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Online Video Consultations to Manage Covid-19 And Beyond

The coronavirus lockdown and ensuing pandemic restrictions have put a lot of pressure on Practices to deal with patient demand, but it has pushed the video consultations topic to the front of the queue, with NHS England’s decision to start a 48-hr tender procurement of online consultation systems that included text messaging, video consultations and automated triage.

In a letter from Nikki Kanani (NHS England’s Medical Director for Primary Care) to all primary care providers and commissioners, GP surgeries were told to start moving to a ‘triage-first model of care’ as soon as possible to keep up with the demands of reacting to the impact of Covid-19.

Last week NHS England issued a confidential 48-hour tender for the rapid provision of online primary care consultation systems, explaining “Video consultations should be used for remote management where possible. Options are being developed nationally to enable roll out of video consultation capability to all practices as soon as possible.”

What is a video consultation?

Put simply, it's video calling, but a more secure way to speak to patients using remote video call software without them visiting the practice. The NHS has long seen this as a new tool in the Long-Term Plan to improve patient access by 2021 with full access for all patients by 2024. Patients who want face-to-face video appointments with healthcare professionals from their homes will need a smartphone, tablet or computer with a webcam and a secure web browser.

 

How do we get started?

The technology has been around for years, but in a healthcare setting, it should not be your first consideration – it’s all about having your governance in place, both information and clinical. Some systems allow patients to book appointments, request repeat prescriptions and access their health records, so it’s essential that this information is protected.

In data protection terms, the tech provider is the ‘processor’ as the software will process patient’s personal information, so it is important that they comply with IG requirements. There was some hesitancy with the use of Skype because of the vulnerability to cyberattacks, however there looks to be improved confidence in its use as it has been in use by GP Practices for several years. The NHS App has been put forward as a secure tool and the NHS Digital site has a list of assured video consultation systems that can be considered.

As well as having a clinically assured triage process (to help decide when to use video consultations), You’ll also need to have your privacy documents ready for implementation and for your patient appointments;

  • A Privacy Impact Assessment
  • Privacy Statement for your patient to hear at each video appointment

 

 

Wide scale video consultations are already underway in Wales as a response to the Covid-19 outbreak as it was trialled by the Aneurin Bevan University Health Board with some pleasing results. The technology was funded through the Digital Priorities Investment Fund which provides £50m for digital service implementation in NHS Wales regions.

The NHS has provided an implementation checklist for practice who will be making video consultations part of their services, and is a practical guide to put this in place quickly in the current climate. It includes key points to consider such as the following;

Vision: Get agreement for change and work with your CCG/PCN and patients to develop your local service requirements and be realistic about what you can offer through your delivery model (e.g. via your practice or regional hub).

Strategy and Technology: Speak with your commissioners and CPN on what support and resources you need for implementation and involve your local IT Teams to help test your chosen technology.

Engage: A Readiness Assessment for change, including how you will communicate this to your patients and PPGs, getting feedback and training your staff.

Redesign Pathways: video consultations will need a review of your current systems, including;

  • Changes to meet staff rotas and capacity
  • Changes to current triage protocols and appointment systems
  • Designs around patient needs and continuity

Define your new work flow: building new processes with your staff on how to manage and direct patients to video consults and to check that everyone in the practice knows the processes.

Policies and Protocols: clinical and data protection risk assessments have been completed and there is a clear process for reporting issues, incidents and ‘near misses. Work with your practice teams to develop your procedures such as new workflows and consultation processes, templates, coding processes, escalations and contingencies.

Training: All staff (clinicians in particular) are trained in how to use your chosen software, using some test runs and practice sessions as well as peer-to-peer support. They should also familiarise themselves with;

  • how to carry out a video consultation
  • how to review them (including how serious symptoms are flagged)
  • good practice (using recognised regulatory and prescribing guidance)
  • new processes for arranging/notifying patients if a face-to-face appointment or call back is needed

Research carried out in 2019 by askmyGP revealed that patients weren’t embracing video calls as an alternative, but there’s no doubt that there is now a shift in perspective – with recent health advice on the limited access of face-to-face appointments, remote consultations are a necessity right now and  will hasten the NHS digital agenda and make video appointments a regular part of the 21st century practice.

FPM members can now download our new Online Video Consultations Policy in the FPM Policies & Procedures Library, where members have access to a suite of policies, forms and protocols for all your primary care needs. 


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