EP 29: BREAKING THE DIGITAL DIVIDE IN HEALTHCARE: IS ONLINE ACCESS TRULY INCLUSIVE?

no one: [00:00:00] Stories, labels, Misconceptions, NHS remains a blessing. Created in 1948, we want it to remain great. A podcast where we share our stories, explore solutions in all their glories. They say it's broken, but it's not done, with your host Val Barrett and Dr. Jeremy Anderson.

Val: Welcome to Stories, Labels and Misconceptions with Val Barrett. 

Dr Jeremy: I'm Dr. Jeremy Anderson. 

Val: I bumped into Dr. Jeremy on Wednesday and we're like a walking podcast episode because we started getting into this.

Dr Jeremy: Yeah. 

Val: Let's discuss this. We're [00:01:00] going to continue that today.

Today we're talking about the Online GP Appointment Scheme. Solution or slogan? 

Dr Jeremy: Yes.

Dr Jeremy: So that, that came into effect. What day would that be? Was it on Wednesday then? 

Val: He announced it at the conference. 

Dr Jeremy: Yeah,

Val: they announce a slogan, 

Dr Jeremy: and 

Val: to pull a rabbit out a hat.

Dr Jeremy: Yeah. 

Val: Things like that, to appease. Their base but as good as it sounds. 

Dr Jeremy: The idea is everybody hates the 8 AM scramble to try to find, or to try to get a GP appointment. If you have an, if you have something you want the GP to see urgently, they have a limited number of slots to be seen that day and you have to call at eight o'clock in order to get one of those appointments.

Everyone hates it. And so now they're saying, okay, there's no more phone call appointments. It's all [00:02:00] online.

Val: As you can hear, my silence. 

Dr Jeremy: Okay. Somehow Val, you're not convinced that's going to fix the problem. 

Val: No, it isn't. It's a slogan. Soundbites, sound good, but they never work, is it thought through? I don't know. We know that GPs are already overstretched?

We need more. We're a population that's getting bigger, living longer. I'm sure we said one episode that GPS in. deprived areas were getting less, those areas are more likely to have complex issues.

Dr Jeremy: The funding formula is supposed to account for that, but it doesn't entirely. 

Val: When we talk about a fair system, fair for who? 

Dr Jeremy: Yeah. 

Val: The first thing I said to you when I saw you was. But online, immediately, that's going to [00:03:00] cut out a group not using online.

They don't have a smartphone, a laptop, or don't know how to get online. We know we have to move with the times. That's brilliant. But we're always going to have a generation. that doesn't know about computers. Some of them, I remember when we changed from analog television, a lot of the elderly were panicking, 

Dr Jeremy: you 

Val: know, things we've got to remember is brand new to them. I remember getting online for the first time. When we had dial up, talk about an hour. There was things that I didn't know how to do, but I had a son who supported me. I didn't know how to use word. Honestly, I was useless. But now of course I do.

When you're a certain age, [00:04:00] your eyesight may not be as good if you're housebound, you're not going to go to a library to use a computer, or if you do, is there someone there that's going to sit down and spend that time with you? And then plus, if you're ill, Some people can't even pick up the phone to phone the GP. Never mind trying to go online. 

Dr Jeremy: Yeah. Since this new system kicked in, I haven't tried to book any GP appointment. Have you had any experience with it? If it's online, if it's all written text, it requires decent eyesight and be able to read which isn't necessarily the case with a phone, right?

You could just call 

Val: and talk to someone, 

Dr Jeremy: right? 

Val: There has to be that option, I was using that system, when you go online and your symptoms are. 

Dr Jeremy: Oh, is that how the system works? At the 

Val: moment, this online thing. I got fed up. Halfway through, I phoned them [00:05:00] and asked them to do it because I did. I got fed up. I thought, why is it so long winded? Even for me, it was a bit like bloody hell. It's long winded and I gave up. I've never had a problem getting an appointment. They phoned me. 

Dr Jeremy: Yeah, 

Val: I live with lung disease and heart disease and my son's got complex needs as well.

