GPs - working from home, wherever that might be!

MOnica there isn’t even a coherent strategy to have all surgeries accessed in the same way. eConsult is used in just over two fifths, others are telephone, email or turn up, so whilst I agree with you, I’m not expecting anything soon.

I am not saying these thigs shpuldn't be used, but I am concrened that too many people are seeing them as some panacea. I think they hold out many dangers and before such schemes are brought in we should make sure there are clear rules regulating them and the doctors involved with regular checks.

As my daughter's case showed, even with the current scheme, things can go badly wrong. With other even less connected schemes the dangers of probles become more current.

As I said I am not against these schemes but I want to see them with strict regulations and regular checks that are publicised well before we use them. They should be national schemes, not just ad hoc schemes cobbled together by individual or a group of surgeries.

M0nica

But growstuff with any scheme like this you need to look ahead to see what it could morph into only too easily - and I can see a small scheme like this, fine and effective when just a local prgmatic solution, being to be taken up by other surgeries and then the NHS formally itself, who adjust it to make it simpler and cheaper to run, and able to call on a larger pool of doctors.

We can see what happened with call centres. The next thing we will have medical chatbots.

We are where we are Monica. Practices are businesses with reputations to uphold, run by doctors. They aren’t going to employ an unproven overseas doctor, only people they know and trust. Your ideas are good in terms of future plans, but we need a solution for here and now, and there’s nothing else on the table.

But growstuff with any scheme like this you need to look ahead to see what it could morph into only too easily - and I can see a small scheme like this, fine and effective when just a local prgmatic solution, being to be taken up by other surgeries and then the NHS formally itself, who adjust it to make it simpler and cheaper to run, and able to call on a larger pool of doctors.

We can see what happened with call centres. The next thing we will have medical chatbots.

M0nica

I am not suggesting the system will fail everybody, but i do think that you cannot properly supervise and check someone who is not working in this country and may never have worked in this country.

Nothing has been said about how these doctors qualifications will be accredited or what English tests they will need to pass.

I would be happier with a fully run and accredited system than with ^
just a local pragmatic solution to enable understaffed GP practices to continue to function, which they enter into themself^ that really is a recipe for catastrophe.

Nobody is (yet) suggesting that doctors in other countries without accreditation should be dealing with NHS patients.

The article is about a doctor who has worked in the UK for 20 years and is employed by a British-based company with an NHS contract.

M0nica As I said, I have no problem with telephone appointments, but not with doctors conducting them from another country. That would apply even if the doctor was British.

Why? If consultant is British, has British training - why would consultant location matter - modern phones work well, as do computers.

I am not suggesting the system will fail everybody, but i do think that you cannot properly supervise and check someone who is not working in this country and may never have worked in this country.

Nothing has been said about how these doctors qualifications will be accredited or what English tests they will need to pass.

I would be happier with a fully run and accredited system than with ^
just a local pragmatic solution to enable understaffed GP practices to continue to function, which they enter into themself^ that really is a recipe for catastrophe.

Didn't seem this was an overseas system. Someone trained in the UK, from the UK, working outside the UK with computer and phone.

I had a serious underlying health issue for approximately 7 years. "Substantial gaps exist in processes for diagnosis and referral of patients with this disease that lead to underdiagnosis and undertreatment."

"To improve rates of diagnosis and treatment, strategies are needed to educate nonsurgeons and patients about the benefits of surgery and to modify care processes to more efficiently diagnose and refer patients."

Does this disease impact my health and potentially my life span? Yes. "Does this disease shorten life expectancy? Yes. Much more dangerous than having high cholesterol. More deadly than having certain cancer. In fact, having this (non-cancer) tumor is the same risk of early death as having diabetes."

Would I've been suitable for long-distance consult? Yes. In fact I was. After best English trained and speaking doctors, in country, missed it for 7 years,

M0nica

growstuff I think that was our attitude when overseas call centres were first introduced, but we soon discovered all the problems, including cultural problems, poorly trained staff, and, uncertain English. There is no reason not to think this will not happen to overseas medical call systems.

Will these foreign doctors be registered and tested by the relevant medical body to the same standards that it registers and tests foreign doctors working in the UK or will they be accepted without such checks?

I can see so many problems about this scheme, that goes beyond the 'what is the problem with phone consultations, we have had them for a long time' attitude.

As it is my daughter came close to death following a doctor forgetting to order a necessary test in a phone consultation. Had she been in the surgery one glance at her would have alerted him to her problem. As it was it was another 3 months before her GP ordered the relevant test and when the result came back rang her up and sent her for immediate medical treatment as she was told 'You could have a fatal heart attack at any moment'. She was classified as being 'critically ill'. which means life-threatening.

I am sorry if I cannot be so uncritically welcoming of this new move, but our family know what can happen if it goes wrong in the UK with UK doctors, the capacity for it going wrong where doctors/ paramedics/111 staff are in overseas countries with no knowledge of the UK.is far wider and i think the controls will be far slacker.

It’s not a scheme Monica, it’s just a local pragmatic solution to enable understaffed GP practices to continue to function, which they enter into themselves. I do understand that the system failed your daughter, but that doesn’t mean that it will fail for all patients - practices need all the help they can get at the moment, or many more patients will be failed.

I have a friend who is a retired GP. He loved his job but after major heart surgery when he was in his late 50s, he decided that running a small surgery in a deprived area of a large city was no longer viable for him.
He became a locum for several other surgeries in the same city and during the pandemic volunteered his services at their local hospital until it became too dangerous for him.

