Planning for a new ‘normal’ in the NHS

Published: 22nd April 2020
We’re not through COVID yet, but maybe it’s the end of the beginning. We think there are two main changes to ‘normal’ that will last in the NHS.

We’re not through it yet, but maybe it’s the end of the beginning. This week we heard from a number of front line clinicians in areas that have been hard hit by COVID early on. All of them said that admissions seem to have slowed significantly.  We also heard from clinicians who had been expected to be deployed to the front line as the crisis worsened, but haven’t been. They now expect to be delivering a ‘normal’ service again in a few weeks. We think there are two main changes to ‘normal’ that will last:


 – New technology is here to stay
 – COVID is here to stay (at least until there is a vaccine)

What does this mean?

 

1. Patient behaviour will stay changed
 
At the height of the crisis in London we heard stories of empty A&E departments. GPs told of having spare appointments. Consultant Connect calls to non-COVID emergency departments dropped in volume.
 
What happened? For many patients, things that would once have been an emergency were now not worth the risk of a trip to A&E. Things that were not an emergency could wait or be dealt with at the pharmacy. With COVID going nowhere for now, we expect this behaviour to continue. This is, of course, good in terms of the NHS Long Term Plan, which aims to cut hospital attendances by a third. But not like this – there is now a significant risk that many patients with serious illnesses will ignore their symptoms. GPs are going to have to work hard to engage with these “scared” patients in the new world to avoid a non-COVID healthcare crisis.


 
2. New technology means there’s no going back
 
The NHS has modernised more in the past five weeks than it has in the past five years. Hundreds of thousands of GP consultations moved online or onto the telephone. Secondary care is deep into the process of enabling hospital appointments to be delivered via phone or video. At Consultant Connect we have seen a large uptake of telephone advice by healthcare organisations around the country, increasing our service coverage by over a third to over 25 million patients.

The impact has been immediate and, amazingly, as positive as the technology providers have been promising it would be. GPs on Twitter have been reporting that they have finished their sessions early after switching to remote consultations, rather than burning the candle into the night. Patients have embraced the new technology and proved it can work.

We have seen a spike in usage of telephone advice & guidance as GPs have worked hard to give their patients an alternative to hospital. The impact on patient referrals and admissions has been immediate and the feedback from new user GPs has been excellent, for example:

 
‘I have now used the service twice and found it really excellent.  I called from the app on my phone.  There was no wait at all and the consultant answered the call directly.  In these difficult times where GPs will need to work outside their comfort zone, being able to get consultant advice and support in this responsive way is critical.  The service also helped me to manage a patient where I was unsure if a referral was needed, or whether his symptoms were worrying.’
 
‘It’s an amazing service. Wish we had it for all specialities’
 
 
 
 
Technology means that the NHS will emerge from this crisis delivering its services more efficiently and, in many instances, better than before. Clinicians and patients are supportive of the changes. There’s no going back.
 
This is the new normal:

 – Reduced patient demand at GPs and A&E due to fear of infection
 – Increased marketing to patients to use their GP if they have red flag symptoms
 – Shift to remote phone and video consultations being the norm for primary and secondary care
 – Increased use of advice / triage to prevent unnecessary patient trips to hospital
 
 

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