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Video consulting is now far from a niche service, here Dr Sara Shaw and Dr Gemma Hughes discuss the work of researchers in the IRIHS Group to understand how the technology has been deployed across UK health and care settings.

A young woman with a headset on speaks into a computer. © Shutterstock

Video consulting was a niche activity in the NHS pre-pandemic. With the arrival of COVID-19 and the need for social distancing, many (but by no means all) of us quickly adapted to a different way of life that has involved using technology to meet friends, family and – when we need to - health care professionals. For many the internet has, quite literally, been a life saver. But what role does video consulting play in the UK NHS? How far has it spread, and how? Who and what has been left behind, and what might we do to fill any gaps in the provision of video-based services?

In September 2020, we surveyed NHS clinicians, managers and support staff across the UK, to gain insights into the spread of video consulting during the pandemic and consider how to support future service development. The survey forms part of a programme of work, funded by the Health Foundation, looking at spread and scale up of video consulting before, during and beyond the pandemic. Below we pull out headline findings for those involved in planning and delivering this new service model. A draft report of more detailed findings is available here 

A small number of our 809 respondents (20%) were already providing video consulting services pre-pandemic and so were well placed to both step up their own activity, and support other services in getting going rapidly as part of their emergency response.  The majority (76.5%) established video consulting as a direct response to the COVID-19 pandemic, navigating a range of challenges including getting equipment, addressing security and privacy concerns, securing appropriate working space including working from home, and rapidly gaining familiarity with video technology in healthcare. Despite these and other challenges only a handful of respondents (only 3.5%) did not have video consulting set up by the time of the survey.

Those responding to the survey told us that the single biggest factor enabling rapid spread of video consulting was the cancellation of face-to-face appointments at the start of the pandemic. Changes in staff, patient and clinician enthusiasm, video consulting infrastructure (e.g. updated equipment, rapid procurement of platforms, support for home working), combined with executive level support for video consulting, further aided local spread.

So what are providers using video consultations for? At the time of the survey, people told us that they were most commonly being used in general practice for acute presentations and in hospitals for active management of on-going conditions like diabetes. Other uses included patient assessments, provisions of therapies (particularly in mental health services) and provision of advice and support to patients. In children’s and young people’s services video consulting was adapted to enable ‘home’ visits , and continued support and advice to parents and carers.  

As the pandemic has progressed we’ve seen changes in the use of video consulting. The first few months saw a rapid growth in activity. Six months in and some survey respondents reported a levelling off. This was most visible in primary care, where although video had proved helpful to ‘eyeball’ certain patients (e.g. children, care home residents) during the crisis, phone calls and face-to-face appointments have remained central to the provision of primary care. Respondents pointed to limitations of video consulting (e.g. poor video quality, time needed by clinicians and patients to set up video calls) and the perceived value and ease of phone calls over video when visual cues aren’t needed.

What might we learn looking across the four nations? Respondents in Scotland reported greater spread of video consulting, supported by national coordination and rollout via the NHS Near Me service. Elsewhere national procurement of video platforms aided rapid set up, with information about the use of different platforms for different purposes also helpful in shaping video-based services. The vast majority of respondents across the UK used three platforms - Attend Anywhere (including the NHS Near Me service in Scotland), AccurRx and Microsoft Teams - on the basis of ease of use, availability and level of security offered. Other platforms were being used on a smaller scale, with providers guided by local historical use, existing contracts and provider preferences. On-going discussions with providers suggest future use of more than one platform, each suited to different specialities or needs.

Group video consulting (where two or more patients consult with one of more clinicians) gained significant impetus at the start of the pandemic. Around half of survey respondents told us that they had set up group video consulting. However, this translated into low levels of activity with only 100 people then reporting actual use, and typically at low volumes. Group video consulting also affected choice of platforms, some of which were unsuited to hosting groups.

Our survey focused on NHS staff, not patients. We know from policy and practice that there are significant concerns about digital inclusion and inequalities of access. It is perhaps unsurprising then that the single most important thing that NHS staff across the UK told us would enable further spread of video consulting was increased support for patients to use video consulting. In fact, a high priority was placed on informing and supporting patients and the public about video consulting.

Video consulting is now far from a niche service. Our findings clearly show that there is variation in uptake and use across settings, specialities and the devolved nations, but that video consulting has rapidly become part and parcel of the NHS. The promise of a vaccine is raising questions about what a ‘new normal’ might look like. There is some way to go before we can let down our guard. In the meantime, it looks like video consulting is here to stay. Support for patients, as well as staff, availability of a range of platforms suitable for different kinds of consulting, national coordination and infrastructure support, and clarity over when to use remote and in-person consulting, will all be critical in enabling sustainable video consulting services in the coming months and years.

Find out more

Our research on the spread and scale-up of video consulting is on-going. Download our draft report of emerging findings from the survey.

See our guidance on video consulting and papers reporting research findings. Further information about the study can be found here.

Opinions expressed are those of the author/s and not of the University of Oxford. Readers' comments will be moderated - see our guidelines for further information.

Comments

Sally Napper says:
Sunday, 13 December 2020, 11.20 am

I work in hospice care and my team have found it very difficult to adapt to using video or telephone for palliative patients . Is there any work looking at this area

Gemma Hughes says:
Wednesday, 16 December 2020, 3.17 pm

Our team is not looking specifically at this currently, but agree this is an important area. We did have some responses to our survey from people who have found video consultations useful for palliative care during the pandemic. You might also find this rapid review published in the BMJ of interest: https://spcare.bmj.com/content/10/3/271

Maimie Thompson says:
Thursday, 31 December 2020, 12.38 pm

Yes. As part of the Scottish Government Technology Enables Care public engagement we collaborated with Hospices and other organizations and got some excellent feedback. What we found was some mixed views and circumstances when the video was a good option and when not to be used. In fact with almost all groups/patients the use of video eas nuanced and taking a binary approach, as with anything in health care, often not helpful. Happy to send you some information if you let me have your contact details.

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