Can Near Me help you and your patients? Applying learning from high Near Me users in Primary Care

The current demands on GP Practices are both unprecedented and unrelenting. Our recent experience with these three Practices, suggests that there is the potential for video appointments to play a role in alleviating some of that pressure.

Near Me is a video consulting service that enables people to have health and social care appointments from home or wherever is convenient. Here is a short introductory video

As such it is a key enabler in delivering Realistic Medicine, allowing greater opportunities to deliver care based on what matters to the people we care for.  Rosie Cooper National Improvement Lead – Near Me Programme for Scottish Government’s Technology Enabled Care Programme, offers some insights on the use of #NearMe video consultations by GPs in Scotland.

A recent deep dive into three practices that are high users of Near Me reveals some striking similarities which are transferrable.

Background

The Covid-19 lockdown in 2020 saw a rapid scale-up in the use of Near Me across Scotland. It brought many benefits (Find out more here) including reducing the risk of the spread of infection. Use by GPs peaked in May 2020 with over 15,000 per month. Since then use has significantly declined to a tenth of that figure (around 1,500 per month (Figure 1)).

People who use Near Me, 93% state they have a positive experience and 97% would use it again. The Near Me team was keen to explore why some GP practices continued to use Near Me more than others.

Figure 1 GP consultations per month from January 2020 to September 2022

People who use Near Me, 93% state they have a positive experience and 97% would use it again. The Near Me team was keen to explore why some GP practices continued to use Near Me more than others.

Our Deep Dive

We carried out a deep dive between April and July 2022 to identify any common themes underpinning patterns of use and learning from them. You can read the full report here.

We knew there was a real spread in how video consultations were being used, from nothing to a trickle to hot spots of high use. We also knew that even within practices, use varied from individuals being super users to those never using and some having practice-wide adoption. Our starting point was to identify the highest using practices per practice population and to interview GPs from the three practices to hear their perspective. A general overview of the Practices involved can be seen in Figure 2.

“We knew that there was a real spread in how video consultations were being used, from nothing to a trickle to hot spots of high use”

Figure 2 Overview of the Practices involved.

Key findings

Consistent high use Practices of Near Me revealed several key similarities:

• All used scheduled appointments.
• Appointment slots are either dedicated to Near Me appointments or flexible for remote consultation telephone / Near Me appointments.
• All rooms in the practices are set up with equipment to hold a video consultation, including the receptionists who can offer and make test calls if requested.
• All receptionists promote the use of Near Me to patients when booking appointments and play a vital role in supporting patients to use Near Me.

We heard how Near Me had enabled the continuity of service while GPs were isolating with Covid-19, highlighting the potential for flexible working. One of the Practices described how they physically could not expand the practice but Near Me offered an alternative way to increase staff capacity. Again, this provided an opportunity to capitalise on the benefits of flexible working in recruiting and retaining staff. Read more here about how Near Me can aid recruitment and retention here SRMC-Bulletin-September-2022.pdf (scot.nhs.uk)

Participants shared their experience of where Near Me worked very well. Patients with mental health problems, medication reviews, neurological presentations, and residents in care homes were all highlighted along with other positive opportunities (Figure 3).

“Patients felt better able to describe their problem using Near Me than trying to explain on the phone.”

Figure 3 Examples provided by GPs where Near Me works well.

Golden Nuggets

We were really interested to hear that “It’s generally easier to pick a waiting patient up from the Near Me waiting area than to phone out.” It had not occurred to us that there were frustrations with patients not picking up a phone call or the potential for misdialling, both requiring rework. In contrast, the Near Me waiting area supports workflow, here the patient can wait for the Doctor’s availability and be messaged updates if there is a delay. From other work in the Near Me programme, patients have told us that using Near Me helps them explain their situation. This was corroborated from the participants we interviewed including:

“Patients felt better able to describe their problem using Near Me than try to explain on the phone”.

It seems obvious but there was consensus that familiarity is important. “After a patient has used Near Me once, they find it much easier to use it again.”

Practice administrative and reception Staff are key to offering patients the choice of a Near Me video appointment when they contact the practice and can help with  familiarising patients with the system. That familiarisation grows confidence with the technical aspects of the call, which in turn allows both the clinician and patient to focus on the purpose of the appointment. Working with the Care Navigation programme we have developed a “Near Me Quick Start Guide for Practice Administrative Staff” (figure 4) to support their role and we are very grateful to everyone who helped to pull this together.

Figure 4 Available resource: Quick start guide for Practice Administrative staff.

Barriers to using Near Me

Naturally, we were keen to understand what the staff thought some of the barriers to Near Me not being used more widely and consistently across GP Practices in Scotland. Lack of equipment, technical and digital skills, patient buy-in and ability were all thought to be barriers to overcome. Other thoughts are highlighted (Figure 5).

Going forward

The functionalities of Near Me continue to grow and most recently the Group Consulting platform was launched. Up to 60 patients can join a group call with the same ease and safety, and has already been embraced by mental health services and dietetics. Here is a basic video describing how to use Near Me Groups. The three practices we spoke to describe their multidisciplinary team and in particular, the role the Practice Nurses and Advanced Nurse Practitioners play in long-term condition management. Is there a role for Near Me to support group education and condition management? Perhaps even a role in supporting women seeking advice for menopause and perimenopausal symptoms?

While the Practices involved in this deep dive did not use Near Me Consult Now (due to their well-developed scheduled system), it does present an excellent opportunity for

those Practices who prefer to use the telephone to provide ‘eyes on a situation’, with an easy process to convert to video call. Dr. Paul Baughan GP and Clinical Lead Primary Care Team (HIS) and Dr. Marguerite Smith, GP and Clinical lead for Banff; describe their positive experiences of using #ConsultNow here.