From famine to feast? Staff experiences of video consulting in the NHS during the Covid-19 pandemic
11 March 2021
COVID-19 Health Services Research Policy & health systems
Dr Gemma Hughes and Dr Lucy Moore write about current research on video consulting, led by Dr Sara Shaw, with funding from the Health Foundation.
Levels of video consulting in the NHS appear to have gone from famine to feast since the Covid-19 pandemic first hit. As requirements for social distancing and managing the risk of infection took hold in spring 2020, so video consulting proved crucial in enabling contact with health services. But as the pandemic progressed and staff adjusted, what happened to video consulting, and did the apparent feast continue?
As part of a project on the spread of video consulting, funded by The Health Foundation, we have been interviewing NHS staff involved in video consulting across the four nations. Since September 2020 we have interviewed 40 clinicians, managers and support staff working across primary, secondary and community services. We have been struck by the diversity of ways in which video consulting has been deployed, the range of services offered (from sexual health services to obstetric assessments to cardiac rehabilitation groups), and the diversity of patient groups involved (including children and young people, adults with learning difficulties and people with mental health problems, to name just a few).
We have been impressed by the creativity, inventiveness and motivation of staff to rapidly find ways to continue to provide services. Clinicians sourced headsets and webcams, re-purposing equipment and physical space – at home and in the clinic – to carry out video consultations. Support staff rapidly refocused on installing video software, providing training, procuring and distributing devices. Professional bodies rapidly produced guidance to support video consulting. National and regional bodies provided funding and support to set up and run video services, relaxing restrictions where appropriate (e.g. relating to procurement of video technology). Much of the work involved in shifting to video consulting was challenging, stressful and far from perfect. But this mobilisation across the NHS meant that patients were offered assessments, therapy, and advice and support that they would otherwise be unable to access without risking transmission of the virus.
Some clinicians found video consulting surprisingly effective, enabling them not only to sustain relationships with existing patients, but also to assess and build rapport with new patients – something many felt they would not have attempted pre-pandemic. This held true across a wide variety of services and patient groups.
A small number of staff had used video consultations prior to the pandemic, for instance in a clinic for women with gestational diabetes, but had typically experienced lengthy delays in gaining organisational approval for routine use of video (often as a result of information governance and data protection requirements). These staff, and their services, were in a prime position to swiftly accelerate and expand video consulting when the pandemic hit. Activity quickly took off, and (in some cases) support was provided to other services to do the same.
Some clinicians who were new to video consulting found it enhanced consultations, allowing them to pick up on non-verbal cues and feel more connected than talking on the phone. Some found this visual element important simply when talking with patients (e.g. about harm reduction strategies in sexual health services). Others valued the ability to make visual assessments via video, for instance, an occupational therapist working with adults with learning disabilities was able to continue to safely assess and support people living in the community. Clinical assessments were also carried out successfully, including one clinician who conducted initial airway assessments by video. All were clear that there were limits to video, with in-person consultations also required, for example for a full physical examination or if a risk was identified during the video consultation that could not be managed remotely.
While video consultations proved helpful to some clinicians who had not previously used it, others found few advantages over telephone and face-to-face consulting. This was particularly the case in primary care. We heard, for example, from one rural general practice with poor internet and mobile phone coverage and a patient population that was largely unfamiliar with video-link technology. Well-equipped with PPE, the practice was able to offer socially distanced, outdoors, in-person consultations throughout the pandemic for patients who needed to be seen, with telephone contact as an alternative. In this situation, the introduction of video consulting was not considered necessary or advantageous.
Video consulting was disappointing for some. One clinician told us how he had welcomed the chance to use video to consult with his patients, but that the process of connecting via video made it unsatisfactory (with some patients unable to access internet and/or technology, and others more comfortable with phone or email). Several interviewees talked about a sense of loss in the clinician–patient encounter compared to an in-person consultation, and the way in which video restricted the clinician’s ability to deal with complex issues with their patients.
The level of video consulting has rapidly increased across the NHS since the start of the pandemic, shifting us from famine to feast. This has brought clear benefits in terms of enabling patients to continue to access services. It has also brought diverse experiences and preferences for staff, across a range of settings and specialities. Given this diversity, there is unlikely to be a perfect recipe for how video consultations should be taken forward beyond the pandemic. Instead, we expect to see clinicians continuing to create new combinations of consulting, adapting according to the ingredients they have to hand, and taking into account their own tastes as well as the preferences of their patients.
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