Can video ease pressure on primary care?

While the COVID-19 pandemic accelerated video consultation provision, it’s fair to say that take-up has not been as widespread as expected by those championing online expansion.

In this blog, we look at whether video consultations can become an essential part of the primary care toolkit or will be relegated to niche healthcare roles.

The UK primary healthcare industry faces numerous challenges, including increasing patient demand, limited resources and the need for improved access to healthcare services. These challenges have highlighted the urgency for innovative solutions that can optimise healthcare delivery while maintaining quality care.

Video consultation development was fast-tracked as it was seen as one of the ways to interact with patients while minimising physical contact during the pandemic.

What was being seen as an optional extra became a key part of online services offered by Silicon Practice and others.

However, while video seems to have found a place in urgent care settings, its takeup has slipped back into general practice.

Clinicians in control

Silicon Practice provides a secure and user-friendly platform for video consultations. With robust privacy measures in place, patients and healthcare professionals can connect virtually, ensuring confidentiality and maintaining the trust between providers and patients.

From the very start, video consultation sessions were developed by Silicon Practice to keep the clinician in full control.

Sessions can be scheduled online, with notifications sent to patients online or by SMS, or happen on demand – directly in response to a patient message received through our advanced dashboard or when the clinician is on a telephone call to a patient.

Patients are messaged to remind them of a forthcoming video appointment and if the clinician is running late, they can notify the patient in the online ‘waiting room’ without having to begin the consultation.

The Silicon Practice dashboard itself can be tailored to each practice’s requirements. Staff work hard to ensure customers are satisfied with how their site works at its launch, and practices have the flexibility to alter their site and dashboard’s functionality as needs change.

Can phone calls do the heavy lifting?

It’s fair to say that the takeup of video consultations has not been as great as politicians and the public might have expected.

While fewer than 1% of UK general practice consultations occur by video, that still means that around a million video consultations could be provided each year (based on 300m general practice patient consultations annually).

Although the perception can be that video consultations are being offered as a replacement for face-to-face consultations, they can, in fact, be a useful way of seeing patient reactions or a way of picking up on their behaviour, which might speed up the decision on which course of action to take next.

It has also been reported that patients with mental health issues have been able to have a video consultation when they would have been anxious about leaving home.

It may be that easy phone communication acts as an unintended barrier to greater video consultation uptake.

Clinicians have reported that phone conversations provide much of the information they need to base a medical decision – even if that often means scheduling a face-to-face consultation.

Instructing a patient to perform a self-examination during a video call requires giving detailed instructions. However, clinicians typically consider personally examining the patient as an easier, quicker and more accurate assessment method.

Urgent care medics lead the way

There may be lessons to be learned from the fact that a focus group study conducted in 2023 found that urgent care GPs were keener about the technology, using video more frequently than ‘in-hours’ GPs.

Urgent care GPs found that their anxieties about using video were overcome by training, and once they were confident, the technology had a range of benefits. These included during the initial assessment, allowing better rapport and trust between clinician and patient.

In addition, they found that video has value in a wide range of conditions, including identifying safeguarding issues. It also proves useful for involving others in the consultation and optimising resource utilisation.

‘In-hours’ GPs identified a range of problems and generally were less confident treating patients without seeing them face-to-face compared with those in urgent care.

Where video proves most effective is in supporting decision-making, for example, being able to see how distressed a patient is, which may not be as apparent from a phone conversation.

One in-hours female GP told the study: ‘I find some people can sound really awful on the phone, but when you look at them on the video, you can see instantly … they’re actually all right and vice versa.’

Beware of the two-tier system

While rural areas would seem ideal places for video consultations, potentially saving on long journeys for the patient or clinician, there are concerns that this could lead to a two-tier system.

Poorer families may not have access to broadband, which the more affluent may take for granted, and GPs also reported those with larger homes had Wi-Fi blackspots.

The focus group study also found a wide split in use across the age ranges – some elderly patients, used to speaking to relatives online, were adept, while others struggled to use video.

However, poor takeup by some GPs and barriers in day-to-day use doesn’t mean that the potential of video consultations has vanished. It may be that we are still just starting to explore the potential of video.

Functionality has been increased by Silicon Practice to allow group calls, which could prove invaluable for clinicians needing to have a translator involved in a consultation, a trusted third party or to bring in another clinician for advice.

Video has been used to link with nursing home staff to discuss patients, to at least partially replace visits and for statutory functions such as issuing death certificates, and this could be an area where the technology increasingly comes into its own.

Conclusion: Video’s flexible future

There are many reasons why video consultation uptake continues to be slow.

However, it is still a relatively new technology. A certain amount of resistance from patients and clinicians is inevitable but additional training would seem to be one way of making better use of the equipment which so many people now have at their fingertips.

If we can overcome those barriers and the demand for video in primary care expands, you can be certain that Silicon Practice will be ready.

post by Bruno Clements