Virtual Consultations: Reflections on our digital transformation

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Jul 08 2020 Blogs


Recently I have been reflecting on the apparent ‘sudden’ dawning to many people within the NHS, that services can be provided virtually to address the current impact of the COVID pandemic. From my experience of spending nearly 10 years at NHS Direct, this has been going on in pockets for years (telephony, not necessarily video), and often far more successfully and extensively overseas. Back in 2010, Wennberg published a large study in the NEJM on the positive effects of telemedicine combining self-management support and shared decision making for people living with long term conditions[1]. More recently, Professor Trish Greenhalgh has written extensively on the benefits of virtual consultations, as well as the barriers that until now seemed to hold us back[2]. Maybe the current climate will help us overcome many of the barriers to this change both from a patient and a service perspective, as there is a pressing need to ‘re-start’ and keep elective care going.

Yes, it will never be an option for everyone, but even my parents are now Whats Apping friends and Zooming family, so the older population, like us all have become far more tech savvy through necessity and  will likely be more open to this in the future.   Likewise changes in the last couple of weeks have shown how the NHS can overcome the logistical, infrastructure and regulatory barriers that have held us back for years, and with a common purpose can be solved quickly.  As Mel Pickup, Chief Executive of Bradford Royal Infirmary recently tweeted:

“No let’s never go back to business as usual! Let’s restart ‘business BETTER than usual‘ we’ve learned too much through this experience;  innovation, agility, cooperation & collaboration, valuing what’s important, more actions than words! Shame on us if we do go back #nogoingback”

Since my time at NHS Direct, the service has morphed into NHS 111, and focuses on urgent care. However many of the old NHS Direct sites that are now providing 111, used to provide a range of elective and diagnostic type services via telephony, which were safe, efficient and very much appreciated by the patients and the NHS organisations commissioning them. I am sure a number of these services will still be continuing or have evolved into more sophisticate video offers, as well as other providers operating them.

Now, I know NHS Direct was like marmite to much of the NHS; it was often seen as an expensive service (due to all sorts of reasons). But there is still plenty of organisational memory out there to help NHS organisations and systems on the ground to transform clinical services virtually. Technology and its pivotal role in our lives has moved on in the 9 years since I left NHS Direct, so there are so many more options and opportunities now. So, my suggestions are;

  • Look around and see what experience you have locally
  • See what experienced staff you have who cannot or do not want to work on the frontline but would be brilliant working virtually
  • Pool resources across the system to provide capacity and capability to cover extended hours and skills
  • Focus on enhanced recovery and shared decision making skills to ensure that the right patients are being cared for in the right places at the right time and are prepared for their care and discharge appropriately.

Don’t look a gift horse in the mouth!

[1] Wennberg D et al; A Randomized Trial of a Telephone Care-Management Strategy; N Engl J Med 2010; 363:1245-1255


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