So I, one day I'm sitting down the phone rings and I noticed it's the GP I thought, I haven't had any tests phoning me to see how I'm doing. Do I need any other support? 

Dr Jeremy: You are lucky if you have a GP that does that. 

Val: I know. Perhaps I'm their favourite. I don't know. It's, I get a good service. And I remember because they used to be around the corner. And they were, when they were moving to a bigger building, so they could offer an even [00:06:00] better service. So they are equipped out. They've got loads of staff. I went across the road to the pharmacy.

And said, Oh, I'm thinking of moving. He said, don't you dare. He said your GP is one of the best. Because they keep in touch with us. About their patients. 

Dr Jeremy: My GP has never called me 

Val: perhaps they don't like you.

Dr Jeremy: Some gps are more engaged you have a good one.

Val: Take them gifts. .

Dr Jeremy: When I did wanna make an appointment with my GP I got an appointment. . I had to wait. Five weeks for it, right? It's good thing. It wasn't urgent. I don't know what I would have done. If I needed an urgent appointment to the GP. 

Val: So if you need an urgent appointment, you're going to have to think, okay, let me book it now, just in case five weeks time,

Dr Jeremy: that's my question within your system, right? So the old system was. If you could make the call at 8 o'clock, then you could maybe get one of the [00:07:00] limited slots for that day. With the online service if there isn't an 8am scramble to book the appointment online How does it work there's still a scramble. Just, there's still no, it's an online scramble rather than a phone scramble. 

Val: Have you ever tried to book for a theater ticket or a ticket to go and see a band? Sure. Yeah. And you are waiting in a queue, it doesn't matter how many tickets they've got.

Dr Jeremy: Just hammering that F5 button. 

Val: I remember once when me and my son were going to see WWE, we're in a queue! Honestly! It's waited over an hour! Just because it's going to change from phone, To online doesn't mean you've suddenly got a thousand places. You're still going to have the same amount of doctors and the same amount of spaces. 

Dr Jeremy: We're trading the 8am scramble for an online ticket purchase with our [00:08:00] GPs.

Val: Unless they've pulled something else out of the bag. I don't know. Is this a fix we've been waiting for? Or just another slogan without substance? What do you think? 

Dr Jeremy: Sounds like a slogan. 

Val: They love a slogan, they love a rhyme. 

Dr Jeremy: So they've implemented it. So what is the results being? 

Val: I don't know if you're going to see any yet. I don't know if it started because they only announced it. 

Dr Jeremy: Didn't it come into force this week?

Val: I haven't got a clue. I wouldn't know. So I don't phone my doctor urgently. I don't need to.

Dr Jeremy: I think I'd heard that it was supposed to be rolled out nationwide on the 1st of October. 

Val: Okay. 

Dr Jeremy: Online, I'm seeing mixed results. Apparently one London GP surgery has cut weights from 14 days to three. 

Val: Not bad. 

Dr Jeremy: That's an improvement, right? But for an [00:09:00] urgent appointment, do you really want to wait? Three days. 

Val: What's your definition of urgent? Same day, isn't it?

Dr Jeremy: You want to be seen same day, right? If you've got, a gum infection, teeth hurt, something awful. 

Val: You've got GP. You've got the dentist. You go to 

Dr Jeremy: You don't want the dentist to say, see me next week. You want someone to look at you, if you've got a dentist, 

Val: if you've got a dentist. If you have a dentist. 

Dr Jeremy: If people aren't using the phone lines are freed up. So when they do call, they can access the receptionist better. 

Val: Those phone lines will still be buzzing. 

Dr Jeremy: Yeah.

Val: It's like I said. Not everyone has access to online. Not everybody has the internet. Not everybody wants the internet. We're forcing people to have something they may not want or can't afford is the government going to give out free internet? Is there anywhere in the world that has [00:10:00] that?

Dr Jeremy: Yes, might be San Francisco. There was I think it was a place in California that had free Wi Fi. But in terms of the problems so far, there's been pushback, some GP practices have refused to implement it, or there's some sort of technical problem with it.

