NHS needs ‘hybrid’ system that embraces virtual appointments – peers

The Government must create a hybrid system for the NHS that embraces virtual consultations while allowing face-to-face appointments to continue, according to peers.

Baroness Martha Lane-Fox, chairwoman of the House of Lords Committee on Covid-19, said the benefits of the move towards digital healthcare seen during the pandemic “are immense” but people who are less digitally able must not be left behind.

A new report from the committee said “the future will be hybrid” and services will need to be “provided both remotely and face to face, with some patients preferring remote services, others preferring face-to-face services, and some preferring a mix of both”.

However, the study warns that going digital “can never be seen as a universal solution” because some medical appointments cannot be effectively provided remotely.

It cites the Royal College of Nursing (RCN) giving the example of needing to be able to smell wounds if infection is suspected, “and, in some instances, being able to use touch to discover what kind of pressure elicits pain to help staff ascertain adequately the patient’s health problem”.

One medic told the committee that they had referred patients with suspicious-looking moles for investigation when seen in person, when the patient had actually gone to the surgery with a different complaint.

According to the Royal College of GPs, approximately a quarter of GP appointments were carried out remotely prior to the Covid-19 pandemic but this rose to around 70% during lockdown.

The committee report said that, while organisations like Healthwatch have found that “for many people remote consultations offer a convenient option for speaking to a healthcare professional”, others have said that some patients, including those with mental health problems and disadvantaged communities, may struggle to access care.

Peers said the pandemic has also highlighted the need for greater investment in the technology needed for digital healthcare, with a British Medical Association (BMA) survey finding that 46% of doctors have found that internet speed/bandwidth is a barrier to providing remote consultations, and 56% feel that current IT infrastructure significantly increases their day-to-day workload.

The committee concluded that digitally-delivered services “present opportunities to save time and treat more people” but face-to-face consultations must also be available “as an alternative when clinically preferable or desired by patients”.

Speaking to Sky News, Baroness Lane-Fox said “there hasn’t been a strategy at the heart of Government or within the healthcare system for this new blended approach”.

She added: “So what we’re calling for is for the very heart of Government, led by the Prime Minister, to think about what this hybrid world, where some things will be done better online but some will absolutely not and people will need that face-to-face support and connection offline, what it means and how it filters through the whole of the government system.

“This is a big change and we’re saying it’s super-urgent because some of these challenges that we faced, we overcame. and actually there were some benefits to them.

“But for other people that was not the case at all, and we need to have much clearer, joined-up thinking at the heart of Government, led by the Prime Minister, to make sure that we take the best of what’s happened over the last year, but don’t leave people behind and certainly don’t create terrible services for people going forward.”

As part of its new hybrid strategy, the Government should work with the NHS to evaluate what treatments are suitable to be offered digitally, the committee said.

It added: “The digitally hybrid healthcare service in England should be underpinned by a code of practice giving patients the right to receive services online or offline, as well as guaranteeing a minimum service standard for both online and offline healthcare services,
including a right to contact their doctor digitally.”

Pritesh Mistry, policy fellow in digital technology at the King’s Fund, told the PA news agency that some people who are unfamiliar with digital technology may be concerned “that it isn’t a proper appointment”.

He said: “There’s a need to be able to communicate and effectively raise awareness amongst the public that it is an effective mechanism, and if there is concern that it’s something more serious, then the doctor will bring you in.”

Speaking about digital consultations versus face to face, he said: “They definitely should complement each other, because there’s different benefits to each one.

“It’s about choice and convenience – that’s really what it comes down to.

“So, how does a person wants to access healthcare in a way that works for them, that meets their needs?”

Asked whether there will be increasing use of digital appointments in future, he said: “If you look at the trends in society, things have become more digital and society and populations have become more digitally able.

“So that’s seems to suggest that the trend would eventually go towards higher and higher, more digitally driven access.

“But I think there are some things that you’re always going to want to do personally.”