Video consultations - public and clinician views: consultation report

Executive summary

Key findings

• Over 5,000 people responded to the public engagement and consistent themes emerged across all types of feed-back received.
• Strong support for the use of video consulting was found: 87% of the public and 94% of clinicians thought video consulting should be used for health and care appointments, providing it is appropriate for the consultation.
• The public stated a small preference for use of video over phone both during periods of physical distancing for Covid-19 and afterwards.
• Health professionals identified a clear preference for using video consulting within the ongoing management of conditions, rather than in undifferentiated diagnosis.
• The public and clinicians identified a range of benefits and some barriers of using video consulting
• Main benefits identified: improving access, convenience, and reducing the risk of infection.
• Main barriers identified: connectivity (and other issues relating to digital exclusion) and lack of private space for video calls.
• Service providers should stop making generalised assumptions about the groups of people who can or cannot use video consulting.

Introduction

Near Me is an online video consulting service that enables health and care appointments to take place at home or close to home. It is procured for use across Scotland by the Scottish Government's Technology Enabled Care Programme. Near Me is powered by the Attend Anywhere platform.

Although Attend Anywhere has been available nationally since December 2016, use prior to the Covid-19 pandemic was relatively small and focused in rural and island areas. At the start of the pandemic (March 2020), a rapid scale up plan was introduced to accelerate the use of Near Me across Scotland. This was informed by, and only possible because of, the early work undertaken in 2017-19. Much of this work was funded by the TEC Programme's scale up challenge.

In February 2020, there were around 300 Near Me consultations per week. By June, this figure had reached 17,000 per week, and this high level of use has been maintained ever since.

The early development of Near Me had taken a co-design approach, with significant patient and professional involvement including choosing the name 'Near Me'. Therefore, a logical extension to this approach was to include a national engagement exercise as part of the rapid scale up of Near Me. The objectives of the engagement exercise were to:

• Understand the potential benefits and barriers of using video consulting for health and care appointments, from various perspectives both during Covid-19 and beyond.
• Understand the views of people who had never used Near Me, including gaining insights about those currently excluded from using the service.
• Identify potential improvements to the Near Me service.
• Review the Near Me Vision and governance arrangements as appropriate.
• Raise awareness with service users and service providers about how Near Me can be used for health and care appointments.

Approach

The engagement exercise comprised significant awareness raising using social, local, and national media. In addition, individual stakeholder engagement took place with both public and health professional groups: 300 organisations were contacted Although the vast majority of feedback was received via online surveys, the range of activities to engage other views by telephone and hard copy was a key approach. Responses from the public and clinicians were received across all health board areas.

Healthcare professional responses were received from across professional groups and care settings. There was an even split across care settings: primary care (28%), secondary care (25%), community services (23%) and mental health services (19%).

For professional groups, the split was: doctors (23%), nurses (20%), physiotherapists (13%), speech and language therapists (10%), psychologists (9%), occupational therapists (4%), dietitians (4%) and other including podiatrists, dentists, midwives, pharmacists, optometrists and health visitors making up the remainder.

An important part of the engagement exercise was the co-production of an Equality Impact Assessment (EQIA). This was to assess the potential impacts of protected characteristics, socio-economic, and remote and rural factors on the use of Near Me video consulting. Both the engagement activities and EQIA examined how video consulting could be made more accessible, both for specific protected characteristic groups and for the public. It has not been possible to find an EQIA for face to face or phone consultation which makes it difficult to compare the impacts on those with protected characteristics across different types of consultations.

Key findings

1. High acceptability for the use of video consulting

• Almost nine of ten (87%) public respondents to the online survey thought video consulting should be offered for health and care appointments.
• This figure was closely matched by people who responded by phone or hard copy, with 81% of this group saying video consulting should be offered for health and care appointments.
• For health care professionals, 94% thought video consulting should be offered for health and care appointments, with 4% unsure and only 2% thought video should not be used.
• Public responses were analysed to control for gender, disability, age band, health board and previous use of Near Me. There was little difference in views between females and males (87% vs 88) or for people with or without a self-reported disability (83% v 82%). Although a drop off in support for video consulting was seen in older age groups, it was a relatively small reduction.
• One surprising result was the high percentage of females responding (80%) for which we have no explanation.

2. Public preference for use of video over phone consulting

• The public stated a slight preference for use of video over phone consulting both during periods of physical distancing for Covid-19 and afterwards. Video was the most preferred option during periods of physical distancing, with face to face the most preferred option once physical distancing is over.
• This contrasted with the health professional views, who had a smaller preference for video over phone, and overall scored the acceptability of phone consulting more highly than patients.

3. Near Me has a wide range of potential use

• Health professionals identified a wide range of potential uses for Near Me.
• A clear preference was identified for use of video consulting within ongoing management of conditions (eg, asthma, mental health conditions, various outpatient follow up appointments), rather than in undifferentiated diagnosis (eg, first presentation of abdominal pain).
• Health professionals were also asked if there were any consultations when they would not use video: three out of four who responded (75%) said there were some, with the most frequently cited being when a physical examination is required.
• This finding backs up the positioning of Near Me as a tool that should be used where appropriate (considering clinical conditions, and patient factors including social circumstances and choice).

