Thinking about what’s happening in the NHS in these troubled times, I recently re-acquainted myself with a line in a book called The Leopard by the Italian writer Giuseppe Tomasi di Lampedusa. The gist of it is, if you forgive my translation: “If we want things to stay as they are, things will have to change.”
Professor Paul Gray, the former chief executive of NHS Scotland, used a recent blog in The Melting Pot to reflect on this very theme. “Whatever we do,” he wrote, “please don’t commit to putting health and care services back to ‘the way they were’ when all this is over.”
Many people in all walks of life are saying the same thing. Covid-19 has forced us all to change the way we do things.
I was heartened to learn recently of an initiative by the Scottish Rural Medicine Collaborative, which was set up and is funded by the Scottish Government to devise and test innovative ways of addressing the long-standing problem of GP recruitment and retention in remote and rural areas. Such places have long since proven to be a barometer of problems yet also solutions. Some of the collaborative’s work in addressing the issue of GP recruitment in some of our more isolated communities is now being applied in urban settings too. It is a curious fact that rural solutions will nearly always work for urban settings but not the other way round.
With much of the NHS’s routine work now in abeyance, while the clinicians involved in it are responding to more pressing matters, the collaborative has turned its attention to looking at capturing the essence of improvements in remote and rural communities during the Covid-19 pandemic.
The collaborative recognises that some of the fixes being developed to cope with the current situation may in fact turn out to be long-term, stable solutions for the future. It is therefore looking at developing a template which provides guidance on how information about these potentially sustainable quick fixes can be collated, recorded and shared. The idea is that others might learn from them and they can provide the basis for future working practices.
Like just about every other body, the collaborative’s own working practices have necessarily changed during the Covid-19 lockdown. Its core team now meets remotely rather than in person, and when this crisis ends, it will continue to do so. There is less need to travel to meetings and virtual get-togethers are somehow shorter and more productive. And it is taken the coronavirus to force changes that could have happened earlier, why?
Throughout the country, for example, general practitioners are getting used to functioning in like manner. Most consultations with patients now take place remotely, either by telephone or, in Scotland, increasingly by using Near Me. Developed and tested in 2018 and 2019, this video consulting system was initially used mainly in the Highlands, where distances were an issue, to connect patients with consultants and other specialists.
The intention had always been to increase the use of Near Me throughout Scotland including from the comfort and convenience of people’s own home but because of the pandemic this plan has been accelerated. Now, every GP practice in the country is equipped to use it, allowing people to receive urgent health care and advice remotely from the safety of their own homes, without exposing them or the staff to infection risk. It is even possible for doctors to use it from their home if they are at high risk of infection. And, of course it is not just about doctors. There has been a surge of interest and use by allied health professionals, social care and other settings.
Is it better to consult with patients this way rather than seeing them face-to-face? While the fight against coronavirus continues, it most definitely is; in most cases, the risk involved in face-to-face consultations is simply too high.
Many GPs who would never previously have considered using video conferencing are now embracing it and say they will continue to use it post-lockdown. Some won’t, of course, but they must realise that if we want things to stay as they are, things will have to change.
The shaping of the 2018 GP contract in Scotland was seen as the most significant reform of primary care in more than a decade. That may be so, but it did nothing whatsoever to change issues around access and an appointments system in need of reform. The coronavirus has done the job for us. As Professor Trish Greenhalgh, who is leading Scotland’s Near Me evaluation, recently acknowledged: “Suddenly, the relative advantage of virtual consultations has changed dramatically.”
Going to a GP surgery or for a hospital out-patient appointment isn’t always easy wherever you live. Carers or parents must get back-up cover for their charges and travelling to see a clinician – and parking when you get there – can be bothersome. Never mind time taken to travel and all the other inconveniences. And who thinks about the impact on climate change on all these high volume, often short car journeys? Bigger hospital car parks are not the intelligent answer. They are not needed while the coronavirus is around, and they certainly should not be needed when this crisis is over.
For as long as I can remember, decisions in the NHS seem to be taken in a mist of well-intention obfuscation or compromise. Ask professionals to come up with and implement something that’s forward-thinking and game-changing and chances are you will get something akin to the status quo. Something that may be roundly supported.
But we all know that if things are to stay as they are – if we are to continue to provide a caring, compassionate, free-at-the-point-of delivery, safe and sustainable National Health Service – things will have to change.
The coronavirus is teaching us some harsh lessons and I am sure that what much of we are having to learn will be as applicable post-lockdown as it is now. Video consultations in the health service is a great example of that. If you know of any others, do tell the Scottish Rural Medicine Collaborative and jot down your own insights and learning. Selective memory never tells the real story – the reality of managing change; the history and context of why its often such a struggle.
Maimie Thompson is a former Head of PR and Engagement for NHS Highland