Val: Yeah.

Dr Jeremy: And this is interesting, apparently the system has no direct booking, like when you go online to book an appointment, you don't actually book an appointment, you submit a request. Yeah. Yeah. And they triage your request. So I think that means you're going to have people gaming the system, right? You have to big up your symptoms in order to get prioritized. If you want to get seen urgently, it's not just I have a chest cold. It's I'm having chest pains. Or whatever it takes to push yourself up in terms of priority. 

Val: Okay. I'm just going onto my surgery website, check it out and see how it goes. Yeah. Because I know [00:11:00] I can book online. It's just, I never have.

Dr Jeremy: Yeah. I've booked long before the system was rolled out. But, excuse me,

but it wasn't for an urgent appointment. I think that's what we're talking about here so it seems the online system is a matter of telling people your symptoms or listing up your symptoms and they decide how urgent your case is.

Val: Okay. I'm just logging in book appointment.

Okay. Dates have come up. The 4th today till the 11th of October. Huh. 

Dr Jeremy: So within the next week, 

Val: all types, the earliest one is tomorrow. I did not know. My GP was open 

Dr Jeremy: on a Sunday. 

Val: Yep. 

Dr Jeremy: Yeah. 

Val: Wow. That's quite good. Considering today is Saturday and it is [00:12:00] 3. 30 PM and the next available appointment at my GP is Sunday the 5th at 7. 40 PM. Wow. 

Dr Jeremy: That's not bad. Your GP seems really good. Yes. I'm sure we'll have listeners writing in saying, how can they join your GP practice?

Val: Oh don't. I think this is good. Wow. I did not know that. 

Dr Jeremy: Yeah. So what if you needed to be seen right away?

Val: That's what A& E's for.. All it's going to do I think when they say these things, it raises people's expectations. Urgent is A& E. That's accident and emergency. 

Dr Jeremy: I was thinking about, my patients who need medication, it's not [00:13:00] an emergency in the sense of they didn't chop their finger off or something. But, They basically, they need medication that if they don't take it now, it's, things are going to get bad they're fine, but need to see someone now to prevent a bad thing from happening 

Val: Is this regular medication they take? 

Dr Jeremy: It may be.

Val: If it is, I'm on regular medication, I have a dosset box and one medication cannot go in the dosset box. Cause once you open it, you have to use it. 

Dr Jeremy: Oh, 

Val: that's for my heart. Sometimes they order everything for my dosset box and forget. I need the other one. So I can go online, look at the list of my medication, tick it, write URGENT NEED IT NOW, send it off, then I can phone, the receptionist said yes, I've [00:14:00] seen it. I've passed it to the doctor. They sign it. It will be at your pharmacy within one hour, which is across the road. And that's how mine works. 

Dr Jeremy: Okay. Once again, you have a fantastic GP. 

Val: Once again, I'm never moving. I'm not I don't have any complaints. 

Dr Jeremy: It's working great for you. Yeah. 

Val: So the fact of the matter is because they're not private, it's still NHS. If my surgery can deliver a service like that, where the customer is completely satisfied why can't others do the same? What's the formula? They have that others need.

Dr Jeremy: That's a good point.

Val: Because we're not asking. Yeah. Others to do something that's impossible. Because if somebody else's has shown that it is [00:15:00] possible, then it can be done. 

Dr Jeremy: Talk to your GP and say, what are you doing that other GPs aren't? 

Val: Did ask. I did ask them and they did say, because we do know it got better since they moved. They got a bigger premises. 

Dr Jeremy: Just having the proper size physical building. 

Val: They were then able to have more doctors, physician assistants? More nurses. 

Dr Jeremy: Yeah. 

Val: More receptionists, more sites. They have the big site. And satellite sites, if that makes sense. 

Dr Jeremy: Yeah. Yeah. That sounds great, Val. In comparison to some of my patients they're supposed to be prescribed a medication, but it gets missed. Or even if it has been prescribed, their pharmacy doesn't stock it normally.

