Accessing remote doctor’s appointments

Summary of the report: ‘Your Virtual Assistant’: The patient experience of Ask NHS. Published by Healthwatch Buckinghamshire May 2021:

Research conducted by Healthwatch Buckinghamshire explored patient experiences of remote appointments (telephone, video, or other online) with a doctor in general practice with from people in certain groups.

They identified three groups most likely to have difficulties with remote appointments. These were:

• those aged 65 or older
• people with disabilities – especially people with sensory impairments, learning difficulties, or dexterity issues
• those who had language barriers (people who speak English as a second language or users of British Sign Language)

Methodology:

Healthwatch Bucks. interviewed individuals (by telephone) and worked with local organisations. Only nine people were willing to be interviewed, so further methodologies were applied:

• Attended two ‘Mind the Gap’ sessions run by Buckinghamshire Mind
• Attended a dementia focus group run by The Alzheimer’s Society
• Talkback (an autism charity) interviewing five people on our behalf

Views were gathered from a total of 30 patients – 9 directly through telephone interviews, 19 through other groups and a further 2 people sent emails.

They also sent a short questionnaire to general practices to determine how they were delivering remote appointments and any changes they had made to improve the patient experience.

Conclusions:

People accepted that appointments were being carried out remotely given the situation with the Coronavirus pandemic and they recognised that this would be a way of having certain types of appointments in the future. However, there is still a preference for face-to-face appointments where possible, particularly for vulnerable patients. Telephone appointments were mostly preferred, when there was a lack of facilities, desire or skill to use other forms of technology. Those who were dependant on carers were more likely to be happy to use any method of contact providing it had been organised and set up for them, and they had help if needed. Some people choose to ‘self-exclude’ from certain methods of communication, but everyone had access to at least a landline or mobile phone. With few exceptions, most of the respondents were unhappy with the process of booking appointments, especially over the telephone.

Recommendations:

Good communication:

Buckinghamshire Clinical Commissioning Group (BCCG) should encourage general practice staff to follow the core principles laid out in 'Good Communication with Patients'.

Patient-centred:

All clinical communications to patients should centre around their specific care, not internal NHS processes or systems.

Booking remote appointments:

Buckinghamshire Clinical Commissioning Group (BCCG) should work with practices to ensure that the appointment booking process is as easy and as quick as possible to minimise stress.

Communications Method:

Ensure an inclusive communications method for each patient, taking into account their personal circumstances. Ensure that, when working with patients with disabilities, mental ill health or age-related conditions:

• remote appointments are offered with consideration of the patient’s individual preferences, circumstances and abilities.
• face-to-face appointments are offered as a reasonable adjustment 
• they understand all their options for face-to-face or remote appointments and are given a choice (where practical) ensure that any changes to guidance about the patient’s right to choose the type of appointment are communicated to all patients and practice staff in a clear and timely fashion.
• maintain notes on the reasons for a preferred communications method for each patient, not just the method.
• ensure that where contact with a patient is through another person (such as a carer or family member), that their relationship to the patient, communication preferences and contact details are also clearly noted.
• ensure a suitable follow-up method has been agreed with patients with memory difficulties or for reference by a carer, to record/confirm what was covered in any remote contact.
• ensure that withheld numbers are not used when doctors and practices contact patients.
• to introduce a ‘safe word’ or password with patients to ensure that they know that a call from their practice is genuine.

During remote appointments Deliberate Language:

Language should be clear, simple and easy to understand, and tone should be active. Avoid turns of phrase which patients themselves may not identify with … If required, handle compassionately. Patients with ASD, learning difficulties, mental health or age-related conditions may find remote appointments more stressful or become anxious during an appointment.

Depending on a patient’s needs, clinicians should:

• stick to agreed times for contact.
• stick to the agreed method of contact.
• speak slowly and be prepared to repeat information.
• ask the patient to repeat what you have said rather than just asking if they have understood.

Considering the above factors, ensure the length of the appointment is appropriate.

Safety Reassurance:

All clinical communications to patients should re-enforce that the NHS is safe and is here to care for all patients who need it. At the beginning of a remote appointment, the patient should be asked if they feel that they are in a safe and private environment, and that they are comfortable with using the technology in use.