Long term virtual NHS?

[yearnewwhatever]

Inspired by a thought on a different thread and by my current experiences as an NHS worker where we are being pushed to do all therapy assessments online (not just due to lockdown but long term, big shift etc)

How do the public feel about the vast amount of outpatient work being done online? Eg

• Majority of GP work
• psychology / counselling
• swallowing assessments / communication assessments
• children's speech and language assessments
• autism assessments
• podiatry reviews
• physio assessments
• hand therapy
• consultant appointments
• post discharge follow ups

There's many more. My trust are aiming for 80% compliance across the board long past covid. There are quite a few people at the top who fail to see people as not fitting into clean boxes and not everything can be done online or even easily tried. Staff morale is quite low because it's not what they signed up for (future generations of NHS workers will know no different I imagine though)

I should think the practicality, efficiency and efficacy of this will vary enormously between various groups.

Although there's a lot of rhetoric about continuity, F2F and hands-on, there are some communities that have scarcely, if ever, experienced this level of service.

I'd agree, however, that there will be demographics of HCWs for whom this lack of contact will be alienating and remove a fair amount of their sense of vocation and job satisfaction.

Yes, for me I've gone from doing my job in outpatients of a hospital hands on (which is needed) to being largely at home, never seeing anyone and having to do (a pretty crappy sub par version) at home online. But the NHS is now deeming this to be the way forward and that it is clinically appropriate. I feel like the pendulum will swing more to the middle in time when mistakes are made and conditions missed but it will take a while to get there. By which point, I know I won't be in the NHS!

It's hard to say. Some of the things I might make a GP appointment for can be handled remotely. But others really do require an examination, at least to check BP or something like that.

I’m NHS and we’re pushed for 100% face to face so seems different in different trusts. Some of those listed will not be suitable for virtual clinics. Swallowing assessments, counselling, children’s SALT and hand therapy just will not work virtually. The number of patients I’ve spoken to over the last 10 months who have refused telephone or virtual counselling because they want to wait for face to face is staggeringly high. I’d say only 5% have engaged with virtual therapy whereas this would be 60-70% face to face prior to Covid.

I've found the texting/telephone service with my GP practice so much better because I get an appt to speak with a doctor usually within a couple of days compared to pre Covid when it was a two week wait for a face to face appt.
Everything else on your list OP I can't see how it would work long term. I feel there needs to be human contact with patients eg how can a physio assessment be done online surely the physio needs to touch the patient to assess them...

@Indecisive12

I’m NHS and we’re pushed for 100% face to face so seems different in different trusts. Some of those listed will not be suitable for virtual clinics. Swallowing assessments, counselling, children’s SALT and hand therapy just will not work virtually. The number of patients I’ve spoken to over the last 10 months who have refused telephone or virtual counselling because they want to wait for face to face is staggeringly high. I’d say only 5% have engaged with virtual therapy whereas this would be 60-70% face to face prior to Covid.

My department is on that list and we are being made to do it virtually. We can only see a tiny amount of people in clinic and have to justify every single one. I guess it's a post code lottery thing - some trusts will push it more than others.

It's tricky because there is plenty of evidence to support virtual therapy across lots of areas so on paper, it looks plausible. But in reality, the study's are so far removed from what is achievable in the real world...

Some things really don't work remotely.

A friend badly damaged his hand in an accident before Christmas and is now having physio... over the phone. Why?

He assumed it would be a video call, but no - a telephone call, a lot of which consisted of the physio asking him to try eg moving his thumb then asking 'How far can you move it?'
''About 2cm''
'Is it moving straight or on an angle?'
'Kind of in and down a bit, but it won't move much'
'I'm finding it hard to visualise'
You surprise me! Just why not a video call at least?

I think it would be fantastic, provided that there’s an easy recourse to face to face if required, and not an uphill battle. Granted I very rarely interact with the NHS, but to be able to have appointments remotely and without entering hot waiting rooms with other sick people would be fantastic. I mainly use an online app for GP services and it’s fantastic, if the NHS goes down this route it would be great for me. It would also enable better sharing of resources and specialist services across a wider geographic area which would be good.

I think it’ll be ok for some things, but not for others. In quite happy with phone GP appointments as long as there’s the option to be examined if need be, and I have a private psychotherapy practice which has been ok by phone and online though I’ll return to face to face work when I can.

My DD is being seen by audiology, SALT and endocrinology which are all appropriate too. There will be some examinations and consultations which just can’t happen remotely.

DD has had virtual counselling and finds it just as useful as face to face. It might be a generational, but I am very keen for the digitisation of the NHS to go ahead. It's been planned for a long time, and a GP's lost a lot of young patients to on-line when they resisted the initial move. Obviously not everything can be virtual, but many things can, and it will improve efficiency and efficacy. Virtual diabetes monitoring is a game changer for example.

I should say my DD is being seen in person.

It’s an appalling idea. Healthcare professionals need to build a relationship of trust and this is much better done face to face. In person. So much communication is non-verbal and easily missed on video or telephone calls

Some of that list would be fine, even beneficial. I've no objection to maintaining my current GP's way of working, for example. As long as face to face is an option at some point if really needed.
Some of that list though are therapies that surely need a hands on approach so it would be really difficult.