They run out and need to take it, but it's not available for a few days. They're looking at getting sick because of withdrawal symptoms or if they're on mood medications, if you stop taking an antidepressant, [00:16:00] you get a horrible decline

a massive case of depression. It really is something, these medications really are something that needs to be provided steadily. And unfortunately it isn't. When that happens, it's very difficult to get ahold of the GP to get an appointment, to get things sorted.

Val: Our GP have a pharmacist. In the surgery and the GP liaises with my pharmacist across the road, their pharmacist does as well, but I've never had to go without medication for more than an hour. Even one time when I forgot. That was my fault. I called, is it 111

Dr Jeremy: Yeah. 

Val: I called 111. I'm on regular medication for my heart. 

Dr Jeremy: Yeah. 

Val: They can see my notes. They then did the same thing. They got my pharmacy across the road. [00:17:00] To dispense some until the GP was open 

Dr Jeremy: yeah. 

Val: That's fantastic. 

Dr Jeremy: There was an option a backup plan. I think that's one thing that would solve this urgent problem. If there was a backup you could call, even if your own GP can't meet you having a backup would be important. 

Val: That backup was there because I don't think I had a busy week. Andre might not have been well, I was unable to make sure my medication is okay. My dosset box is fine because I collect both of our dosset boxes at the same time. I collect it every four weeks. So we give us four weekly supplies of his and mine. But I've got one that can't go in the dosset box.

And that's the one I forgot to check. It was a weekend. So when I went across the road, they said dial 1 1 1 or sometimes what [00:18:00] they've done, they said, okay, we'll give you a strip and let my GP know. They've always found a solution. It's never been like a day. It's been like an hour. 

Dr Jeremy: Okay. That sounds great. Solution focused, joined up care. That's what you want it to be. 

Val: That's how it's supposed to be because we're all on the system. One have access to the system, and they can see I'm on regular medication and it's there.

Dr Jeremy: Great. 

Val: I don't know. It's sad but when I'm watching these television shows. I only hear the bad stuff. Only when it's not working. 

Dr Jeremy: Yeah. 

Val: And we need to remember. 

Dr Jeremy: Yeah. 

Val: The NHS when it works well. I don't know as a person who works in the NHS, what that must feel like when everyone keeps talking it down and you're trying your best [00:19:00] and your hands are tied.

Dr Jeremy: It's well known within media that, if it bleeds, it leads, right? 

Val: Yeah. 

Dr Jeremy: So it's an over focus on the negative. It just doesn't seem like news to say, this just in, everything is working exactly as it's supposed to.

What's most interesting to us is when things are not going well, right? We hear about, crimes but there's never news of 99 percent of people obeyed the law today.

Val: That would be weird. 

Dr Jeremy: We live in a world focused on the negative. And when it comes to something like healthcare or policing or government, or you name it, whatever the topic we're always focused on how it's going wrong, how it's not working. And at least in your case with your GP. It seems to be working well. Gold stars.

Val: But if we don't talk about the ones that work how are we supposed to learn? How are we supposed to say this is best practice? 

Dr Jeremy: Yeah. 

Val: That's the whole point. Because then when everyone's saying, oh, it doesn't work, it doesn't work, then it [00:20:00] gives other people who don't really like the NHS to say the whole lot's got to go.

Dr Jeremy: Yeah. 

Val: How much percent would you say is bad? 

Dr Jeremy: I would say a lot is bad, but I guess I'm basing my assessment on, my sampling, like my patients come and talk to me about the problems they're having accessing the healthcare system. But again, people don't see. A psychologist to talk about all the things they're not frustrated about, they're not depressed about, right? I only talk to people who who are struggling, right? 

Val: But what you just mentioned, when they come to talk to you, these are things that there are solutions.

Dr Jeremy: There are solutions, or they're supposed to be. I have a guy who probably needs a knee replacement. 

Val: A what replacement? 

Dr Jeremy: A knee replacement.

Val: Oh, okay.

