Matter for Discussion: Digital consultations

Members can view a recording of the debate here.

Health care systems around the world are struggling with rising health care expenditure, staff shortages and structural barriers to accessing services. Digital transformation is seen as an opportunity to improve access to care, promoting a personalised approach while potentially containing costs.

UK governments have long been aware of the promise of digital technology and have produced guidance aimed at improving access to technology and promoting the use of remote consultations (NHS England 2019, 2020, Health and Social Care Board 2016, Scottish Government 2021,). In Wales the new agency Digital Health and Care Wales was established in 2021 and will take forward the transformation of digital services. In Scotland, for example, digital consulting has been developed as ‘Near Me’, which has evaluated well among clinicians and patients, although its limitations are recognised.

Commercial tools supporting remote consultations were already in use before COVID-19. But the pandemic meant that health and social care staff had to adapt clinical consultations to ensure that patients were still able to receive the health care they needed and to tackle the care backlog COVID-19 created. The RCN developed guidance to support staff who were being asked to see and/or treat patients via telephone, video link or other remote consultation process (Royal College of Nursing, 2020).

Technical and cultural challenges persist. Poor connections can limit a clinician’s ability to observe the patient and interpret signs properly. Variable connectivity may reduce access to services for some, particularly those in remote or rural locations. Remote consultations also raise patient and professional privacy concerns for service users.

Some patients may be at greater disadvantage, such as those with no access to a smartphone or PC, those less proficient with the use of the technology, or people with learning disabilities and individuals with visual or hearing difficulties. Targeted investment may be required to ensure organisations have appropriate technology, cyber security and digital skills training for both staff and patients.

Early evidence suggests that services offering a hybrid of traditional routes to accessing and delivering care alongside digital were able to meet patients’ clinical needs and preferences (Health Foundation, 2022).

Questions remain about whether remote consultations limit the delivery of holistic care, impact unfairly on non-digital users, and provide the tools necessary to tackle the rising demand for care.

Nursing staff have a responsibility to consider what is best for their patients and for health and social care more widely.

Reading lists for each agenda item can be found here.

References

Health and Social Care Board (2016) eHealth and Care Strategy. Available at: www.health-ni.gov.uk/publications/ehealth-and-care-strategy (Accessed 20 April 2022)

Health Foundation (2022) Access and delivery of general practice services. A study of patients and practices using digital and online tools. Available at: www.health.org.uk/publications/access-to-and-delivery-of-general-practice-services (Accessed 20 April 2022)

NHS England (2019) The NHS Long Term Plan. Available at: www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf (Accessed 20 April 2022)

NHS England (2020) Using online consultations in primary care: implementation toolkit. Available at: www.england.nhs.uk/wp-content/uploads/2020/01/online-consultations-implementation-toolkit-v1.1-updated.pdf (Accessed 20 April 2022) 

NHS England (2020) Video consultations in secondary care. Available at: www.england.nhs.uk/outpatient-transformation-programme/video-consultations-in-secondary-care (Accessed 20 April 2022)

Royal College of Nursing (2020) Remote consultations guidance under COVID-19 restrictions. Available at: www.rcn.org.uk/Professional-Development/publications/rcn-remote-consultations-guidance-under-covid-19-restrictions-pub-009256 (Accessed 20 April 2022)

Scottish Government (2021) Scotland’s Digital health and Care Strategy. Available at: https://digihealthcare.scot/strategy (Accessed 20 April 2022)

Welsh Government (2015) Informed Health and Care. A Digital Health and Care Strategy for Wales. Available at: https://gov.wales/sites/default/files/publications/2019-03/informed-health-and-care-a-digital-health-and-social-care-strategy-for-wales.pdf (Accessed 20 April 2022)