‘We found a really substantial desire for video consulting. Over 85 per cent of the public said that video should be used for health and care appointments’
the pharmacy might be offering a delivery service, again with minimal contact with the delivery person.
‘I think there are different models, but I don’t think that has been embraced in community pharmacy widely at all. I don’t believe for one minute that digital services are right for every consultation – it has to be used when it is both clinically appropriate and the right choice for an individual patient. But I think, without a doubt, the profession is underestimating people’s appetite for remote consultation, particularly at a time of pandemic.
‘In my previous role, I worked with the Scottish Government as the national Near Me lead. Near Me is NHS Scotland’s video consulting service across all professions and across all health and social care. Over the summer, we asked the public about their views on how they wanted their consultation with healthcare professionals to take place - across video, phone and face-to- face consulting. We engaged with over 300 patient organisations and charities, ran surveys and invited people to comment.
‘We found a really substantial desire for video consulting. Over 85 per cent of the public said that video should be used for health and care appointments, with only around ten per cent saying ‘no’. When we asked them what consultation types were acceptable, both during a period of physical distancing and when physical distancing is over, video was first choice during a time of physical distancing, then phone call, and then face to face. When physical distancing is no longer needed, face to face comes out top – but video is still preferred over the phone.
‘Patients expressed very clearly that there is a difference with video of being able to see the person you are talking to. They said it helps build that therapeutic relationship in terms of
the trust in their health professional, helping them know they were being listened to and taken seriously.
‘It is interesting that other professional groups are ahead of us. We are seeing, for example in psychiatry and psychology, an absolute shift in how services have been provided in recognition and response to patients wanting to speak to a professional by video.
‘Patients were saying that it is the relationship that is important to them and video helped maintain that. The fact that this has been recognised in mental health is, perhaps, an early indicator that everybody should be looking at that and asking ‘am I delivering the services in the way that my patient wants?’
‘With all of the changes the pandemic has brought, NHS Pharmacy First is very important and it’s important for two reasons. If we go back to the start and the Programme for Government and the aim of care closer to home and community access to services, one of the examples the government gives is Pharmacy First. NHS Pharmacy First - without a doubt - already does - and will continue to improve - local access to services. But, in addition to that, I think as the general public increasingly use Pharmacy First to come in and have a consultation, then being able to do that remotely will be important and could really shift things. Given the public appetite for remote consultation, I think community pharmacists should be the ones who are providing that service for their communities because, if they don’t, it will be provided in a much more distant way by companies operating very remotely. I’m not convinced that achieves the continuity of care that people want, so there is an opportunity here for individual community pharmacies to offer a service for their patients so that those patients, who are used to coming in and talking to their community
pharmacist, can continue to talk to that same pharmacist remotely.
‘If we look at general practice pharmacy, I think there are an enormous number of pharmacists working in general practice, who have had to change the way that they have worked as a result of COVID, but are still managing to do very important work.
‘People are looking at how they deliver care in a different way. Where once we happily invited everybody in for reviews and for face-to-face appointments, that’s now far more time-consuming when we need to wear PPE and clean rooms between patients. So, here too, there is clearly a need to deliver consultations in a different way and that is really where this digital option really comes in. Beyond that, though, it is really interesting that we are beginning to see some GP practices thinking about how care can be delivered across the whole team in a slightly different way. So, rather than bringing the patient in first and having a discussion, perhaps taking some bloods while they are there, and then booking them in for a follow-up later, there are models emerging around a much more streamlined pathway of how a patient is managed.
‘So it could be that, working together, the team identifies all the physical monitoring that a patient needs. Do they need a blood test? Do they need their blood pressure taken? Are there other physical assessments that are needed? Then they make an appointment, perhaps with a health care assistant, for all of those physical tests. Or have they got their own blood pressure machine to do remote monitoring? This is something that I think will grow increasingly in years to come. Once
the results are available, the relevant healthcare professional, whether that is the nurse or the pharmacist or the GP - or all three - would then have a follow-up consultation remotely. And actually, that’s a much better model for the patient. If the monitoring test results are in place already, then you can make a decision about future treatment based on what those results tell you. So I think there is an opportunity to streamline and improve the way that services are delivered across the whole team within GP practices. I know that that is happening in some practices already and I hope that happens more widely - both to deliver a better care experience for patients and to make sure that the very best is made of pharmacist skills in practices.
‘There is a final, fundamental change that COVID has shown us, which offers a new model and that is in recognising the ability of the workforce to work remotely. I think that applies to GP practice pharmacy and in some ways in community and hospital pharmacy as well. There are plenty of examples of health professionals, who were shielding during COVID, but managed to maintain clinical roles by working remotely with access to appropriate clinical information and using remote consulting tools. I believe we, as a profession, should not lose sight of this. We know that there are people who are out of the workforce because, for example, they have caring responsibilities that make it difficult for them to travel to work in a full-time way. So here is an opportunity. COVID has shown us different models of working that we might explore in the future and these may help address some of the recruitment difficulties we have as well.’
SCOTTISH PHARMACIST - 7
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