What are others' experiences of virtual clinics. Our clinic adopts the process of Appointment at Clinic and then no further communication means everything is OK - until the letter telling you, you need to increase medication doesnt arrives. Effectively virtual glaucoma care is now a screening service like a bowel cancer or cervical but with those you always get a negative or positive result.
Husband has been inadequately treated for 9 months because he never got a letter telling him to change his medication. Believe his GP was informed but was told that GPs don't alter their prescribing until the patient contacts them. Frustration as the face to face appointment was also 8 weeks late prolonging the time he has been on insufficient medication. Cheesed off in that the medication that was added was one that has already been proven to be ineffective. In a face to face consultation the clinician would have been told this. Pretty certain that he doesnt fit the RC Opthamologists definition of what is a suitable patient for virtual assessment. Very unhappy all round. If only this could have been the first time that something went wrong but this 'outstanding' hospital has previous form.
Surely its time for there to be communication standards for virtual clinics. No news is good news cannot be the default that applies. Is this so for other parts of the country ? Do you get a communication informing you of the results of your virtual clinic? What are the views of GUK on what the process should be.
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Anonoms
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I am really sorry to hear about your husband’s poor experience with virtual clinics, it sounds like it has been very stressful for you both. At the very least your husband should have got a letter after the virtual clinic, without it needing to be chased up with the GP. We do hear your frustration regarding the eye drops too, and again this is something that shouldn’t have happened. In future, if you have not had any correspondence from the eye clinic after 2-3 weeks or if there are any further issues with his drops then please contact the eye clinic/eye secretary as soon as possible to chase it up with them.
The PALS (patient advisory liaison service) department work hard to address problems such as this and are in every hospital to support patients. If need be, please further escalate your concerns with them.
GUK recognises the value of virtual clinics as for many they can be beneficial. With that being said, we understand that the system is not faultless, and they don’t always run as smoothly as planned. There are standards and regulations in place to ensure things like this don’t happen, and when they do it’s important to chase this up and escalate it further. We do work with partners and statutory services to improve the patient experience wherever we can.
Please know you can contact us on our helpline Mon-Fri 09:30-17:00 if you ever need some advice about appointments, as we are happy to talk through this in more detail with you if you wish to.
The standard process is that there is NO letter to the patient giving results( negative or positive) after a virtual clinic and I believe that is not a good process. Can you point me to the standards you mention in your reply that state that there should be a communication. As a patient of this hospital you cannot know whether the absence of a letter means that your results are OK or whether your letter is lying on the floor at the sorting office or pushed through the wrong letter box. TBH I think that if there has been a change in treatment that actually that should be a two way communication as unfortunately ongoing allergies to medication don't seem to be recorded . I accept that there is now a system at this particular hospital that allows you to register on a web portal but not everyone is computer literate and he was not registered for this. It appears that the cost of sending an NHS letter is around £1.00 the surgery that is now be necessary will cost about £3000. Having to contact a human to go through your record to check if anything has changed would cost more than a 1.00. I am told that a virtual glaucoma clinic triples the amount of patients that can be managed ..can some of those cost savings not be put into keeping patients informed? Previously the RNIB had the ABC campaign to allow patient to understand what treatment intervals should be and to give patients the tools to ensure adequate treatement, but the one sided approach of virtual clinics means that something different is needed.
Unfortunately the rcophth guidelines don't specify that patients should be told their outcome. York Hospitals have clearly recognised that this is necessary and state that they will answer queries as well as provide outcome information. How can that approach be rolled out to the rest of the country? GUK is named as a partner in developing the rcophth guidelines - will these guidelines be subject to review, can you push for a nationwide approach to post examination communication.
I never know who I will see at the glaucoma clinic. Sometimes it's the consultant, sometimes it's one of his team, other times it's the monitoring nursing staff who do scans etc and then a consultant will review them.
I sometimes receive a letter in the post afterwards. Other times not but I now always look on Patient Access or the NHS App to see if the report letter has been added as a document. Even if your eyes are stable, there should be a letter confirming.
I've had to chase up the GP sometimes, when I've been given a new prescription for the GP to continue and it's not been added to my repeat list.
After my last visit when I was seen by the monitoring staff, I received an appointment out of the blue via the NHS App to go to an iritis clinic at a different hospital. It totally threw me so I called up and was told the Rheumatology clinic I'm under had requested the appointment. But when I finally got access to a copy of the report online, I could see that the appointment was made by a senior optometrist who'd reviewed my scans and not Rheumatology at all!
