UK: Virtual Consultations: Reaching Where Other Services Can't

Healthcare consultations are traditionally face-to-face interactions. As the demand for healthcare services continues to grow, it is increasingly difficult for patients to obtain timely and convenient face-to-face appointments. This week's blog, by the Centre's analyst, Amen Sanghera, explores recent developments in the use of virtual consultation made possible by the move from analogue to digital services and how these consultations (including telemedicine, video and chat-bots) could improve efficiency and connectivity across healthcare and provide better support to patients.

Virtual consultations: A growing market

Globally, the demand for healthcare is growing, and the patterns of diseases are changing, largely as a result of people living longer but with more complex and costly comorbidities. At the same time, people's expectations of healthcare are also increasing, fuelled by access to more information and understanding than ever before. Most healthcare systems are struggling to respond to the changing expectations and patterns of demand in a cost-effective and sustainable way. Meanwhile, healthcare, like many other sectors, is entering a period of rapid technological change. Advances in technologies and new discoveries are fundamentally changing how we prevent, diagnose and treat diseases, and in certain circumstances, challenging the need for face to face consultations.

This growing demand for services can impede people's access to care when they need it most. As a result, there is a growing private market offering people access to doctors (that is more advanced than online booking systems) at convenient times, via virtual online chat/video rooms and interactive health apps accessed from a smart device or computer. Albeit most services are currently provided through out-of-pocket subscriptions, insurance companies and providers are starting to commission such services to help alleviate demand. Despite the costs, people are using virtual consultation services in increasing numbers, attracted by the perceived benefits, including:

• minimising travel
• being able to see multiple patients quickly, such as residents in nursing homes
• convenience in booking consultations to times that suit your life style
• improving networks between doctors, patients and other healthcare professionals
• encouraging self-care
• potentially reducing costs to the healthcare service (though evidence is still very mixed)
• reducing risk of healthcare associated infections.¹

Video consultations can overcome geographical boundaries and provide access to services in remote areas or those with limited numbers of healthcare professionals. The technology is also proving its worth in the healthcare response to natural disasters, as seen recently in response to Hurricanes Harvey and Irma.²  One of the most significant problems that can occur after a natural disaster is the collapse of health infrastructure. Telemedicine can help bridge that gap and serve as a vital resource in an emergency by virtually connecting patients to providers. A 2012 study found that a telemedicine hub set up at a central command center to connect people with a network of specialists can improve survival rates and help decrease mortality rates associated with natural disasters.³

Global estimates suggest the virtual consultation market will grow from 19.7 million consultations in 2014 to 158.4 million by 2020.⁴  The virtual consultation market, has been particularly successful in the US largely due to the dominance of favourable reimbursement by payers and the convenience the service offers patients who may sometimes be large distances away from their 'local' practice or teams coordinating their care.⁵  While it is a rapidly expanding market in low-income countries, many high-income countries are still struggling to improve the scale of adoption, due to ethical and regulatory barriers as well as concerns about data security and affordability, including the UK's NHS.

The UK NHS perspective

Across the NHS, demand for services has increased substantially in recent years, for example:

• in 2015, 89.5 million attended outpatient appointments, a 4.4 per cent increase on the previous year⁶
• the number of consultations occurring in general practice, are estimated to have increased by 19 per cent between 2008-09 and 2013-14;⁷
• a King's Fund analysis suggests consultations increased 15 per cent between 2010-11 and 2014-15 with a 63 per cent growth in telephone consultations; the proportion of telephone to face-to-face consultations changed from 10 per cent to 14 per cent.⁸

Across primary care, there is a small but growing demand for online services to be provided by GPs.⁹ In recognition of this, in 2016, the NHS GP Forward View, announced funding to accelerate the uptake of technologies and ways of working, including a three year, £45 million fund, to help GPs purchase online consultation systems.¹⁰  Currently, GP online services are usually limited to booking appointments, re-prescribing; few involve virtual consultations. Indeed, an independent review of the 2013 GP Access Fund established that video consultations have been difficult to implement with hurdles including poor broadband (in both GP offices and patients homes) and lack of patient enthusiasm.¹¹  Moreover, a 2016 survey of 319 GP partners, managers and salaried GPs found limited usage, enthusiasm and future plans for virtual consultations, with 86 per cent having no plans to introduce internet video conferencing as an alternative to face-to-face consultations.¹²

Despite this current lack of experience, the NHS appears determined to deliver virtual consultation capabilities, including using the HealthConnect platform to bring video consultation services to between 1500 and 2000 GP practices across Greater London by 2017-2018.¹³ At the same time, the number of private sector providers offering these services is growing considerably. Figures for one entrepreneurial provider suggest that in 2016, 1 in 100 people in Britain have downloaded their app, and 2000 people are joining their service daily.¹⁴

Conclusion

As the NHS increases its adoption of  virtual consultation services more widely, it will be important to ensure that it responds to patient and staff expectations, including: 

• making the technology truly simple to use across a wide range of demographics, including different cultures
• providing staff the right levels of training and support so they feel confident in using virtual consultations and understand the right times to utilise the technology
• demonstrating the value for money of virtual consultations
• clarifying how virtual consultations can act to lessen the workload of staff across the organisation
• ensuring the quality of the video and audio feed is adequate so that it enables healthcare staff to make decisions that are not detrimental to patient safety
• maintaining high levels of confidentiality and data security.

There is an imperative, therefore, to educate staff and patients to use the technology to help ensure the future efficiency, effectiveness and interconnectivity of our healthcare systems. Despite the current challenges in employing and utilising video consultations, it is extremely likely that the patients of tomorrow will be comfortable and willing to accesses virtual services. Many of the challenges are solvable, and attention should be given to optimising the long-term benefits. Indeed, virtual consultations could prove to be the digital foundation that revitalises patient and staff engagement with healthcare.

Footnotes

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