Patient Voices: Remote Video Consultation in West Yorkshire
Against a national backdrop of increased reliance on remote video consultation in the wake of the ongoing pandemic, where its use was seen as an effective and safe way to ensure the continuity of service delivery with minimal risk of contact between clinicians and patients, West Yorkshire Health and Care Partnership (WYHCP) recognised the need to gain a deeper understanding of the needs and experiences of more excluded groups to inform the procurement and use of remote video consultation technologies.
There has been a number of national and local research studies since the pandemic started and West Yorkshire Health Care Partnership were also keen to understand and listen to the insights and experiences of local people including groups who are more likely to be digitally and socially excluded.
What we did
We carried out both primary and secondary research and facilitated co-design activities for the ICS, this included:
A rapid evidence review including literature from Leeds Healthwatch Insight Work, Oxford Inclusive Remote Video Consultation Research, Leeds and York Partnership NHS Foundation Trust Remote Consultation Discovery Research and other national and local literature.
User research was conducted with groups in West Yorkshire who are more excluded including; Elderly people (Age UK Wakefield), People with sight impairments (Kirklees Visual Impairment Network), LGBTQ+ community (Brunswick centre) and Refugees and Asylum seekers (Leeds Asylum Seekers Support Network).
Two co-design workshops with people with lived experience of remote consultations in primary and secondary care.
The outputs from this work included the following:
A rapid review report
Co-design workshops write-up
User needs report (excluded groups)
Technical specification for commissioning purposes
A key findings report
What we learnt
We have collated some key findings from the rapid review, these include:
Understanding the patient needs and assessing what is appropriate for the patient on an individual basis is key.
There is a need for support and resources for user groups to be able to access remote consultation platforms and benefit from them. This includes factors such as:
Costs for patients to access remote video consultations.
A need to take into account language barriers and accessibility functions.
One to one support (for example from administrators / digital champions).
Not everyone has a private space for an online video consultation. Pharmacies, community assets and general practices could be utilised for patients.
Shared good practice to promote remote consultations and evidence-based implementation will motivate staff and users to get on board with remote video consultations.
The views of people who will be using video consultations are key to making remote consultations accessible and sustainable.
With a push in utilising online services across the NHS, practices should take into account that not all patient groups will be able to book online and alternative access is key to avoid widening health inequalities.
We have broken down the key findings from the user research and co-design workshops into the following categories:
Before the appointment
Making the appointment - contacting GP surgeries at a prescribed time each morning via telephone has a number of difficulties, for example:
Everyone is calling at the same time.
There is no interpreter/translator at first contact.
Usually a time where people get ready for school/work.
First point of contact - the person who answers the initial call decides who you get to speak to next. This can cause some difficulties as some people do not like sharing information with a non-medical person which can cause a negative experience.
Expectations - people go into this situation with an outcome in mind and if that isn’t met (even if it’s not medically sound) then the service is perceived as poor.
Terminology - sometimes people can’t describe a problem in the way that gets the relevant point across (for example saying pimple instead of cyst has big ramifications on if you speak to the Doctor).
Privacy - having to share information with an interpreter (family or professional) is uncomfortable for some.
Accessibility - taking into account disabilities and language barriers.
During the appointment
Existing negative opinions on video consultations - there is a general opinion that phone and digital are just poor substitutions for face to face appointments. For example, an assumption might be that the camera quality may not be good enough to see what the patient wants to show the doctor.
Privacy - not everyone has privacy or feels safe conducting a video consultation at home.
Costs - telephony/virtual/face to face all have associated costs that not everyone can meet and therefore can affect a person’s willingness to engage.
Lack of understanding - some people are willing to put up with a service that does not work for them but they understand it, than a service that does work for them but they don’t understand (for example a telephone appointment where a person describes what a symptom looks like because this is the service).
Patient pressure - there seems to be much pressure on the patient ‘getting it right’ when accessing or calling consultations. Having a simple method of the phone ‘ringing’ and pressing one button to start the consultation would reduce the pressure.
Choice - In a post COVID-19 world, patients need to feel that the decision of their consultation is medically justified rather than a way to save money or time. By allowing patients to have a choice and opinion which is heard about what appointment is best would be an advantage. Including a feedback mechanism if their consultation isn’t working for them.
Live captioning / transcription - people try to make notes and take everything in. A video being transcribed in various languages would help for record keeping and in understanding what is going on.
Recommendations for using remote video consultation
We have developed a checklist to use and consider when implementing and improving your remote video consultation offer.
Choice - Patients need to be offered a choice and do what works for them, in their immediate circumstance and in line with all their immediate needs
Multiple methods of communication - Email/SMS/letter to inform people of their appointments. Circumstances change and methods of communication should mirror this
Flexible times to contact a GP surgery/secondary care service - This will avoid busy phone traffic at the same time each morning and suit the needs of those unable to contact the service first thing
Flexibility of the consultation - Being able to share links with others who aren’t physically there (e.g interpreter, family/friend for support)
Guidance on what to expect - Easy read guidance on how a video consultation works and what to expect. Pictures would benefit first time users (or people who haven’t used them for a while)
A single platform that works - patients want a single place for their video consultation that works on whatever device they have available. This needs to be the same for all health services
Privacy - When contacting the GP surgery/secondary care service, there should be no expectation to share the nature of the problem to a non medical person. The patient should also be made comfortable to alter the video consultation setting to ensure privacy (blur background or turn camera off when uncomfortable).
Feedback mechanism - To learn how to keep up to date and understand expectations of patients
Terminology - consistency and simple language. Support in different languages and options of live caption and translation (including sign language)
Avoiding a negative experience - ensuring the patient journey is smooth from the first point of contact and setting expectations
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