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Maintaining authentic patient contact in the shift to remote consultations

Many patients are now reaping the benefits of remote consultations with their primary care pharmacist. But they're not for everyone, cautions Danny Bartlett

In my experience, primary care clinicians are becoming increasingly reliant on technology as the multi-disciplinary workforce grows. Maintaining and monitoring patient contacts within my team while providing all members of the primary care network (PCN) with adequate and fair clinical space access has been a tricky balancing act.

Before COVID-19, there was a much heavier focus on face-to-face consultations in primary care. However, given the need to reduce face-to-face contact during the pandemic, there has been a major shift to telephone consultations and conducting appointments remotely. As the lead pharmacist in my team, I’ve had to adapt to the needs within each of my GP practices and be able to shift my pharmacists and pharmacy technicians to work completely remotely when there is no clinical space for them.

This has meant my team is doing roughly 20% of their appointments face-to-face and the remainder by telephone. This allows them to conduct their appointments from – or via – a shared workspace within practices alongside other professionals such as paramedics, physician associates or social prescribers.

Read more: 30 pharmacies trial virtual consultations in NHS Digital pilot

This then raises the question of whether we are as clinically effective remotely as we are face-to-face. My feeling is that in the majority of cases, pharmacists are more clinically effective in a remote setting. For me, it means I can get through almost double the amount of calls in relation to face-to-face appointments because I can contact patients in more flexible ways. This might be through text messages or emails using Accurx software. Or it might simply be just having the ability to contact patients during working hours rather than them having to take more significant time away to attend an appointment in person.

For certain demographics, this has meant we have been able to secure key interventions in cohorts of patients who might otherwise not have made time to see a medical professional. I have noticed things like uncontrolled blood pressure, high cholesterol, and even stroke prevention in atrial fibrillation have been the key clinical successes of this more flexible approach with patients. I favour a much more preventative approach to medicine rather than reactive, meaning we are capturing patients at higher risk of developing cardiovascular disease and stepping in before a cardiovascular event happens.

However, remote consultations aren’t beneficial across the board. Patients who struggle to use technology such as email or mobile messaging are at risk of being left behind if we move over to this method completely. That's why it is vital to keep a balance, making both available. Patients with severe frailty or who are on multiple medications may need a more holistic and in-person appointment. It is important we offer that to all patients who feel it would benefit them.

In my academic role, it is essential that undergraduate pharmacy students are aware of the different types of consultations, and we are ensuring they can conduct consultations in each of these patient settings.

Read more: Well launches digital pharmacist consultations with Push Doctor

The biggest issue in our sector is space. We have a fantastic array of multi-professionals, many of whom didn’t exist in primary care before PCNs were formed. But with a finite amount of clinical space, we have had to be incredibly innovative in the ways we offer services to patients.

My stance is that we should be flexible and keep one eye on the potential benefits of cohorts of patients who would prefer a more remote appointment while maintaining a consistent offer of in-person appointments to ensure all patients are brought along on the journey.

 

Danny Bartlett is a lead pharmacist at a PCN in West Sussex and a senior lecturer in medicines use

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Barnsley
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