4. Benefits of Near Me video consulting

Both the public and health professionals identified the lower infection risk of video consulting as the number one benefit which reflects the period in which this consultation took place (during the Covid-19 pandemic). Notably, this has previously only described as a minor benefit of using video consulting (eg, to reduce people coming into GP practices with norovirus).

Health professionals perceived that the biggest benefits to patients were reducing the need to travel or take time off work, whereas the public scored improving access to services more highly. Another difference was in the importance of the environmental benefits which appeared in the public's top five but was much lower in health professionals' perceived benefits for patients.

For health professionals' benefits for themselves, enabling patient access to services was key both in terms of wider access and delivering a method of consultation that patients requested.

The Equality Impact Assessment (EQIA) identified the following benefits of Near Me:

• Enables people to attend appointments in a safe manner, reducing the risk of infection, particularly for older people, individuals shielding and pregnant women.
• Improved access to health and care services through removing travel barriers. This is particularly relevant for people with disabilities, elderly, frail, people suffering chronic pain, people with carer responsibilities and people living in rural, remote and island communities.
• Reduced time off work or education to attend appointments, especially relevant for carers, young people, and from low socio-economic backgrounds.
• Supports carers, family members and translators to be involved in an appointment, particularly for ethnic minorities, those with disabilities and older people.

5. Barriers of video consulting

The barriers for using Near Me were also scored by the public and health professionals much lower than benefits.

In terms of disadvantages, both the public and health professionals identified poor internet connectivity and resulting poor call quality, and a lack of access to a video calling device as the main issues. The public rated a lack of private space for a video call more highly as a barrier than health professionals anticipated, and health professionals over estimated patients' need for support to connect calls.

For health professionals, in addition to poor quality of calls, the main disadvantages were concerns about missing something on a video appointment and a preference to see patients in person.

The Equality Impact Assessment (EQIA) for Near Me identified the following barriers with Near Me:

• Attitudinal barriers resulting in limited use of Near Me for certain groups where clinicians or organisations may make general assumptions about video appointments not being appropriate for certain cohorts.
• Lack of a safe and confidential space to conduct a video appointment, particularly for younger people in a house with others, carers or those with disabilities and situations where domestic violence is occurring.
• Lack of inclusive communication of Near Me information and patient resources limits use, especially for people where English is not their first language, have a learning disability or low literacy skills.
• People who are digitally excluded for whatever reason. Particularly for younger and older people, minority ethnic populations including gypsy travellers, homeless people, rural, remote and island communities, and those from low socio-economic backgrounds.

6. Improving accessibility of Near Me

The following themes were strongly identified to improve accessibility of Near Me video consulting:

• Improve digital access, both in terms of internet connectivity and access to devices.
• Consider introducing or expanding the idea of local hubs (such as used in the Highlands), clinics or community-based borrowable devices where people can access Near Me if they do not have their own device or the private space for a consultation or lack the skills to use video.
• Ensure there is choice over how consultations are provided, so that Near Me is used where it is both clinically and socially appropriate for an individual patient's situation.
• Improve patient information about Near Me, for example, translated leaflets, awareness about how to make test calls, and clearer information about how to involve interpreters or family members for support in video calls

For health professionals, the top five actions to make video consulting easier to use, listed from biggest to smallest impact as follows:

1. Improving digital access to make it easier for all patients to use digital services.

2. Patients requesting video consultations.

3. Ability to provide mixed clinics (some face to face, some video) rather than all video appointments.

4. Improved internet connection at the consulting location of choice.

5. Best practice guidance from professional bodies.

The EQIA examined how to improve accessibility of video consulting services and made the following recommendations:

• Continue to maintain choice and appropriate deployment of consultation type including face to face appointments.
• Consider the need for local hubs/clinics to access Near Me.
• Establish processes to enable interpreters to join Near Me appointments where appropriate. This would include both services-provided interpreters and informal interpreters/support for appointments, such as from family members.
• Establish and communicate processes to enable patients to do a test call.
• Raise awareness about consultation options including appointments by video.
• Continue to build links with Connecting Scotland, Public Health Scotland, and Scottish Council of Voluntary Organisations to understand the scope and impact of digital exclusion on use of Near Me and provide advice to ensure compatibility
• Develop inclusive communication and guidance materials for using Near Me, including easy read, languages other than English, visual, and bespoke to groups as required (eg, young carers).
• Share best practice inclusive guides/resources with health boards across Scotland.

Conclusions

This engagement exercise has demonstrated strong support for Near Me video consulting services from both the public and clinicians.

Going forward, health and care services should offer video consulting whenever it is appropriate considering both clinical and social factors. This should be combined with person-centered choice to deliver the vision of care described in Realistic Medicine.

Service providers should stop making generalised assumptions about the groups of people who can or cannot use video consulting and enable individuals to make their own choice whenever possible.

Further work is required to maximise the benefits of Near Me, including raising awareness of the service, increasing the use across services, addressing digital exclusion, improving patient information and expansion and/or creation of local hubs for people to use Near Me.

Guidance to further embed the use of Near Me should be developed in collaboration with professional bodies, including use in social care and the wider public sector.

The Executive summary has also been published as a separate document.