Lots of that yes, but there needs to be an in person option. I absolutely cannot do online counselling. I just wouldn’t talk, it’s hard enough to get me to talk in person. I wouldn’t turn up for an online session as it would be pointless.

I do prefer the current triaging by phone my go surgery are doing though. Same day phone appointment then they decide if you need to be seen in person and when. It works really well so I hope that stays.

Student nurses are looking at getting virtual placements...or non face to face ones at least. So I assume it’s going to be carried on in the NHS moving forward. Much will be lost in this move but I guess we also stand to gain as well. Save money, time etc.

I love online GP appointments. I can phone up, ask for a call back, and then get on with work until they ring. Maximum 5 minutes out of my day. Normally I'd have to get out of work (or arrange to go in late) travel for half an hour to the surgery, wait for ages for my appointment, have the 5-minute consultation, travel half an hour back - easily 1.5 hours out of my day.

Obviously there needs to be the face-to-face option too, for people who can't access online services, or who need to be seen in person, but I personally hope they keep online GP appointments in the future.

I think a lot of the other things you mentioned would be trickier; my guess is they'll go mad trying to make everything online for a while, until they realise it's not possible, and then they'll swing back closer to a happy medium.

I’m NHS and I do quite a few things on that list.

I’d like to work from home but realistically I can’t do my job.

I am however slightly worried that the government will take the opportunity to bin people off the enormous post covid waiting lists by saying they ‘failed to engage’ with online therapy.

Whilst I think it could work well for some things for some people it’s a very depressing thought to move to default remote consulting.
There’s a lot to loose. Building up rapport, non verbal communication, picking up other physical signs opportunistically ( eg notice a concerning mole whilst examining someone’s chest or just notice that someone has lost weight/ appears depressed/ is struggling with mobility etc) ...

Nope here. I struggle on the phone and can not use video services full stop.

Surely online physio is just a nonsense concept?

The vast, vast majority of stuff is better face to face.

Some disciplines are more passable done digitally than others.

I have a massive problem with it because when it doesn't work patient care is affected.

Several examples:

DH post Covid out of isolation, GP refused to see face to face, delayed diagnosis for serious medical issue which could have meant much worse outcome (high risk of death if left untreated).

Me, Covid related acute onset of symptoms that mean I now have a disability (private test confirmation as GP didn't refer initially) that will impact my employment. Cannot speak to GP/nurse on telephone, not referred to any specialist service as per NICE guidance. GP online messaging not working and phone line closed over several days so cannot resolve. Now past the two week urgent referral guidance and still not even referred.

DD has an online ASD assessment this week, we have waited 2 years for this. I just have to hope they can pick up the subtle nonverbal behaviours via Zoom.

Surely online physio is just a nonsense concept?

It depends. My CCG only offers appointments where the physio has to deal with 2 patients (separate 'cubicles') at a time. I was booked for some physio where it was impossible for the therapist as the 'other' patient was post-stroke and had negligible short-term recall as well as poor balance/proprioception as she wasn't safe to leave by herself.

Overall, no matter what your condition, my CCG will only fund a maximum of 6 sessions a year.

tbh - a 10-15min virtual session that was just revising my programme would be helpful.

I hope the NHS takes on board everything they have learned and use that, whilst understanding there will be some appointments that need to be F2F (a lot, in reality) but that actually, there is also a lot that can be done, and this would be even better if more would use videocalls.

Examples - Pre-covid, someone with a UTI had to wait for an Dr's appt to get the antibiotics needed, even though the patient has had them fairly regularly over a decade and knows full well what it is. FAR better in COVID times
Example 2 - In our area Children's SaLT has a 2 yr waiting list pre-covid. Many (not all) of these children have capable parents who are just looking for a 'steer' in terms of what they can do / try. Many of these children are in Nurseries where staff can support the children given advice by the S&L Therapists. During COVID, the SaLTs have set up an advice line and a lot more children are getting some sort of support than ever before.

Example 3 - Assessments for Autism - another 2 year waiting list in our area, yet these children have very often been seen by specialist educators who could offer considerable input into the assessment. Yes, there are children that are borderline who need longer assessments, but there are some children where there is clearly no dispute - I could make a really valid argument for trusting fellow professionals in the children with more significant needs.

Example 4 - there have been some excellent training workshops and webinars on line to support parents with children with sleep issues, with children with challenging behaviour, with children with sensory processing issues. The uptake for these has been incredibly high, whereas Triple P / Happy Parenting courses etc F2F always struggle with numbers. Getting the input right at the beginning of the journey, saves the NHS £££ and so much time later. Again, a case of learning from what has been thrust upon us by accident, and hanging on to the positive changes when most F2F things can resume has to be a good thing.

Also, in usual times, all NHS services have lot of time wasted with missed appointments. If people don't pick up the call at their appt time, then the practitioners can move on to the next person on a list, which you can't do when seeing people in person.

Now, don't get me wrong. Overwhelmingly, most Health appointments need to be F2F, but I hope the NHS don't throw the baby out with the bathwater in the scenarios where things are proving to be working well.