Remote by default?

I was fortunate to be invited to attend an event on 24 April hosted by the Nuffield Trust at the House of Commons on 'Getting the best out of remote and digital general practice'.

by euanmccomiskie

The meeting was co-hosted by Professor The Baroness Finlay of Llandaff (also President of the CSP) and Dr James Davies MP. There were many GPs in the group but also representatives from other professions, patient organisations, think tanks, central leadership organisations, and other professional bodies.

I was invited as the Health Informatics Lead for the CSP in recognition of the work we are doing on using digital in physiotherapy as well as my role representing AHPs in digital health networks.

In the meeting the key findings of the research study “Remote by Default 2: the new normal?” were presented by Professor Trish Greenhalgh, Chief Investigator for the study, and Director of the Interdisciplinary Research In Health Sciences unit, Nuffield Department of Primary Care Health Sciences, University of Oxford and members of her team. This research builds on previous work of in-pandemic remote care in UK general practice. Although the research does focus on general practice there is significant recognition of the role of the multidisciplinary team in primary care, and particularly the increasing role of physiotherapists through the role of FCPs. Many of the findings also translate to other areas of health and social care practice as well as in primary care.

There was recognition that there are still very few GP appointments delivered using video consultation. The telephone continued to be the most used technology but, unlike the perception from the media, two thirds of GP appointments still happen in person. There was also recognition that those in most deprived areas are those least well served in terms of technology provision in primary care.

The main findings of the research are 5-fold:

  1. Benefits of digital and remote care are there but are hard won and technology itself will not deliver these benefits, people are key to success or failure
  2. Practices and patients are at different starting points in their ability to embrace technology
  3. Making remote care safe requires review of the entire process from requesting a consultation to the consultation itself
  4. Quality for some is achieved at a cost to others with vulnerable populations at particular risk of exclusion. In places, over use by the “worried well” is consuming availability and closing doors for those who may need services more. Digital by default, even if done with good intentions, can exclude groups of patients and parts of the workforce
  5. Technology is not just “plug and play”. It requires careful procurement and implementation to have the optimal impact and there are still fundamental problems with hardware and connectivity in places

There was also discussion of the complex environment of primary care in which digital and remote are trying to innovate. Although whole other events are needed to focus on the provision of workforce and services in primary care, the human factors of change, and budget, it must be recognised that they have a significant impact on what can be done in technology-enabled innovation.

The role of supporting the workforce was also discussed. In particular, the importance of recognising and valuing the role that administrative and reception staff can play in maintaining the physical and digital front doors of primary care. Also the challenges of all staff, including non-clinical staff, in triage given the increasingly complicated presentations encountered in primary care, as well as the failure of some current digital solutions in this space to recognise that.

Part of the output of the research was also around competencies for all group involved to make the most out of remote general practice. The CSP are exploring those and intend to work with Professor Greenhalgh and her team at the University of Oxford to include those as part of our work in digital physiotherapy.

I was also able to talk with Jamies Davies MP, colleagues from Scottish government, and the Nuffield Trust, about our work around remote consultations, the research we contributed to around UK AHP digital competence, the Physiotherapy Health Informatics Strategy (PHIS), and also our recent commission by NHS England on the foundation digital learning resources.

Baroness Finlay closed the event with some wonderful words that stuck with me, and I paraphrase … “evidence and data are critical to understanding and answering challenges in health and social care”. The CSP and our work with the PHIS aim to work with our members to generate even more meaningful data that we can use to understand and answer the challenges in physiotherapy.

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