At some point in the not too distant future, there is every chance that Covid-19 will no longer be part of our daily lives. The news briefings will have faded in our memories and the threat of a second, third or fourth spike of infections will have been tamed, or even eliminated if we ever get a working vaccine.
But when the virus has gone, its effects will remain. At least some of the changes we have recently adopted, in how we shop, work, greet each other and access our healthcare will become embedded as standard practice. Some of the changes are obvious. Will sales of face masks and hand sanitisers ever go back to pre-Covid levels? Almost certainly not. Will the ratio of time spent working at the office rather than home revert to pre-Covid levels? No.
But other changes may be more subtle and harder to discern or attribute to the coronavirus. In the world of healthcare the virus has had a twin effect. Firstly it has introduced new habits and processes. Secondly, and possibly more importantly, it has dramatically speeded up change that was already in play.
During the Coronavirus lockdown almost all non-urgent primary care consultations were conducted remotely. In many instances it wasn’t just the patient who was at home during the online consultation, but the doctor or nurse who was operating remotely.
It’s clear that, in many cases, these consultations clearly worked for everyone concerned. So why not adopt the model going forward, something that certain medical experts are already calling for, at least at the point of triage. Similarly with the electronic prescription of drugs. Doctors, nurses and pharmacist reported a surge in the use of systems whereby drug prescriptions are sent straight to pharmacies allowing medicines to be collected in person or delivered - in many cases within the hour - to the patient’s door. The urgency of the situation facing the UK healthcare system also led to a stripping away of bureaucracy surrounding healthcare provision and a further blurring of the dividing line between the work of doctors and nurses.
In most instances these changes have been welcomed by medical experts and those representing them, lending weight to the idea the changes may be here to stay. To further explore what changes might be here to stay and which will be passing fads, (med)24 spoke to two leading experts in the field of medical care, Professor Martin Marshall, Chair of the Royal College of GPs and the Marie Therese Massey Professional Lead, Royal College of Nursing.
"General practice has undergone significant changes in the way GPs and our teams have delivered patient care during the pandemic – and the speed in which these changes were implemented has been remarkable.
“GPs have been using technology to deliver consultations remotely to patients where appropriate. This has been necessary to protect patients and primary care professionals in the community and prevent the COVID-19 from spreading. Remote consultations can also be convenient for patients. And research has shown they can be a viable alternative to face to face consultations – particularly for patients with simple health conditions, or who need to see the GP for more ‘transactional’ reasons such as seeking a repeat prescription.
“It is likely that while many of the established features of general practice which patients know and like will be reinstated as we start getting back to normal, some of the changes we have implemented will remain. The RCGP has called on the Government to develop a remote care plan to ensure technological gains that have been made during this crisis are retained post-pandemic for the benefit of patients and the wider NHS.
“It remains that remote consultations will not be suitable for all patients. Those living with multiple conditions and other complex health needs really benefit from seeing their doctor in person – and this is helpful for the GP, as well. Some tasks, for example vaccinations, blood tests or if a medical examination is necessary will clearly need to be done in person. Some patients will simply not have access to the necessary technology, and we must safeguard against the potential for greater use of technology to widen health inequalities.
“Another way general practice has changed has been the decline in bureaucracy, allowing GPs and our teams to focus on delivering patient care. This is also something we would like to see retained to some extent after COVID-19.
“Any permanent changes to how care in general practice is delivered needs to be handled with caution, to avoid undermining relationships and trust between GPs and their patients - a central aspect of general practice. It is vital that any long-term change in the way care is delivered continues to recognise the importance of face-to-face contact for some patients - and offer flexibility for patients, so that they can continue to receive care in a way that is most accessible and comfortable to them.”
Marie Therese Massey
“A lot of thought will need to go into future strategies for patient care, which appointments can be done virtually, which ones need to be done face to face, but with the appropriate social distancing. This could move on to other forms of delivering treatment such as drive through clinics, which are already being used for vaccinations. Some services are already being delivered in innovative ways such as using gazebos outside or even in the patient’s own car.
“The genie won’t go back in the bottle in terms of remote consultations and group consultations. However, it is very important that healthcare workers are trained to undertake these kind of consultations and people aren’t just thrown in. There is a skill to doing a remote consultation, there are lots of areas that need to be considered in terms of safety, consent and dealing with intimate consultations. There is a skill to learn, whether it’s about having what we call a courageous conversation, around, say, end of life care. Clearly moving forward you do need the skills - and the technology as well - to do the job successfully. This is why the RCN have produced guidance on how to successfully manage a remote consultation
“Being able to deliver the personal care in this environment is going to be very important. What we have to consider is the service we are going to be offering is not the same as just clicking on a YouTube video of, say, how to use your inhaler. It has to be far more personal and about offering a wider treatment, not just something that is specific to the particular matter.
“But there are opportunities here too. Now is the time for innovation. Now is the time to look at making change and sustaining it. From a nursing perspective this could be the time for taking more of a leadership role in delivering services. There is also the forms of treatment one can offer, particularly around mental health and all-round wellbeing. One of things we should be looking at is social prescribing, looking at the whole patient rather than just a narrow view of the particular ailment they are presenting. So what can we get them involved in, what can we get them to do, socially as well as medically.
“My personal view is that a lot of the things that only recently entered people’s lives, like hand sanitisers and face masks are likely to be with us for a long time. I find I automatically do the ‘covid swerve’ to avoid other people as I walk along the road. Is it possible that things like shaking hands, face to face meetings are going to reduce in the future? Yes, I think it’s possible if for no other reason than technology will allow it. I’m not saying it’s a good thing or bad thing, but it may well be that we all get a bit less touchy feely.”