“Because of the risk of COVID-19 infection, in April 2020, 90 per cent of GP consultations were conducted remotely by telephone or video, compared with 33 per cent in April 2019”. IRISi interviewed leading researchers and key specialists to talk about the impact of the pandemic on Domestic Violence and Abuse in the UK – and here are 3 responses to our Look Beyond campaign questions from Dr. Jeremy Horwood, Research Fellow at the Centre for Academic Primary Care (University of Bristol)
As we continue with our “Look Beyond the Pandemic” campaign, IRISi interviewed leading researchers and key specialists to talk about the impact of the pandemic on Domestic Violence and Abuse in the UK. Here is what Dr. Jeremy Horwood, Associate Professor in Social Sciences and Health at The Centre for Academic Primary Care (CAPC), Bristol Medical School, University of Bristol, told us.
Jeremy also led the evaluation of IRIS ADViSE (Assessing for Domestic Violence in Sexual Health Environments) which provided IRIS-based training to the sexual health workforce, with the aim of increasing professional awareness and improving their responses to women experiencing domestic violence and abuse. IRISi is now working to support areas to commission and run this intervention in sexual and reproductive health services.
1) How did the pandemic impact General Practice? What were the main difficulties clinicians had to face once the lockdown was put in place?
The COVID-19 pandemic has abruptly changed how GP practices deliver their services. In a few weeks, clinicians and patients were asked to transition from face-to-face contacts to ‘digital-first’ solutions (that is, telephone, video, online) wherever possible. Our Rapid COVID-19 intelligence to improve primary care response (RAPCI) project monitored changes in general practice during the first few months of the coronavirus pandemic to examine how staff coped and how consultations with patients had changed in Bristol, North Somerset and South Gloucestershire.
Because of the risk of COVID-19 infection, in April 2020, 90 per cent of GP consultations were conducted remotely by telephone or video, compared with 33 per cent in April 2019. By July 2020 this had changed to 85 per cent as practices slightly lowered the threshold for seeing patients face-to-face. Of the 90 per cent of consultations conducted remotely, 88 per cent were telephone consultations, and just over one per cent coded as video consultations in patient records. The true proportion of video consultations is probably higher, as GPs often code consultations which start as telephone but switch to video as telephone consultations.
The delivering primary care during a pandemic has been an ongoing challenge for staff. For example: face-to-face consultations requiring infection control procedures such as putting on and taking off personal protective equipment (PPE) which can be time consuming; telephone consultations took longer as the complexity of problems patients presented with increased (including increasing mental health problems); and implementing ‘total triage’ systems, whereby every patient has a phone call or completes an online form before making an appointment, was draining for staff.
2) What has General Practice done to adapt to this new reality? According to your findings, what do we already know about the quality of these adjustments?
GP practices have had to rapidly adopt new ways of delivering care remotely to responding to the new norm of social distancing to reduce the risk of COVID-19 infection. This is a huge change, with GP practices and patients having to transform the way they interact overnight. This shift to remote consulting was a successful initial response to the pandemic and meant that patient care could continue during the first intense lockdown and GP practices were able to maintain contact with vulnerable patients.
3) What has the pandemic taught clinicians about their practices? What do you think has been learned and will not be forgotten?
Clinicians have learned that remote methods of consulting can have value for some patients, e.g. telephone consulting may be sufficient for many straightforward medical enquiries. Some clinicians preferred patients sending a photograph then a telephone-consultation for problems that required a visual assessment. Video-consulting was useful for children and nursing homes, and problems which require dynamic assessment during lockdown. However, after the initial lockdown some clinicians found high levels of remote consulting a strain. Many missed face-to-face contact and were concerned about clinical risk and found it difficult to set a threshold for seeing patients face-to-face as lockdown eased. Remote method of consulting may have value for some patients, such as straightforward medical enquiries, they cannot replace face-to-face consultations in situations which are more complex.
Jeremy is an Associate Professor in Social Sciences and Health at The Centre for Academic Primary Care (CAPC), Bristol Medical School, University of Bristol. He co-leads the Behavioural and Qualitative Science Team for National Institute for Health Research Collaborations for Leadership in Applied Research Collaboration West (NIHR ARC West). He is also Intervention Optimisation and Implementation Theme co-lead for NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation.
Dr. Jeremy Horwood is an Associate Professor in Social Sciences and Health at The Centre for Academic Primary Care (CAPC), Bristol Medical School, University of Bristol. He co-leads the Behavioural and Qualitative Science Team for National Institute for Health Research Collaborations for Leadership in Applied Research Collaboration West (NIHR ARC West). Jeremy led the evaluation of IRIS ADViSE (Assessing for Domestic Violence in Sexual Health Environments) which provided IRIS-based training to the sexual health workforce, with the aim of increasing professional awareness and improving their responses to women experiencing domestic violence and abuse. He has also been helping adopt IRIS for Pharmacy settings.