Dr Jeremy: So he's probably needed a knee replacement for a year, maybe two. But, just because he comes into hospital a fair [00:21:00] amount. Is he an inpatient or outpatient? Who knows? Does he get seen as inpatient or outpatient? He maybe misses some outpatient appointments. And he's being seen by different departments. Should he be seen by rheumatology? Should he be seen by orthopedics?

Val: Orthopedics? 

Dr Jeremy: Yeah, or both, right? Or maybe he needs the pain service,

Val: is the pain service going to replace his knee?

Dr Jeremy: No, but they might help in the meantime, there isn't a lot of joined up care. If he's an inpatient, does he get referred by the inpatient team? If he's an outpatient, he should be seen by his GP, but maybe he doesn't have a good GP. He's been pushed one way or the other, or people say they'll do something, but it never gets done. He's enormously frustrated, right?

Val: That's people not taking responsibility. I would have thought, the main person, especially when you're living with a complex condition, that doctor should be the one that [00:22:00] makes the referral. 

Dr Jeremy: GP you mean? 

Val: No, not the GP. The doctor that looks after him for his condition, Andre's been in the same boat when he had to have orthopaedic surgery, everything's done from the haematologist.

Dr Jeremy: Oh, really? Okay.

Val: Because even the haematologist referred him to have an up to date MRI scan. Even though we have a neurologist, there's a lot of these consultants that enter this holistic approach and his neurologist is like that as well. He said, I don't just look at one thing. I look at everything.

Dr Jeremy: Okay. 

Val: I think the only people that should go the GP route are people that don't have a long term condition who have a consultant. 

Dr Jeremy: Yeah, if you're just a guy who played a lot of football and blew out his knee, then he needs to go to the GP and get referred. I think, that's an example of [00:23:00] the kind of frustration I get with my patients. Has this it's not that he, never gets referred. But it's a kind of thing of is it really that bad? Do we really want to do this now? His life is happening now. He's suffering now. But then 

Val: Isn't it for the orthopedic surgeon to judge how bad it is? 

Dr Jeremy: The orthopedic surgeon is judging that. They've seen him. 

Val: Oh,

Dr Jeremy: but then, if he's being seen by them, he gets dropped by someone else. So there is a mess going on and I don't really know how to fix it. 

Val: Sounds like something else is going on. We can't say too much, but sounds like there's something else.

Dr Jeremy: I'm trying to pull these cases together. I can't be specific about a person, with that one long term condition. 

Val: Yeah. 

Dr Jeremy: They develop long term complications I work with people with sickle cell. Every problem gets viewed through the lens of sickle cell. Everything needs to be managed by [00:24:00] hematology, but the complications the hematologists don't deal with that, they need to refer it out, 

Val: right? I know what you're saying, but in 30 years, never encountered that. I can only tell you what's gone on with us. Never encountered that. If we get referred to epidemiology, neurology, orthopedic, rheumatology, whatever, ology. We've never had an issue. They've looked at that problem. Oh okay. Everything started from the emphasis of having sickle cell, but out of that epilepsy, osteoporosis, out of that grows different things.

That is not the remit of the hematologist. The hematologist looks at that and thinks this is when you need specialists. [00:25:00] You need the epidemiology needs to come in. The neurologist needs to come in. So that doesn't make sense to me. 

Dr Jeremy: I wonder if the difference between Andre's experience and some patients is Andre is almost never an inpatient. He comes to outpatient appointments and gets regular follow up, right? Yeah. Whereas I think one of the things that kind of throws a spanner in the works, For a lot of my patients is if they're constantly in and out of hospital that they maybe miss their outpatient appointments a lot because they're in hospital. So things that would normally get referred and coordinated don't end up happening. Does that make sense? 

Val: Yes. I know we've gone off topic a minute. We'll come back I just want to quickly ask cause you mentioned that some, are in. Hospital. Yeah. And they missed the outpatients. 

