The Remote Geriatrician

Dr Emma Vardy is a Consultant Geriatrician and Clinical Dementia and Delirium Lead at Salford Royal NHS Foundation Trust. She is Chair of the BGS Dementia and Related Disorders Special Interest Group.

The COVID-19 outbreak has meant a change for everyone’s working patterns and rapidly. In my case, due to an underlying medical condition, this has meant remote working.  I thought I would share my experience to encourage others in a similar situation, but also to assist colleagues adapting to the requirements for non-face-to-face care in areas such as outpatients.

Current circumstances require fast adaptation and innovation.  On 16th March I was advised to be non-patient facing.  That first day was spent having CPR discussions with families, facilitating fast track discharges and completing advanced care plans.  Since then, after the initial ‘what can I do?’, I have developed a very different job plan to the one I had before.  In describing my activity hopefully others can pick up some tricks of the new trade!

Converting some clinics to telephone didn’t feel too unusual as I had already started doing some telephone follow-ups, but doing telephone appointments for new patients felt very different.  The good news is that it has been working surprisingly well.  It is essential to have administrative staff able to ensure contact details are correct and identify where a carer needs to be present.  On opening those consultations, it is helpful to establish this is a very different way of doing things and that there will be challenges.  Careful thought needs to go into whether tests are pressing or can be delayed, with consideration of how to minimise contact with other healthcare professionals.  High quality referrals laden with information and results have been invaluable.  Patients and carers have without exception been extremely grateful we continue to look after them, and I have also noticed people seizing the opportunity to ask about other ailments.  Telephone consultations can be very productive, and video consultations would add further tools to this new trade.

Team meetings have all changed to virtual using Microsoft Teams.  Not only is this useful in maintaining social distance, but also as a remote worker, in maintaining those team relationships and links.  Two sets of colleagues I have had a great deal of contact with have been my operational services manager, and also the IT team.  They have been so helpful in establishing new services, and supporting the technical ability to deliver them.  Reaching out to other leaders across the organisation, to let them know my skill and availability, has also been useful in helping to shape and disseminate policy rapidly.  Working remotely  allows me the headspace to have a helicopter view of what is going on and to provide insights that other busy acute colleagues may benefit from, although knowing the right time and forum to raise them is a skill in itself.

Using all technical solutions available is vital.  I have discovered functions held by our electronic patient record which I am sure will be maintained in the future, such as developing patient and task lists.  I have also gathered remote ‘kit’ such as a work phone, smart card reader and ability to access the NHS e-referral service used by colleagues in primary care.  An awareness of relaxation and changes to information governance disseminated through NHSX is really helpful; for example we can now use Whatsapp for communication with colleagues and also with patients (noting issues of confidentiality in relation to personal mobile numbers).  I’d also advise not underestimating what older people can do with technology; there is evidence to show that they will use it when needed and seem to be upskilling themselves fast!

Most recently I have acquired supervision and task planning for a remote junior colleague. There is a lot that they can do, through our electronic patient record, and they can also reach out to ward colleagues with offers to take on tasks that can be managed by telephone.  As my portfolio of tasks increases, so does theirs, ensuring they continue to learn.

Hopefully I have shown just what can be done by colleagues working remotely, but also colleagues developing remote services. 

On a more sobering note I can say that remote working can be lonely and isolating at times.  Reaching out to colleagues in a similar situation has been and continues to be helpful.  Remote working can mean working in an uninterrupted fashion, which is highly productive but can be tiring and very intense. Never has there been a better time to ‘get things done’ but remember this is marathon and not a sprint; pacing is vital for mental well-being and self-care. Guilt is another feeling remote workers have experienced.  A very senior colleague helpfully said that remote workers are valuable team members and will be part of the backbone of the NHS.  Remote workers: it is so true. Please remind yourselves of that.

Helpful references:

1. Centre for Ageing Better. (May, 2018) The digital age: new approaches to supporting people in later life get online. Available at: http://doi.org/10.31077/ageing.better.2018.05a [Accessed on 7th January 2020]
2. Covid: a remote assessment in primary care. (2020) BMJ 2020;368:m1182  
3. Information Governance, NHSX (2020).  Available at: https://www.nhsx.nhs.uk/key-information-and-tools/information-governance-guidance [Accessed on 27th March 2020]
4. NHS Digital (2019) Digital Inclusion guide for health and social care. Revised version 2019. Available at: https://digital.nhs.uk/digitalinclusion [Accessed on 7th January 2020]
5. Portz J.D., Bayliss E.A., Bull S., Boxer R.S., Bekelman D. B., Gleason K., Czaja S. (2019) Using the Technology Acceptance Model to Explore User Experience, Intent to Use, and Use Behavior of a Patient Portal Among Older Adults With Multiple Chronic Conditions: Descriptive Qualitative Study. Journal of Medical Internet Research. 21(4):e11604 doi: 10.2196/11604