After piloting the technology for non-clinical use, Gill Hitchcock reports on how primary care managers in south Wales are looking to overcome confidentiality issues to explore its potential for GP consultations

Communication is key to effective healthcare. 

This is true of clinicians sharing expertise and patient-critical information, but equally to non-clinical support staff. 

“As practice managers, the ability to get people’s opinions is very valuable, but we are quite isolated in our roles,” says Gareth Thomas, business manager for four NHS GP surgeries in Gwent, south Wales.

Over the past six months, his work at Risca surgery near Newport – from where he also manages the Crumlin surgery in North Celynen and two other branch surgeries – has become less solitary, as the NHS Wales Informatics Service has selected Risca as a test site for Skype for Business.

“It’s an extremely useful and powerful tool,” says Thomas. “It gives me the ability to have face-to-face discussions, and through the course of each day it’s now used by admin staff and managers.”

While Thomas was very much in favour of the pilot, Lynn Carter, the IT manager for the four surgeries – which have 25,000 patients, 60 nursing, managerial and administrative staff, and 15 GPs between them – did not share his enthusiasm. 

“At the moment it’s used mainly for non-clinical business, but it is part of the NHS Wales network which is considered secure for any patient-identifiable information”
Lynn Carter, IT manager for four Welsh GP surgeries

“We had different opinions, if I’m honest,” she says. “I had a lot of scepticism to begin with, thinking this is another pilot, more work and wouldn’t be something we would be using. 

“But I accept that I was wrong. At the moment everyone who is using it really sees the benefits. Gareth pushed for it, and I have to eat humble pie.”

By using Skype to communicate with staff at the other three sites, Thomas is saving the time and petrol that was used making journeys. He uses it to hold bi-weekly meetings with departmental heads as well. 

And, five times each year, he meets with practice managers in his wider local network of GP practices. Known as the Caerphilly cluster, it is one of 64 such networks across Wales, each serving up to 50,000 patients. The next meeting, to discuss local plans, will take place over Skype. 

In addition to free video calls, the four surgeries make use of free Skype voice calls. Thomas says the added benefit of this is that it makes landlines available for external callers, so it is easier for patients to get through to surgeries.

The initiative started in late 2017 as part of an upgrade to the NHS Wales national infrastructure. Technical support and advice was provided by the NHS Wales Informatics Services. And following the success of the pilot, this spring the informatics services started rolling out Skype to GP surgeries across Wales. 

Apart from paying for additional headsets, cameras, and speakers – which Thomas sees as a good investment – the cost of implementation has come from the Welsh Government. Risca received funding from the government’s Efficiency Through Technology Fund, aimed at supporting health and social care projects that use technology to improve the efficiency. 

Thomas says that Skype connectivity is good because it uses the NHS Wales network and connectivity from the Public Sector Broadband Aggregation network.

“We have a 10MB link out from our surgery into the cloud, and I have never experienced times when connectivity has been degraded,” he adds.

A spokesperson for the NHS Wales Informatics Service says that Skype has its own integrated security and all Skype-to-Skype video, voice, file transfers, and instant messages are encrypted.

“We have an ‘acceptable-use policy’ for Skype,” says Carter. “It’s been tied into our information governance policy, and added to our staff handbooks.

“At the moment it’s used mainly for non-clinical business, but it is part of the NHS Wales network which is considered secure for any patient-identifiable information.” 

Thomas thinks Skype is useful for clinical purposes. There have been times when it has been necessary to discuss an individual patient, for example when a practice nurse has needed to talk about someone with the members of a multi-disciplinary team. 

“But, obviously, the acceptable-use policy outlines what they should and should not do about discussing patient identifiable information,” he says.

Carter takes up the privacy issue, saying: “The acceptable-use policy says Skype is for clinical use only when risk assessed. When we are discussing any patient-identifiable information, we use the patient computer system number, rather than the patient’s name or NHS number.”

“We have a 10MB link out from our surgery into the cloud, and I have never experienced times when connectivity has been degraded”
Gareth Thomas, business manager

Using Skype for conferences between large groups has been problematic, however. 

“It doesn’t cater for large groups,” says Thomas. “If I am at my desk speaking and there is a group somewhere else, with five or 10 people around the table, it’s difficult to do that via Skype for desktop. So, we are looking at the requirements for better conferencing facilities.”

Governance
Asked for his advice about Skype for other primary care practices, Thomas says they must ensure staff are fully aware of information governance policies. They must be clear about what they can and cannot use this for. And managers should be prepared for some people who will not be keen to adopt the technology, including GPs. 

“Initially, it was a bit of a shock,” he says. “Their thoughts were ‘oh my goodness, another application’. But as they see us using it, they can see advantages of using it themselves, perhaps when they want to discuss a particular patient or, in the future, communicate with a hospital and discuss a particular issue with a consultant.”

He talks about the potential for a GP to use Skype to help a patient presenting with a dermatology problem. If the GP and the patient hold a remote consultation with a consultant, it could result in quicker treatment for the patient without the need for a hospital appointment, thereby cutting costs.

There is also scope for Skype in consultations between GPs and patients. Thomas thinks it could improve access to primary care for patients who are housebound, or for those in full-time work. And, given the pressures on general practice, remote consultations could free up GP time and the capacity for more appointments. 

But confidentiality remains a stumbling block, in Thomas’ view. For instance, there may be issues if a patient is in a public space or can be overheard. So, he sees this as a long-term development, and one which will require national guidance.

But Thomas (pictured left) would like the opportunity to have remote consultations with his own GP, adding: “Security is a factor, but there will be a cohort of patients who would really welcome it.”