Who knew....the doctor will now see you via video?

In this blog post, Dr Luise Marino, Programme Lead Nutrition and Dietetics at the University of Winchester, looks at the knowledge and skills health care professionals need to future proof health care services through video consultations post the Covid-19 pandemic.

This time last year, the NHS Long Term plan for doctors and other health care professionals (HCPs) to routinely hold video consultations seemed a long way off and Professor Trish Greenhalgh (University of Oxford) encouraged us not to hold our breath.

Fast forward to March 2020, and all NHS outpatient clinics and elective surgical procedures were stopped for three months, and our national treasure had to, with uncharacteristic 'Bolt' like speed, transform overnight to deliver health via a computer or smart phone screen. During the first six weeks of lockdown 87 per cent of consultations were done virtually. Zooming, MS teaming, (programmes most of us had never heard of), became the new norm with virtual politeness including; muting the mic, virtually raising your hand and ensuring our backgrounds were suitable for viewing. We forgot how to wear normal clothes and elasticated waist bands were our friend, spreading from the glut of freshly made banana bread; our comfort food during these uncertain times.

The NHS vision has been for hospitals to stop being somewhere, and for them to become everywhere, making healthcare more accessible, focusing on patient centred care. Prior to the COVID-19 pandemic, 50 per cent of patients, young and old, did not want video consultations. However, during lockdown, satisfaction with virtual appointments was high, with 90 per cent of patients embracing this new way of receiving health care. In our own research we have shown using a nutrition pathway and providing telephone consults to parents of babies with congenital heart disease improves growth and reduces the number of days spent in intensive care.

Health care professionals, particularly those working from home, were similarly positive, finding them to be more time efficient and a good way of staying in touch, with patients often more relaxed in their own homes. However, as these services have been rolled out so quickly some of the usual processes associated with setting up a service may have been bypassed, potentially increasing the risk of poorer outcomes for some. Particularly, as digital poverty may increase the gap of access to good health care, with some individuals and families having to choose between paying for the WiFi or buying food and some health care professionals relying on their own personal tech.

How can we ensure a virtual health care revolution is a change for good?

To future proof health care services using video consultations, HCPs need to have enough knowledge and skills to run them; setting up guidelines and processes around service delivery.

1. Training - not everyone working in health care is on the same digital page, and the challenge will be to continue with the rapid up-skilling so everyone working in this environment offers care to the same level, thereby reducing unintended variation.
2. Webside manner - empathy and communication in a virtual environment will be different from those used in face-to-face consultations; HCPs need to hone the nuanced communication skills needed for a good webside manner.
3. Getting the right tech - a recent survey of dietitians working in the UK suggested that whilst 75 per cent had undertaken more online training to up-skill in certain areas, almost 50 per cent did not have the correct digital tools to support this. The same is true for patient groups: access to the right equipment may yet see certain groups marginalised further.
4. Write it down - health care professionals need to write the process of the service down - a bit like a recipe for banana bread - what are the ingredients, methods and what to do with it when it's done.
5. Check and reflect - is it working? Is the service offered fit for purposes? What do patients think about it and are the outcomes the same or better than would be expected from a face-to-face consultation?
6. Keep going - this health care revolution is extraordinary and has the potential to reduce variation, improve outcomes and reduce inefficiencies - but we need to pay attention to the details and keep going.

Patients also need to be regularly consulted and asked how the service should be run and could be improved. To support HCPs, we have developed a short training course,  Remote working: A health care professional's guide to virtual appointments, with the aim of support HCPs to feel more confident in this new way of delivering health care.

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