Agenda item

The Chairman invited to the table:

·         Nitish Lakhman – Manager, Barnet Healthwatch

·         Councillor Caroline Stock – Chairman, Barnet Health & Wellbeing Board

Nitish Lakhman provided a snapshot of the findings in relation to patients’ experiences of accessing GP appointments remotely.

The broad consensus had been that there were many positive aspects to this new way of working which included the following:

-       Being able to access an appointment whenever was convenient thereby allowing patients to schedule appointments around their life, jobs and commitments.

-       Sufficient time being allocated to speak with a doctor.

-       Prescriptions being provided on the same day.

-       Patients feeling protected from Covid and other illnesses that they might pick up within the GP Surgery Waiting Room.

-       The ease of being able to talk to a doctor virtually meant that issues like childcare were not a problem.

However negative aspects of the system had also been reported by many patients which included:

-       Inefficiencies of the system, with long forms and numerous questions having to be completed.

-       Algorithms sometimes being too sensitive and recommending patients attend A&E, therefore ending up using acute pathways unnecessarily.

-       The lack of choice around whether to see a doctor virtually or in person, as the decision is made by the clinician.

-       Some medical concerns not being appropriate in a virtual context, with some patients feeling uncomfortable or concerned about digital security.

-       Accessibility issues for those unable or not confident in using digital services.

-       Privacy and data concerns around sharing personal and sensitive issues on-line and General Data Protection Regulation (GDPR) requirements not always being adequately communicated to patients.

-       Frustration with the inadequate telephone system, with some patients reporting having waited up to 1.5 hours to get through.

-       Frustration of patients leading to abuse of reception staff.

Nitish Lakhman reported that issues with the length of the form had been highlighted as an area for improvement. He also said that often patients had to fill out multiple forms for each issue when booking an appointment, which was a downside of some of the systems being used by GPs. Feedback from some GPs had also been that they had been unable to cope with the increased administrative work associated with using E-consult as they had to spend a long time reading through all the forms.

Councillor Stock, Chairman of the Health and Wellbeing Board, said that some forms involved at least six pages of questions, if not more, and that often the questions were either not applicable or did not meet the needs of patients with multiple ailments. She said that patients became frustrated when they just needed to speak directly with a GP and were unable to do so. She explained that digital diagnosis was not always suitable or satisfactory, with some conditions requiring in-person appointments. She also raised concerns about some patients having reported being asked to show inappropriate areas of their body on camera and how unacceptable and upsetting this was. Councillor Stock further raised the issue of non-verbal clues being missed through virtual appointments as well as additional clues or concerns that a doctor may pick up from an in-person visit also potentially being missed, which could delay early interventions and diagnosis of conditions.

The Chairman raised the point that the form meant that the information was all patient led, so that other related symptoms could be missed.

A member raised the issue of religious and cultural traditions and how this had not necessarily been considered. For example, some women would only be able to speak to a female doctor and the system did not allow for this choice. They also stressed the fact that often women would not be comfortable disclosing personal medical information via a digital platform, which could discourage them from seeking medical advice. The Member also mentioned that cases of domestic violence or abuse were often picked up by GPs, which again could be missed through virtual appointments.

A Member enquired as to how many hours GPs were now spending seeing patients in comparison to before the pandemic. Councillor Stock advised that this had been raised at the Health and Wellbeing Board and that data was being compiled.

Nitish Lakhman informed the Committee that recommendations had been made to improve the system which included:

-       A hybrid model whereby patients could choose whether they wished to be seen virtually or face to face, which would improve the empowerment and autonomy of patients.

-       Simplifying the online booking form, reviewing which questions were essential and providing a filter option for follow-up appointments to reduce data entry for patients.

-       GP Practices improving their communication and ensuring all GDPR requirements were clear and available to patients.

-       Consideration of implementing a call back feature to reduce the length of time patients had to wait on the phone. 

The Committee agreed that they had a duty to challenge systems and ensure that any safeguarding issues were properly considered and addressed. The Committee further agreed that a model whereby there was a balance between when it was appropriate for an on-line consultation and when face to face was required, was most important.

Members asked for data on the number of hours GPs were seeing patients to be provided at the next meeting on the 7 December. Healthwatch Barnet would be invited back to the next meeting, as well as Colette Wood, a GP, a Carer and a member of a Patient Participation Group (PPG).

RESOLVED that the Committee noted and commented on the written report and verbal update.