Dr Jeremy: If they're having a flare up of symptoms in one area, that's the problem. It means it's harder [00:26:00] to follow up and refer them. on for other specialists. I think if we take Andre as an example, his sickle is stable and he almost never comes in as an inpatient. He attends his outpatient appointments regularly, consistently. If he develops any other conditions, That's the time to sort out the referrals, right? 

Val: Yeah look, it's like that time when we went to have a heart scan. So they always make sure he has regular scans. And they caught the blood clot. 

Dr Jeremy: Yeah.

Val: Imagine if we didn't go. A lot of it is we attend. appointments, even though he's well, it's about staying well. When we talk about the NHS, it shouldn't be about, being sick. It should be about staying well, he eats good, he exercises, he [00:27:00] works.

Dr Jeremy: Yes. 

Val: He attends routine appointments, bone density scans heart scans, liver ferry scans? 

Dr Jeremy: Yeah. 

Val: Blood tests every month for his transfusions so if anything was to show up, they would see it. Okay. The other day when we went in for bloods, His hand was hurting. It had swollen up 'cause he had an accident at work and we went into daycare within less than an hour we had an x-ray. 

Dr Jeremy: Yeah. 

Val: I said this to him the other night, it may sound weird, in some cases people think you are unlucky because of the condition you have, you've got a professor. You've got so many consultants taking care [00:28:00] of you. Your bloods are taken on a regular basis. You have scans on a regular basis. So if anything was to appear, they would catch it. Yeah. You've got people, walking around that could have a clot that's traveling. And all it's going to do is hit their lungs or their heart. They have to go to their GP to be referred you get to see a professor. Consultants. That's what's keeping you well. Yes, you've got this condition. But like we've said before, we've never allowed the condition. to influence what he does in his life. He works with kids, he has a positive outlook. I don't say you're sick unless he's on the ward. 

Dr Jeremy: Yeah. 

Val: You're at home, staying well. Same for me. The heart's a bit iffy, when I go to A& E, if I have a problem with my heart, I get seen quick. I've never had to sit [00:29:00] in A& E for long. Don't think this has always been the case because it hasn't. It has not. But I, like I said, whether people think we're lucky or unlucky, cause we both have long term conditions. We get excellent care. That's all I can say. 

Dr Jeremy: Hopefully this GP surgery booking system, if they can work out the kinks, hopefully it can work well and get people seen quicker.

Val: Kinks! How are they going to get the elderly online? And how are they going to get staff? 

Dr Jeremy: Does it make it easier for people who want to use the phone? 

Val: Not the point. 

Dr Jeremy: No, but maybe that's how it will work out. Because the whole point of 

Val: having this Is that people get appointments, not just to free up the phone lines so people can have a chat. Cause people are phoning. Yeah. What are they phoning for? They're phoning for appointment. 

Dr Jeremy: Yeah, 

Val: So you're freeing up the phone lines. You're not blocking it, but phoning about something. There's [00:30:00] always that group of people that will always phone for an appointment. The 8am scramble is still on. It just might be a bit reduced because the 8am scramble is going to be divided now between the phone line and online. Who gets there first? You decide. They've 

Dr Jeremy: i'm wondering what people will do to game the system. 

Val: Oh, all they've done is move the deck chairs. It's all they've done. A lot of things that should have happened before this, yes, we need to move with the times. We understand that, but they also need to be realistic. Are the GP surgeries, able to move with the times at this because they like soundbites and coming [00:31:00] up with these things, but are they bringing GPs with them or leaving them behind? That's the worst thing the government can do. It's alright for them to sit in Westminster, saying to a GP in the North or in the Midlands, or another part of the South, this is what you've got to do.

Dr Jeremy: Yeah, 

Val: but we haven't, we're not giving you any resources. Really? It doesn't make sense. And then when it doesn't work, who do they blame? They say the NHS system doesn't work. They make the system. They make the rules. It works better when you've got resources and it works better when the GPs who are in social care. Are in alignment with the government's goals. 

Dr Jeremy: Yeah. 

Val: If they're not in alignment, it isn't going to work. You're [00:32:00] raising people's hopes. You're telling people all the 8am scrambles going to go, when really, I don't think it is.

