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 think it really varies depending on the type of healthcare and depending on different aspects of each type of healthcare too.

I had an absolutely amazing physio appointment during the first lockdown that was over the phone. He diagnosed my problem just by asking lots of questions, and then prescribed me the right kind of splint to use and some exercises which really helped. For that, being over phone felt really convenient and I was really positive about the experience.

My son's 12 month check being done over video call though was less positive. The health visitor said she had no concerns about his communication skills because he "made eye contact with me straight away" errr no, he's just trying to grab at my phone!

Autistic dd recently had a psychiatric appointment over the phone - but she has massive anxiety around talking on the phone (zoom etc even worse) so the entire appointment was with me, with dd standing close by feeding info to me.

She is fine in person.

She was prescribed ADs without actually saying a word to the psychiatrist. Not ideal, is it?

I think there needs to be a mix and some patient choice. I've loved having my gp and consultant appointments on the phone or video in the main, have a lot of health problems and this saves me a lot of energy. I work as an nhs therapist in mental health, a surprising amount of people have been really happy with phone or video appointments and would prefer this as an option for similar reasons. There will be some people who want to be seen face to face and this should be provided as well of course and the plan is for my service to continue to offer a tel or video service for those that want it post pandemic. I've had people access therapy who would never have come to face to face appointments for a variety of reasons.

I’d love it for some things like pointless drug reviews after so many refills of long term medication. That you would have or no meds which consisted of you saying no problems all good.

For someone who was housebound for years I missed out on so much basic care that couldn’t be done on phone or email. NHS will only do home visits for serious illness and the link and so many things I put up with just wouldn’t have qualified for a home visit for. Many hospital appointments are just chats and not looking at an exam and are a lot of unnecessary travel and waiting around.

It takes me two buses each way to go to hospital appointments that sometimes are just reviews with no exam needed. With GP appointments I sometimes find myself just wanting to ask some questions that don't necessarily need an examination. Virtual appointments have been wonderful for both those situations during lockdowns. Obviously I quotient want then for everything, but they can be great.

I think people don't realise yet there will not be going back to the 'old' NHS, which will be hard especially after all the talk about protecting it over the past year. Yes I believe some services will be mostly online/over the phone, others reduced or redeveloped. I had very good experience with remote apointments so far (GP, injuries, physio etc) which were very quickly followed by face to face if needed. The whole pricess was much faster than usual, saving me commuting and waiting time, no need to arrange childcare, take time off work etc.

@Isadora2007

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.

Yes, our current students at uni are having full virtual placements. Will be interesting to see how it changes their outlook on their career when graduated and working.

So many people have their own blood pressure monitors and oximeter now I don't see the point in these face to face clinics.

I’ve always thought my GPS were good and the more I read about others, the better they sound.

I’ve managed my blood pressure myself since pre pandemic. I just share my results with them and have a phone call if one of us feels meds need tweaking. Obviously this isn’t for everyone but if that flexibility is there it saves a lot of time for the surgery as I don’t have to go in for checks regularly. Same with most of my meds.

Some things on your list might work OP but children’s speech and language online? Really?? Ridiculous IMO.

Ds is autistic and currently on the Camhs caseload. He won't communicate by phone or video call. At the moment his Camhs worker can only meet him outside of our house. Online therapy won't work for him. I was told yesterday they all the support groups that Camhs run, have been cancelled for a year.

For the GP service, I think a phone triage works well, we get advice quicker and can still be seen in person if necessary. But we are a small village practice.

I'm much less happy that my DD13's 2-yearly check up for a condition she was born with was done by phone with not even photos asked for. And highly suspicious that they can accurately decide if my DD11 is autistic without meeting her.

What’s to stop these virtual services being outsourced abroad?

I have pelvic pain in pregnancy and the NHS only do telephone appointments. So I’m paying to be seen privately instead. Just another way to push us to use private services?

bath the autism assessment online does not sound good. Ds was diagnosed about 18 months ago, he was 15 at the time and had masked so many of his difficulties for years. He would not have participated in a video call. And even if he had been willing to, I'm not sure that those assessing him would have been able to pick up on everything, especially as it had been missed in school for long.

I would like to see some services especially some GP appointments done online, or at least the option. GP appointments are so tightly scheduled that they are never on time (usually late) and at least if you are at home you can be having a cuppa or doing something else whilst waiting.

@Zogstart

Some things on your list might work OP but children’s speech and language online? Really?? Ridiculous IMO.

I've been told by colleagues that they are expected to do 80% of peads SLT online/virtual clinics. They have to find a way to make it work. There's lots of evidence supporting it apparently.

I think it depends on what it is. I'm diabetic and having my Specialist Nurse appointments over the phone has been a dream compared to driving half an hour to the hospital, spending at least the same again driving round trying to park, waiting for the appointment (which is always late, usually due to other people being late because of parking!), going in for a 5 minute chat and then driving home again.

Instead of wasting 2/3 hours of my working day for a 5 minute appointment, I have a 5 minute phone call and a hell of a lot less stress.

It also means I get to attend the appointment rather than repeatedly cancelling and rescheduling because I can't take half a day off work (because the stupid 'wait for a letter with a random time and date' approach is from the dark ages)

I think it's more likely there will be increased demand for this in the private sector. There are already many private "virtual GP" type services and for many issues they are really useful.

