By Dr Laura Woollett, Kingskerswell and Ipplepen Health Centres, South Devon
Since January of this year, myself and fellow GP at Kingskerswell and Ipplepen Health Centres, Dr John McCormick, have been visiting care homes in South Devon as part of the practice’s initiative to adapt its consultation methods to the needs of care home residents and staff.
The outbreak of the COVID-19 pandemic meant face-to-face consultations had to be minimised to protect this vulnerable community of people and the staff who care for them. But despite the challenges COVID-19 has brought, together we’ve continued to adapt the way we offer consultations to the needs of practice patients living in care.
A new method of consultation
When patients are in care homes, they are still ‘in their home.’ However there are other stakeholders to consider, such as residents or temporary staff who need to be supported to help care processes to adapt, not just to COVID-19 but to the diverse needs around care for older people more generally.
Triaging using telephone and video consultations are providing different ways of undertaking patient consultation and proving helpful in setting up long-term approaches to flexible, patient-focused care. Since the beginning of the lock down period, the practice has been undertaking weekly telephone triage and video consultations with care home staff and residents. Telephone triage has involved speaking to residents who are unwell or to care home staff who have concerns about a resident’s health. Video consultations are when the doctor ‘sees’ the patient for a consultation via video technology.
How does this new method of GP consultation in care homes work?
Firstly, each care home is allocated a specific day for regular telephone triage. This means I am able to have dedicated time with each resident and the staff are reassured that a doctor will be calling. After telephone triage, residents in need of further consultation will be reviewed by video.
We use innovative, easy-to-use technology. For video consultation, the residents and practitioners use a third-party video calling and messaging service (in this case, accuRx) to communicate. Using a phone with video function has helped me to perform remote examinations.
The system is flexible. If the care home staff are worried about a patient between appointments, they are urged to call for assistance. With the triage system, if a visit is necessary after telephone or video consultation (or consultations) this can be arranged.
The system also ensures practitioners have access to the equipment they need. We’ve been working closely with the care home managers and staff to ensure the correct equipment is available to complete the telephone triage. This includes basic observation equipment such blood pressure machine and thermometer. All of this equipment was easily obtainable and relatively low cost.
We take a collaborative approach. The system is proving effective through the cooperation between GPs, care home staff and residents. Together we are sorting out the equipment needed and ensuring the consultations can happen to best suit the needs of the patients.
What have been the main benefits of our approach?
Already we are seeing positive health outcomes for the patient. They gain access to, and advice from, a clinician that is responsive to their needs. This means they get access to telephone or video consultation, and face-to-face support either via video, or in person if required.
We’re delivering and operating consultations more efficiently. We estimate we ‘saw’ approximately 200 patients through this triage system in the first two months of lock down. Through effective triaging I am saving an estimated two hours of clinical time per week. I can use this time to focus on patients. Care home staff can rely on regular triaging and share all their queries during the pre-arranged times.
We’re providing a safer process during the pandemic for everyone involved. Working with care home staff to triage residents using telephone and video has played a part in minimising the spread of COVID-19, especially between vulnerable people in care home settings, their staff and GPs.
Our practice has facilitated crucial face-to-face visits to meet specific urgent or emergency needs in the community. However, these were done by GPs as part of emergency, same-day response processes. I did not need to visit care homes for more routine work. Telephone and video consultations have provided essential initial consultation options before any face-to-face consultation is arranged.
Finally, we’re establishing positive care beyond the appointment itself. The technology is easy to adapt to. While some of the more technical aspects of the triage process took some staff in care homes a little time to become used to, once they had some practical experience with the phone and consultation system it was easy to facilitate wider use and advocacy for the system.
Our initiative has proved a great achievement for all involved. Being able to mobilise care so quickly for the benefit of residents, their health and their carers has been both warming and humbling.
As the public health situation in Devon evolves, Dr McCormick and I, together with our colleagues at Kingskerswell and Ipplepen Health Centres, are continuing to use the opportunity to provide telephone and video consultation with local care homes. In doing so we can both minimise the ongoing risks from COVID-19, and provide face-to-face care that responds to the needs of the residents and their carers.
The South West Academic Health Science Network (SW AHSN) would like to thank Dr Laura Woollett and Dr John McCormick from Kingskerswell and Ipplepen Health Centres for sharing their story with us at this time.
The availability of digital tools like video to support care pathways has grown significantly in the South West over the last few months in response to COVID-19. Our health and care partners across the region have incorporated digital care pathways into their work as part of their response to the pandemic and in support of those most vulnerable in our communities.
We are facilitating learning from this initial phase of COVID-19 in order to support other health and care teams to optimise digital-first care pathways across general practice, outpatient, community and care home settings. To learn more about this work please visit our webpage or contact our programme lead for supporting digital-first pathways, Stuart Monk (Stuart.Monk@swahsn.com).
Key enablers to a flexible and adaptable triage system
- Cooperation between GPs, care home managers and staff
- Having the dedicated time to focus on each patient
- Availability of basic equipment to undertake basic observations e.g. blood pressure machine, a pulse oximeter and thermometer
- Wi-Fi availability