Dr Jeremy: Yes we'll see what happens,

Val: because it's like saying everyone can get on the train, but not building ramps or ticket machines. 

Dr Jeremy: Yeah. 

Val: According to Age UK, around 2. 7 million people age 65 and over in the UK don't use the internet. That's more than one in five older adults. So a lot of people needing GP appointments aren't going to use the internet. 

Yeah. There's a risk of deepening inequalities. We're never going to get rid of inequalities. It's just shifting somewhere else. So what they've done is created another one.

In 10 or 20 years they're going to have [00:33:00] to solve this. What are you going to do with the 2. 7 million? They're still going to scramble for the 8am call. And they're more likely, I'm not saying that nobody else matters. They're more likely falling over, may have problems with their hips.

Dr Jeremy: For sure. 

Val: I don't know. 

Dr Jeremy: It's a good start. They'll have to figure something else out. 

Val: A digital queue 

Dr Jeremy: Yeah. 

Val: Yeah. A digital queue But we'll keep an eye on that. See how that sticking plaster works. Rip off that band aid and see that it's still bleeding. We'll see. Yeah, I think that's all we can discuss today. 

Dr Jeremy: Okay. 

Val: We'll do the other one next week. 

Dr Jeremy: Sure. Yeah. Yeah. This the one for next week, if we talk about the National [00:34:00] Care Service. That's interesting. I hadn't heard about that. That's exciting. 

Val: I keep going off about social care, then found this.

Dr Jeremy: Found this, so maybe they've been listening to you. 

Val: And they're going to report on phase one in 2026, it's Dame Louise Casey. 

Dr Jeremy: Yeah. 

Val: She's a woman. She doesn't mess around. I think it's in safe hands.

I hope. Yeah. 

Dr Jeremy: Yeah. At least the proposal sounds good. I'm excited to talk about that next week. 

Val: So our main story was about the new GP. 8 am scramble has gone from telephone to internet. 

Dr Jeremy: Yeah. I think this issue isn't so much about how we label it, but the misconception is that, if you just change the way people make appointments, it's going to solve all the problems. But. We know that's not true. 

Val: Yeah. 

Dr Jeremy: Yeah.

Val: My misconception, is that they think [00:35:00] digital is accessible for everyone. 

Dr Jeremy: Yeah. 

Val: We know it is, if you have it. It's like money. If you've got it, it's great. But if you haven't it's shit, digital systems can exclude the most vulnerable. 2. 7 million adults over 65 do not have the internet. They are excluded that is another inequality. So is online booking a genuine solution or political window dressing? 

Dr Jeremy: Good first step, but probably needs to fix some things. 

Val: How do you modernize access without leaving anyone behind?

Dr Jeremy: That's a good point. Yeah. One option might be having a system in place for people to access based on what they can do. If people are visually or hearing impaired,

Val: yeah. 

Dr Jeremy: They can't accept a phone call, but.

You can there's [00:36:00] devices that will show them text print braille so there are accommodations for people who are not able to access the system in the usual way. 

Val: Yeah. 

Dr Jeremy: So you would need something for older people who are not tech savvy, to access the appointment system by telephone.

Val: Is that a joke? 

Dr Jeremy: No, I'm not joking. I don't mean the exact same system but the same thing where Their needs get triaged and, they go from maybe a five week wait to a three day wait. Still a wait, but at least it wouldn't be an inequality if they benefit the same as everyone else

Val: I still think A& E is still going to get busy. Of course it is. A& E will never change. Until social care gets better. 

Dr Jeremy: We'll discuss that next week 

Val: okay, let me end with my close. So we know modernizing healthcare is essential. If we don't design these systems for everyone. We [00:37:00] risk widening the gap between those who can access care and those who can't. 

I bumped into Dr. Jeremy on Wednesday and we're like a walking podcast episode because we started getting into this.

Dr Jeremy: Yes. So we did have a chat on Wednesday. And yeah. That was, it was lovely to see you in person. 

Thanks, pal. 

Val: Okay. Bye. I