Increasing access
Before deciding to introduce an alternative to a face-to-face consultation you may wish to consider:
- What exactly is the problem you are trying to solve?
- Whether the use of an alternative to a face-to-face consultation is the best solution to your problem?
- That this is not a replacement for the face to face consultation but complementary
- An alternative to a face-to-face consultation is a learning process, it might take time to embed and could develop organically which might include finding more uses than originally expected.
- Commercial interests are at play and people are selling products.
- Is this driven by the availability of funding to trial something for free?
- You might require support and guidance from other institutions such as the Medical Defence Organisations (MDOs) and Clinical Commissioning Groups (CCGs) or Health Boards
Rationale
One reason that some practices consider introducing an alternative to a face-to-face consultation is to increase access for patients, to ensure that they are offering a safe and equitable service. Your existing system may be not be sufficient leading to an unethical service providing a first come, first served system that leaves patients without appointments that they need. You may want to improve the provision of healthcare to those with barriers for attending the practice. This might be the justification even if this is likely to lead to an increase in demand.
If this is the reason that you are considering introducing an alternative to a face-to-face consultation then you may wish to think about the following:
- That each rationale is not mutually exclusive.
- Who is driving the change; is it individual practitioners, local/national (centrally mandated such as 5 year Forward View)/or commercial drivers?
- Is there capacity to manage the increased demand?
- How would this increase in demand be managed?
- Is the whole team behind this, or is it driven by just one or two enthusiasts?
- Which alternative to face-to-face consultations are you considering/would provide the best medium in your situation?
- Why is this the best approach to doing what you are trying to achieve?
- What kinds of consultations do you envisage will be managed using an alternative to a face-to-face consultation for?
- Can you afford it/what is the cost?
- Do you have the appropriate infrastructure/would you need to make changes?
- Is this likely to lead to an increase or decrease in existing GP work? How will you know?
- How will you know whether access has been improved?
- How will you record/integrate the consultation in the patient records?
- What impact will it have on your staff?
- What about information governance?
- What about clinical governance?
- Is this what your patients want?
- How will you inform patients?
- Will your patients seek help elsewhere to a greater or lesser extent? What do you anticipate will be the impact on the local A&E department and GP out of hours service?
Previously there was a good proportion of our patients who weren’t getting into the system at all and that is very concerning to me. I think if you have a limited resource the only ethical way to distribute that resource is to find out what’s out there and then prioritise, you know
We were interested in finding ways of improving access for patients to medical care, whether that was with the doctor or nurse or whatever it was that they needed.