It is estimated that due to Covid-19 and the social distancing measures in place, currently 71% of GP appointments are taking place remotely, be that by telephone or video consultation. This is up from 25% in a similar period last year. In pharmacy, we probably agree that is quite a good estimate - as it certainly feels that there has been an increase in the number of patients coming to pharmacy in lieu of face to face consultations with the GPs, or as a re-invigored “pharmacy first” approach.
But can pharmacy follow the same approach as the GPs in the use of such technology to the same degree? I think I can say with all certainty that we can't and that's coming from an ardent fan of technology.
Certainly, Covid-19 has and will continue to make us look at how we deliver healthcare to our patients, and that is driving some excellent innovation in practice. But I am mindful that we do not need to create new inequities or widen existing ones.
Let’s use prescribed medicines as a proxy for people attending a pharmacy, either for medicine supplies or for general healthcare advice. We know that 90% of adults aged 75 or over have at least one prescribed medicine, compared with only 19% of young adults aged 16 to 24. Meanwhile, 54% of adults in the most deprived fifth of areas have at least one medicine.
So, we know and understand our customer base and must ensure that we are digitally inclusive in the services we might wish to provide using new technologies.
Disability, technological skill level and economic status can all have an impact on the accessibility and utilisation of digital technology. In fact, there are still 4.8 million people who never go online at all and 11 million lack the basic skills to use the internet effectively.
If GPs continue the remote consultation approach this will encourage the drive of patients from “GP first” to “Pharmacy first”, which is a positive aspect, and a role that pharmacy can take up, and expand upon.
An enabler for pharmacy and its use of such technology will be NHS England permitting the use of video consultation in the delivery of enhanced and advanced services, where appropriate for the patient and their needs. Underpinning that will be the issue of “Patient Consent” and how pharmacy captures that.
Currently, the legal directions for Advanced and Enhanced Services state that we must capture ‘from each patient to whom P provides MUR/NMS services a signed consent form to receiving those services’ and we have post-payment verification of those ‘wet signatures’ by NHS Business Services Authority. We need to be a little smarter about the consent process, and what action by a patient could be considered as consent. In fact, capturing this digitally would aid verification, and is more robust in terms of governance if we do this right. So, we need regulation to catch-up with the technology. Work is being undertaken in other areas such as ‘digital prescription tokens’- so perhaps good learning will come out of those processes.
Pharmacy has always been at the forefront of technology adoption and post-Covid there are plenty of systems on offer out there. I know that Barnsley LPC have highlighted a web-based SMS and video consultation service to their contractors. It seems that they have engaged well with technology and there has been positive feedback on its use in the pharmacy setting, with the SMS-to-patient facility being more widely used than video consultation.
I am not trying to predict our future use of video technology but I am mindful of the following axiom - we tend to overestimate the effect of a technology in the short run and underestimate the impact in the long run.