“Prior to the start of Covid-19, the 10 practices didn’t undertake any video consultations as they didn’t have the facility to do so. There has been a very rapid and marked change in the consultation process since early March. We are currently managing 90% of all patient contacts remotely (previously it was 30%). We now have the facility to conduct text, email and video consultations in nine out of the 10 practices".

“Additionally, we now regularly receive photographs from patients to supplement our assessment of their presentation – and these can be received and directly inserted into their records. This was not available before March and facilitates the ease and safety of remote consultations.

“As Covid-19 risks are likely to remain for at least the next six to nine months, remote consultations will remain the predominant consultation method in primary care. Once the pandemic has ended, there will be considerable pressure from patients to continue with these more convenient remote access arrangements.

“At the same time, clinicians will have greater experience of utilising online and other types of remote consultation. They will have more understanding of the level of risk associated with these versus face-to-face consultations and will be more comfortable managing presentations completely online.

“For the majority of acute patient contacts, both clinicians and patients are likely to prefer to conduct remote consultations. I anticipate the vast majority of ‘on the day’ appointments and approximately 40% – 50% of review appointments in our practices will be managed through online consultations in the future.”

“Telemedicine was already an increasing part of primary care medicine before the pandemic. For example, I’ve been showing pictures of lesions on the skin to dermatologists over the internet for many years. 

“I’m certain the spread of telemedicine will accelerate after the pandemic because some doctors and patients will have been obliged to overcome their fears and concerns about it. But it has to be expanded without creating a two-tier system of primary-care medicine – those who have better funds, availability and know-how compared to those who do not. It will not completely replace face-to-face consulting because there are multiple small, visual and auditory cues you cannot pick up on remotely.

“Practices have changed their working methods constantly ever since I’ve been working in primary care, so change is not a problem. GPs have remotely worked for many years, much more than people realise. However, video consulting needs to be made easy so anyone can use it, given the equipment. That is going to be difficult until the whole population is fully IT literate.

“The growing use of telemedicine will allow increased flexibility in working practices, though full confidentiality will have to be retained. I suspect different personnel in practices will become more specialised in different methods of working. Much in the same way as some doctors are now specialists in out-of-hours work, some in telephone triage and some in certain medical procedures. Fewer GPs will be doing everything as they have been expected to do in the past. That may mean more specialisation of practice personnel as well as increased co-operative working between different practices.”

“I strongly feel there is a longer-term role for telemedicine in the community beyond the pandemic. And I’d be very surprised if there isn’t an appetite post-Covid-19 to really explore how telemedicine can be utilised in primary care.

“Most telehealth systems offer ease of use, will work with existing devices and can be accessed via an app on a patient’s smartphone. The platform shares information that a patient enters with their healthcare professional to enable remote monitoring – this enables GPs and nurses to offer more proactive care. Once practices start to think more about the benefits of telehealth for their resident population, it’s something that will gather a lot of momentum.

“From the patient perspective, they certainly don’t see these apps as intrusive or something to be fearful of. Self-care is something most people would like to do more of, such as taking their own temperature and noting how they are feeling. Patients have a much closer connection with their healthcare provider as their symptoms are being monitored constantly. It gives patients more security and comfort. Continued use of telemedicine in primary care will enable general practices to be much more efficiently managed.”

“Historically, telemedicine in general practice has always been on the peripheries. For example, less than 1% of all consultations pre-Covid were telehealth consultations; now it’s about 95%, and these are happening online, via phone or email consultation.

“I’ve spoken to lots of doctors who have said they are now working from home two days a week and, when Covid-19 is over, they would still like the opportunity to continue partly working from home. They’ve realised there’s a different way of doing things. The cat is out of the bag now. It will become quite popular because doctors are now more comfortable with it. Doctors are often the drivers of change and patients are already used to using Skype and FaceTime and they think healthcare should be just the same.

“Our research has shown that up to 70% of consultations can be done remotely without the need for a face-to-face appointment. It’s more convenient for patients and it also increases efficiency for GPs. With traditional appointments, doctors might see six patients in an hour. Yet with telemedicine, they may be able to see 12 patients in the same space of time and this can really increase the supply of appointments.

“The use of telemedicine is definitely going to rise post-Covid-19 and the key challenge is going to be ensuring all patients have equitable access to these new solutions. GP surgeries will have to think carefully about their practice population to make sure patients are not left behind as they change to become more of a digital provider.

“Telemedicine over the next 10 years is going to change the way healthcare is accessed. However, the key issue is going to be tying up the online part of healthcare – what patients can do from their phones – with the offline healthcare experience, where a patient would go to a pharmacy or a GP clinic.”