapid change to digital methods among GPs – specifically one in three GP respondents supported remote consultations, triage tools to enable access to care for those in need and the use of solutions to access clinical systems remotely.
However, using remote consultation as a first option was only endorsed by only a minority of GPs (23%) with 26% saying they would do fewer remote consultations or stop them entirely in the future. The reasons given for this included that these consultations can take more time and that patients should be seen face-to-face unless a patient chooses otherwise, or there is a good reason to the contrary. Eight clinical staff (17%) also shared their concerns about patients not accessing healthcare services, an over-reliance on virtual consultations and the lack of proactive long-term management that was occurring.
Generally, patients have valued being triaged quickly and a reduced need to visit their surgery. Continuity of care particularly for ongoing episodes of care is highly valued. Online technologies are perceived to have improved access and convenience of access to health professionals.
However, it is important to also reflect on the impact of those who have required healthcare expertise but avoided seeking it for fear of catching Covid-19. A theme in the primary care survey was that 17% primary care staff reported their concerns about patients not seeking their services during the pandemic. Not all patients are happy to contact surgeries online and attendance at surgeries for non-Covid-19 issues has been predictably difficult for some patients. Notably, some vulnerable groups, such as the homeless, have experienced even greater difficulties in accessing services.
Digital forms of consultation are not a panacea across all sections of the population – practices will need to consider who they are not enabling to access services through the promotion of digital first approaches.
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*Ipswich and East Suffolk Clinical Commissioning Group (IESCCG) ran a survey of all primary care staff in Suffolk during May 2020. 72 responded: 35 GPs, 13 managers, 13 nurses and 11 others, including paramedics, Physician Associates and mental health workers. The survey was accompanied by conversations during May and June 2020 with 12 primary care leaders in Cambridgeshire, Essex, Norfolk, and Suffolk who it was thought would provide a good insight into changes in primary care.
**The patient perspective has primarily been informed by a conversation with Healthwatch Suffolk who have shared the essence of relevant comments received at their feedback centre.
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