Unless you have your own private GP, one effect of the pandemic has been to make it even more difficult to get in to see your local NHS doctor. Patients are being re-directed and triaged via systems such as eConsult who are "transforming the way" in which medical services are being delivered. One of the biggest features of this shift, apart from being required to answer a series of medically-related questions, is also the need to understand some basic medical diagnostics such as blood pressure, laboratory blood tests and possibly even some cardiology.
Furthermore, patients are increasingly taking greater responsibility for measuring all vital signs themselves through the use of patient medical technology and equipment (PMTE). Some PMTE is also referred to as mobile or mhealth. New organisations such as the Medical Technology Group are being formed to help promote these new patient medical equipment technologies.
Total Health discussed these points with north London NHS GP, Dr Amarjit Raindi, who also operates a private practice on Harley Street.
We started by asking him:
How do I get to see my NHS GP these days?
He replied, “The NHS is now operating a telephone triage system and only those most at need might get an appointment with a GP”. Our whole way of working has completely changed. NHS practices are now only offering 10 – 15 minute slots via telephone or video appointment. There are only a set number of slots for face-to-face meetings and so we have to be careful to select the right cases to schedule for these".
Dr Raindi goes onto explain, "Patients have to use the e-Consult online questionnaire with the symptom algorithms, according to the results of this we will then get back to the patient. The process can speed things up slightly, provided that we do not have to go through everything again and we only need to ask a couple of planned questions.. 78% of all consultations are now currently done online".
What are the biggest changes to how you now practice?
Dr Raindi describes how the pandemic has accelerated the cyber-medicine route. He says, "There is actually more than we thought that we can actually do online, BUT things will inevitably be missed, including cancers. Systems such as eConsult only work properly for basic medical issues. Patients do not present in textbook fashion and if there is weight loss, persistent cough or vomiting then you ideally need to see the patient. In any event, there is something to be said for that human interaction and many older patients do not feel comfortable with virtual meetings".
How much preventative medicine are you doing?
As has been widely reported, attendances at A&E for heart attack and stroke have fallen dramatically. People believe that they cannot get access to services or are too afraid to turn up. All preventative medicine has gone out of the window as we are not taking blood pressure measurements at the moment or taking routine blood samples for analysis. This is resulting in is a mounting backlog of chronic issues.
How have your patients been responding during the pandemic?
There is a large cohort of people who have used lockdown as an opportunity to improve their lifestyles. They are reluctant to go back to their commuting and predominantly sedentary lives. They want to remove the stress, eat better, have a better work-life environment and take up hobbies with more exercise.
However, there is also another cohort who have adopted increasingly lethargic attitudes, exercise less, eat more and are consuming more alcohol.
How are these two groups of patients broadly divided?
These two cohorts are split roughly 50:50.
We are also seeing many more cases of low mood and anxiety with a lot of patients going into crisis with panic attacks for example. There is a lot of uncertainty and stress around finances. These patients are not being seen and not receiving counselling.
What is the post-pandemic outlook?
The goodwill towards the NHS is now running thin. The tide is turning as a result of the lack of ability to be able to get access to services. It is unlikely that things will get better soon either. With the inevitable increase in the usual winter viruses and our inability to rapidly distinguish between the different types of infection things could become increasingly complicated. We will increasingly be diagnosing cases as ‘virus of unknown origin’. Results from tests are already taking longer to come back and matters will be exacerbated as staff themselves have to take time off sick.
Virus of unknown origin
The biggest issue is the lack of proactive, preventative care – especially with the lack of general check-ups. As a result many patients are now seeking means for improved face-to-face time, and faster access to services.
Medical kit bags
At the same time patients are increasingly purchasing their own medical kit bags, especially digital devices such as pulse oximeters, thermometers, sphygmomanometers, 6 lead ECGs, digital stethoscopes. Dr Raindi says, "At our practice we are also arranging more mobile phlebotomy and mobile blood testing". For anyone concerned and wishing to arrange a fast, face to face meeting click here.
