As we were all preparing for 2020—the Year of the Nurse and Midwife—did we ever think we would be as much in the spotlight as we find ourselves at the moment?
It is a testament to the resilience and professionalism of the practice nurse that we have coped and adapted during this exceptional situation.
Use of digital technology in our work environment has been dramatic in its uptake: video consultations; online chronic disease questionnaires; learning how to carry out long term condition reviews with patients who have never had to be cared for in this virtual way—coming so far so very quickly. We have learnt remotely, without the training and support usually received on a face-to-face basis.
In my practice, we proactively contacted patients by phone, SMS and letter. Not only those in shielding groups but also those with a potential to be isolated, anxious or finding the situation difficult to cope with. We used an interpreter for non-English speakers. The aim was to offer advice, signpost to local services or NHS Volunteers, and encourage patients to try going online and support them in doing this. These targeted contacts enabled the practice to increase online users by 980% in the first few weeks of COVID, a considerable achievement in a practice where 40% of consultations require an interpreter. Worryingly though, a proportion of patients were unaware the surgery was still open, and many had a poor understanding of COVID-19 and the advice the government briefed the population on every day.
The reasons why some struggle to access online services and advice are complex and multifactorial
Access to technology
I devised a questionnaire examining aspects of knowledge and use of technology. With medical student volunteers and interpreters in some cases, we rang 200 random patients—ranging in age from 18 years to the over 65s. Of the respondents, 52% needed an interpreter. While the majority of those questioned had technology, approximately 25% did not, and thus the potential to miss vital health messages. In total, 53% said language was a barrier to accessing online services—50% of those questioned had never heard of NHS 111.
As equality of service provision and access for all is a fundamental part of the NHS Constitution (Department of Health, 2015), the challenge is how to ensure those without the skills or knowledge of how to use—or even own—technology are not excluded. The reasons why some struggle to access online services and advice are complex and multifactorial. There are no quick wins, but, as we have seen, the shockingly high levels of COVID-19 infections and deaths in the more deprived multicultural communities in this country and the number of deaths of our colleagues from a BAME background means we have to act to reduce these health inequalities (Public Health England, 2020).
At my practice, based on the tech survey, approximately 1600 patients will need help to get online. The majority of these patients are from BAME communities. This will require a huge investment in time, support, technology and ultimately money—but who will support and fund this critical work?
The COVID-19 pandemic has transformed nursing in this country. Our lives and those of our families, friends and colleagues will never be the same. Our working environment is unlike anything we have ever known. We have all adjusted to new ways of working, and as time passes, we are realising these changes will need to be in place for months if not years.
Technology to maintain communication with our teams enables us to support our colleagues we are not seeing physically, as we are all doing with our families and friends. This is going to continue, and for many practice nurses, at least for the foreseeable future, roles have changed. No longer are they smear takers, immunisers, or will they undertake physical examinations of their patients.
One of the many reasons I became a nurse was to care for people. As practice nurses we are privileged to develop long-standing relationships with all ages of patient, from the cradle to the grave. We get to know families and their communities; we have a unique bond and partnership in care. We need to think about those colleagues who will be unable to see their patients face-to-face for a considerable time, how will this affect them and us? What will need to change to enable these colleagues to develop and learn new skills and how can we, still in practice, support this?
I want to finish with my experience of some positive outcomes of this awful pandemic for practice nurses and patients.
YouTube channels
Firstly, Page Hall Medical Centre (2020) developed a YouTube channel, with an aim of communicating health messages to their patients. Our survey showed of all social platforms YouTube was the most popular, with 75% of patients aware of it. We uploaded short information videos, advice about COVID and how to get online. We also filmed members of the nurse team, demonstrating and providing education on how to use: an inhaler, a blood sugar machine, an electronic blood pressure machine, and how to manage an asthma attack. There is more content to come.
‘The challenge is how to ensure those without the skills or knowledge of how to use—or even own—technology are not excluded.’
The aim is for patients to be able to see the nurse who knows them, all be it virtually. The nurse will also be able to tailor information to groups of patients by sending the relevant YouTube link to them directly, either by SMS or other remote communication method, perhaps following a chronic disease review. This allows the keeping of that important nurse–patient partnership of care. It is important to always being aware there will be some patients with limited IT skills, or a lack of technology available to them.
Video group consultations
Secondly, I wonder how many of us were aware of the success and potential of video group consultations a few years ago? Again, COVID-19 has taught us all to rethink our ways of working and embrace new innovation. Staff working remotely and in practice will be able to communicate, educate and inspire large numbers of patients. There is much evidence to show that this way of working is fulfilling and energising for staff and can be lifechanging for patients (ELC, 2020).
We general practice nurses have, over the last few months, innovated, and digitally transformed our practice in ways many of us may have thought were unattainable. At the same time, we have continually supported our patients through the new approaches to accessing health care. The celebrations for the Year of the Nurse and Midwife are unquestionably not what we planned for at the start of 2020, but I imagine we will remember this year as the most stressful, emotional, memorable and challenging of all our professional and personal lives.