I'm seeing a psychotherapist online (private, not NHS) - started seeing them during lockdown so have never been there in person and I think a lot is missed out really when we are not in the same room. On the other hand it's very time-efficient not having to travel there for an hour each way. I'm lucky to have a private space at home and a high speed internet connection - many won't have that luxury.

I loved the virtual appointment I had for one of my cats too - used photos to show the vet the issue and it was so much easier than wrangling an anxious cat into a carrier and waiting ages in a stuffy waiting room.

I think it's more likely there will be increased demand for this in the private sector. There are already many private "virtual GP" type services and for many issues they are really useful

The biggest disgrace being if you signed up to one of these services, or intend to do so, you were/will be de-registered from your local GP. They are now running the same services, and haven't yet changed this ridiculous and punitive rule.

@TheySeeHerRowling

Autistic dd recently had a psychiatric appointment over the phone - but she has massive anxiety around talking on the phone (zoom etc even worse) so the entire appointment was with me, with dd standing close by feeding info to me.

She is fine in person.

She was prescribed ADs without actually saying a word to the psychiatrist. Not ideal, is it?

That clearly wasn't right for your dd. However, there are many folk with autism who would find being able to talk over a conference call much easier than traveling and being in the Dr's office, so that is why I hope that all available tools are used in the future, so there can be different options to suit different people.

Some things simply need to be examined.

My child has been in agony with her ear for 10 days, constantly leaking green discharge. She has been up in the night screaming with it. I cannot get a GP appointment for shit. When I ring it says to go online and book an appointment and when I go online it says there are no appointments available.

Of course, GP’s shouldn’t be endangered but it’s getting to be a disgrace at this point. They need to sort something out. Eventually I’m going to need to take my child to A&E because she is suffering so much with her ear and I’m worried about an infection becoming blood poisoning.

@Zogstart

Some things on your list might work OP but children’s speech and language online? Really?? Ridiculous IMO.

Outing myself a bit - but I'm currently a SALT student and we are being constantly told how amazing teletherapy is and how lucky we are to be the new students coming through training during all this exciting change - and I'm the old cantankerous one on the course raising the client groups it works less well for, and the fact that it's a mode of communication that many people find quite hard anyway (even if the internet is having a cooperative day) and you're adding that on to the load of people with communication needs and that are service delivery models really being put into place to acknowledge that. I've been quite outspoken in terms of that - but a lot are a bit fearful of questioning if the Emperor has nice new clothes or is bollock naked understandably.

We've had to do one virtual placement (well practice based learning they called it) - actually I was pretty impressed and found it a good learning experience - but it very much depended on who you got allocated to for it - and I got incredibly lucky, into a team and area I really wasn't expecting to enjoy and found it beneficial - I've still asked if I can go back on my own time to do some shadowing as I'd like to experience the physical realities of it as well though.

Personally - I think there are pros and cons and it's what suits best - however I think that online is going to be cheaper, you can whack more appointments in on a day when you're not having to move staff between different local clinics and go to and from the waiting room to fetch a client and we're going to be sold it as some amazing solution and way forward - and face-to-face will become a very niche or private only option - and lots will fall through the net.

I totally agree @Athinginitself
and @Caulker

@Zogstart - our local Children's SaLTs weren't even using video conferencing to begin with. Initially they set up a telephone helpline and have been overwhelmed at how successful it became. Invested parents and staff from Nurseries, and Childminders could phone up, describe the issue, answer questions from the SaLT, and be given advice, tips, strategies. The feedback from parents, Nurseries (I haven't spoken to any childminders), and from the SaLTs themselves has been overwhelmingly positive. Most have been very surprised how brilliant is has been and some SaLTs I've spoken to agree they never thought it was a good plan and just had to set it up as they were forced to. They now acknowledge they are reaching hundreds more dc than ever before. No, it's not ideal, but then nor is sitting on a waiting list for two of the most important (in language development terms) of your life, waiting for an appointment.
They can see that Early Years Practitioners can still deliver on targets they set, using strategies they set and that is excellent use of a scarce resource. They have always known that some parents take on board all their advice and understand the strategies and put it all into practice, and others less so - but that is the case for the week inbetween the therapy sessions for the tiny, tiny minority of dc that actually get a block of therapy sessions anyway.
Am I suggesting there is no more F2F assessment ? - No, of course not
Am I suggesting there is no more F2F therapy ? No, of course not
Am I suggesting that they can provide SO much more support, to SO many more dc by moving with the times and taking on board new things that are having a real impact ? Hell yes.

highly suspicious that they can accurately decide if my DD11 is autistic without meeting her.

I agree.
If a dc has reached the age of 11 and not yet got a diagnosis, then they aren't one of the most obvious 30% or 40% of children who get a diagnosis of Autism. So they would fall into the 60 - 70% who would still need to have a longer assessment, including F2F. However, there are some children, that Paediatricians, specialist teachers, Nursery Officers, and Inclusion staff would be able to be confident in their ability to recognise with discussions with people that know them well, alongside a video call. That would then mean the waiting list for the less 'obvious' children would be shorter.