It’s an increasingly urgent problem in many countries: the number of junior doctors going into general practice is dropping. This means that in a few years, there is likely to be a shortage of GPs as more GPs retire without younger doctors taking their places. Many countries are filling the gaps by recruiting from abroad, but this is clearly not sustainable.
At the other end of the spectrum, we have a different kind of challenge. For pharmacists, simply dispensing drugs is not a viable business model.Fortunately, there is an emerging solution to both problems. In Switzerland, a partnership has been set up between pharmaSuisse, Switzerland’s association of pharmacists, Medgate, Switzerland’s centre for telemedicine, and the medical and accident insurer Helsana. With the support of Cisco and communications provider Swisscom, 200 Swiss pharmacies have been provided with a Cisco TelePresence video communication system which connects them with one of 70 doctors. As a result, patients can now have an initial consultation with a doctor over a video link from their local pharmacy.
So how exactly does it work?
The patient is first assessed by the pharmacist using a flow chart developed by Medgate. This provides a structured process for diagnosing a problem and deciding what course of action is appropriate. If the conclusion is that the patient needs a medical consultation, they then go into a video consultation with one of the doctors. The medical consultation takes place in private, and the TelePresence data transfer system is secure. As well as the video link, there are various diagnostic tools that can also be linked up, such as a blood pressure monitor. Once the doctor has examined the patient, he or she sends a prescription direct to the pharmacy, and the medication is dispensed.
This is not a completely new departure for Medgate: they have over 12 years of experience providing healthcare advice by phone. But the video link has added a new dimension, with doctors reporting that it is much easier to provide a correct diagnosis, and that the system can be used for more conditions when they can see the patient. Although there is currently only one health insurer involved, others are keen to be part of netCare, as the system is called, because it is very cost-effective. And it clearly has advantages in terms of resources, if 70 doctors can cover 200 pharmacies.
Disrupting traditional roles
Of course the early implementation hasn’t all been easy. Doctors were worried that pharmacies were trying to ‘take over’ their role, and intrude on their relationships with patients. It has taken time for them to see that the two services are not in competition, but can co-exist comfortably. The message is that netCare provides an additional resource for patients who are unable to see their own doctor, perhaps because the surgery is too busy, or if they are away from home.
It’s a bit soon to say whether the system is genuinely working yet; for example there’s no data yet about patient satisfaction. PharmaSuisse is currently carrying out a study which will look at this, and results should be available later this year. Nevertheless, we believe this concept has plenty of potential, and not just for general practice. Versions of it are being used elsewhere to address different problems.
Experiment in Basel
The University Hospital of Basel is using a similar system to allow its junior doctors to consult with senior specialists out of hours, using photographs taken with smartphones. Again, it’s an extension of an old idea – the telephone consultation – that has gained new relevance with the use of visual technology. There is also potential for nurse practitioners in remote or rural areas to use a similar system to contact and consult with doctors, whether general or specialist, allowing doctors to cover a much wider geographical area. Since TelePresence can also support translation services, it could also be used for tourists who need to see a doctor but who don’t speak the language. Another possible use is for prison healthcare.
The crucial issue is that with its unified, smart and secure technology, this telecare system has the potential to be used for any number of applications to improve access to healthcare without corresponding increase in resources. Aging populations, shortage of GPs and high street pharmacists looking to supplement their portfolio all point to a perfect storm that potentially will be tamed by collaboration across long distances.