At that time it was safer for him to work remotely, which he has continued to do whilst still doing some locum work.
He's now in his early 70s. He attends regular courses at various university medical schools each year in order to keep his knowledge up to date and is doing a job he loves.
Thanks to modern technology a well qualified, experienced and dedicated doctor can still work for the NHS.

Obviously, there is no substitute for a face to face consultation but in many instances an initial conversation via phone or online may be all that is needed.

Just to point out that all GP practices are small to medium size businesses who contract their services to the NHS.

MOnica I'm not in favour of outsourcing GP services to some random part of the world, but that's not the situation being reported here.

The GP has worked in the UK for 20 years, so presumably has a good understanding of how the system works. She works for the Hurley Group, who operate a number of GP practices in London and elsewhere. If patients in one of those practices rings up, they will by default be given online or telephone consultations. I don't see it really matters where the doctor is.

growstuff I think that was our attitude when overseas call centres were first introduced, but we soon discovered all the problems, including cultural problems, poorly trained staff, and, uncertain English. There is no reason not to think this will not happen to overseas medical call systems.

Will these foreign doctors be registered and tested by the relevant medical body to the same standards that it registers and tests foreign doctors working in the UK or will they be accepted without such checks?

I can see so many problems about this scheme, that goes beyond the 'what is the problem with phone consultations, we have had them for a long time' attitude.

As it is my daughter came close to death following a doctor forgetting to order a necessary test in a phone consultation. Had she been in the surgery one glance at her would have alerted him to her problem. As it was it was another 3 months before her GP ordered the relevant test and when the result came back rang her up and sent her for immediate medical treatment as she was told 'You could have a fatal heart attack at any moment'. She was classified as being 'critically ill'. which means life-threatening.

I am sorry if I cannot be so uncritically welcoming of this new move, but our family know what can happen if it goes wrong in the UK with UK doctors, the capacity for it going wrong where doctors/ paramedics/111 staff are in overseas countries with no knowledge of the UK.is far wider and i think the controls will be far slacker.

Casdon

Obviously it is better if every patient is seen in person by a GP, given a full examination, listened to and then a decision is made as to what to do next Daisymae, but that’s not where we are. I don’t think we will ever return to that either until the job is made far more attractive. It will take many years because so many doctors have left. In the meantime I’d rather have a virtual consultation from a doctor who is overseas than nothing.

I agree. This is the future (for good or bad). I've had more consultations with doctors over the last year than I have in my whole adult life. At least half have been telephone consultations or online/text communications. I've been given face-to-face appointments when necessary. I'm satisfied with that. Quite honestly, I don't care if the doctor is ringing from next door, another part of the country or a different country.

Daisymae

She works remotely for the NHS.

She works for the Hurley Group, which is a private organisation with contracts to provide GP services for some parts of the country, including large areas of London.

My husband has literally just come off the phone. His Doctor just rang him from a Withheld number so I nearly didn’t answer. It always says “Doctor” when someone from our surgery rings

Many professional; people use a withheld number. I used to do quite a lot of telephone interviewing from home when I was an academic. While I was happy to give respondsnts my office number at the uni if they wanted further information about the research I would not have wanted them to know my home number. I have an ex-directory number and my landline still rings was "withheld".

Obviously nobody wants to be in the terrible situation that Monica's family was in.
Some GP work must be done in person. Not everything is suitable for phone/online.

Obviously it is better if every patient is seen in person by a GP, given a full examination, listened to and then a decision is made as to what to do next Daisymae, but that’s not where we are. I don’t think we will ever return to that either until the job is made far more attractive. It will take many years because so many doctors have left. In the meantime I’d rather have a virtual consultation from a doctor who is overseas than nothing.

Loved!

The issue is the obvious drop in levels of service. There's an awful lot that a trained medic can tell just by observing a patient. Telephone appointments are lived by GPs. I can see the role of GP being reduced and eventually eradicated, replaced by AI. Maybe that would be an improvement?

Surely the point is that although this doctor is now living overseas she isn’t completely lost to the NHS? There is a dire GP shortage, the effects of which are mentioned daily on Gransnet. Her doing this is better than her leaving altogether and not being replaceable by her practice surely?

GP's have lots of tasks to do many of which are done at home in their own time.
Patient consultations, however they are conducted, are just a part of their workload.
Of course they need to be professional about their surroundings when working, but they can do that wherever in the world they are - really don't see the issue in the OP.

Whitewavemark2

I think the major issue with GPS phone consultation, is that it is driving people to very hard pressed A&E.

I’ve spent some time in different A&Es lately and it seems clear to me that people are turning up because they simply can’t get to see their GP.

Yes

I think the major issue with GPS phone consultation, is that it is driving people to very hard pressed A&E.

I’ve spent some time in different A&Es lately and it seems clear to me that people are turning up because they simply can’t get to see their GP.

I have no problem with phone consultations, but our family nearly suffered the loss of a member when the system failed her.

What would worry me is that if a practice, or private company started employing, overseas Gps, who were domiciled in their native country and were not familiar with the UK or our medical system problems could arise.

Medecine is 50% science and 50% human relations and there ar so many nuances, minor cultural attitudes, language subtleties, that would be lost where the GP is not familiar with the country, misunderstandings when notes are passed on to the GP seeing the patient - and how would the doctor be supervised to check that they were working in a professional manner and not taking patient calls, while stirring lunch, or lounging in the garden.

As I said, I have no problem with telephone appointments, but not with doctors conducting them from another country. That would apply even if the doctor was British.