I was glad on reading this article (and the many twitter conversations it sparked) to see that there are many GPs and other community workers who are uneasy with a blanket switch to remote consultation as default. However, I have also been intrigued that these conversations have largely taken place around the issue of clinical safety and the 'unknown unknowns', rather than barriers to healthcare.
For many GP trainees such as myself, part of the appeal of General Practice is the opportunity to be part of the solution to health disparities. As one of the few remaining areas of the NHS that are truly open access and free at the point of use, GP surgeries have been the place where many of the marginalised and unseen people in society can be seen and receive care.
The switch to remote consulting first, for many will remove this safe place. It goes without saying that people who can't afford a mobile telephone, don't have internet access, and particularly those who can't speak English, will have difficulty navigating the myriad remote entry points to GP consultation.
The difficulty accessing primary care services for migrants, and particularly asylum seekers and refugees, is well documented (1); though as yet there isn't a large body of writing about this with regard to remote consultations. During the first wave of the pandemic, Doctors of the World conducted a Rapid Needs Assessment for excluded people in the UK, and titled their report "An Unsafe Distance" (2). This report repeatedly uses the term 'digital exclusion' to describe some of the barriers outlined above. The plan for digital appointments being the default threatens that this exclusion will extend beyond the end of this pandemic and well into the future.
Far from the hope of of a bright technological future for general practice, Matt Hancock's announcement was yet another occasion when these 'unseen unknowns' were pushed even further away from accessible healthcare.
References
1. Kang, C., Tomkow, L., &; Farrington, R. (2019). Access to primary health care for asylum seekers and refugees: A qualitative study of service user experiences in the UK. British Journal of General Practice, 69(685). doi:10.3399/bjgp19x701309
2. Doctors of the World (2020) An Unsafe Distance: The Impact of the Covid-19 Pandemic on Excluded People in England.
Available: https://www.doctorsoftheworld.org.uk/wp-content/uploads/2020/05/covid19-...
Rapid Response:
Unseen unknowns
Dear Editor,
I was glad on reading this article (and the many twitter conversations it sparked) to see that there are many GPs and other community workers who are uneasy with a blanket switch to remote consultation as default. However, I have also been intrigued that these conversations have largely taken place around the issue of clinical safety and the 'unknown unknowns', rather than barriers to healthcare.
For many GP trainees such as myself, part of the appeal of General Practice is the opportunity to be part of the solution to health disparities. As one of the few remaining areas of the NHS that are truly open access and free at the point of use, GP surgeries have been the place where many of the marginalised and unseen people in society can be seen and receive care.
The switch to remote consulting first, for many will remove this safe place. It goes without saying that people who can't afford a mobile telephone, don't have internet access, and particularly those who can't speak English, will have difficulty navigating the myriad remote entry points to GP consultation.
The difficulty accessing primary care services for migrants, and particularly asylum seekers and refugees, is well documented (1); though as yet there isn't a large body of writing about this with regard to remote consultations. During the first wave of the pandemic, Doctors of the World conducted a Rapid Needs Assessment for excluded people in the UK, and titled their report "An Unsafe Distance" (2). This report repeatedly uses the term 'digital exclusion' to describe some of the barriers outlined above. The plan for digital appointments being the default threatens that this exclusion will extend beyond the end of this pandemic and well into the future.
Far from the hope of of a bright technological future for general practice, Matt Hancock's announcement was yet another occasion when these 'unseen unknowns' were pushed even further away from accessible healthcare.
References
1. Kang, C., Tomkow, L., &; Farrington, R. (2019). Access to primary health care for asylum seekers and refugees: A qualitative study of service user experiences in the UK. British Journal of General Practice, 69(685). doi:10.3399/bjgp19x701309
2. Doctors of the World (2020) An Unsafe Distance: The Impact of the Covid-19 Pandemic on Excluded People in England.
Available: https://www.doctorsoftheworld.org.uk/wp-content/uploads/2020/05/covid19-...
Competing interests: No competing interests