I too was very unhappy with my first experience with a virtual clinic in August 2023. My pressures were raised but I was assured I would receive a letter within two weeks - however it actually took 5 months to arrive in Feb this year. I had to phone the clinic recently to get my annual appointment as I had heard nothing and was given one over the phone in yet another virtual clinic. I protested at this and said I wanted to see a qualified doctor as I was not prepared to have to wait again if my pressures were raised. After discussing me with the consultants’ secretary, I was assured I would be walked from the virtual clinic for a face to face appointment immediately if that was the case and a note was added to that effect on my record. It will be interesting to see what happens next month. I am not necessarily holding out much hope but it does pay to be proactive. It seems to me that virtual clinics, which might be great for speeding up the appointment process, just creates a backlog of patient problems, particularly those who have been in the system for sometime. (Like me for the past 14 years) The subsequent waiting time for treatment could have serious consequences. I do not think that enough thought has been given to this new system.
I hope it goes OK for you. Last time husband had virtual I managed to get a copy of the visual field test results out of them...they generally refuse this request. It was invaluable because it acted as baseline for the optician to see that there were changes going on and I presume was instrumental in finally getting a face to face appt about two months late.
I agree. I think that there should be someone on duty to do an instant triage if a virtual clinic attender is found to have a signficant problem. That isn't the case with the virtual clinic attended here.
My hospital is now planning to alternate me between a monitoring clinic and a consultant clinic (following successful surgery, always seen by the consultant). Might be something that other hospitals could adopt if resources permit?
The system does already exist across the UK but I suspect there are different administration processes in place with some hospitals closing the communications loop so that you know whether or not your tests were satisfactory and some only contacting patients if they were adverse. The problem with only contacting people that need changes in medication, etc., is that the patient could just assume that stuff is OK if they get no letter. TBH if virtual clinics are to be successful in the longer term I think that there should be two way communication regarding changes and that actually a phone call would be better than a letter to ensure that people are definitely aware that that they need new drugs. The thing is that with a paper file 3 inches thick that reactions to drugs are not at the finger tips of whoever is accessing that file.
I had my first experience of a virtual clinic this year, having had glaucoma for 5 years. I had been dreading this happening as every time I had my pressure checked with the I-care it came out as higher than than measured by the doctor. At the clinic the pressure was measured at 21, where previously it was 16. I was fortunate however and I was given a follow up appointment with a doctor who measured the pressure at 16 again. He said the problem was that I was on maximum drops and this meant the Icare measurement was inaccurate. I told him that this had been the case from the very beginning, so he said in future I will not be sent to the virtual clinic. I have this in writing so I hope it happens.
Result - needed 2 appointments instead of one, and I could predict that this would happen! I could so easily have had a change in medication, or recommended for surgery, relying on a faulty measurement!
Has anyone else had a discrepancy in pressure measurement?
I am sad to read this and wish that there was someone that could advocate for us regarding virtual clinics. My hospital said I would receive results 2-3 weeks after the virtual appointment, but it was actually 4 months and that was with a fair bit of chasing which, let’s be honest, I shouldn’t have to do. I agree that for some patients with a long and stable history, virtual clinics might do the job. They don’t work for me. I was diagnosed in ‘22 after a long delay with lost referrals etc. I was put into the virtual system one year later and, as a result, given an 18 month follow up - however that is probably from the date they wrote to me, not my last appointment which will drag it out to 2 years. My opinion is that the virtual clinic system deprives the patient of the opportunity to speak to a doctor. Personally, I like the reassurance of being able to ask questions about the long term prognosis etc. For context, I was asked if I’d be happy going virtual and I said ‘not yet’ - was still given a virtual appointment. 😔
Thats an important point you raise about length of time between virtual appt and results being available. Do you think no-one looked at the data gathered until 4 months after your visit? I don't believe my partner falls within the rcophth guidelines ..and has had multiple surgeries and very fast progression at one point but like everyone else who wants to really kick up a fuss when its calling to account people and processes related to ongoing treatment. I think a lot of us would much rather have really clear guidelines and let the guidelines do the talking so...review of results following virtual appt within x days and response to patient within x days of review with mechanism being by telephone/email if change of treatment indicated or by letter if patient is stable. Patients who are not stable should not be transferred to virtual clinics. Hospital itself to keep overall records on treatment outcomes of patients referred to virtual clinics which should be made available at CQC hospital inspections. In an ideal world all virtual patients would need no change in treatment.
As you say, It would be a good idea to have clear guide lines which exemplify good practice. I would like a clear definition of ‘stable’. And yes, I suspect that no one looked at my results for 4 months. …
Hi! I am currently in the “virtual clinic checks loop” as my glaucoma is in a stable period, although I’ve just moved from 1 year check back to 6 mth checks.
I always get a letter from the hospital whether result good or bad, however, such is the back log in my area this can be a couple of months or more after my virtual appointment. I always ring after a month if not received a letter as I once had a letter go astray and it was 9 mths (in lockdown) till it was noticed I should have changed drops. So letters are not a fool proof method. I think GPs should have to contact you if they get a results letter that recommends a change of treatment.
In some ways I like the virtual clinics and they are an improvement on the hospital. The fact that they are not at the hospital in our area but in a new venue which is air conditioned, has plenty of free parking and no queues is a plus for me.
On the downside, I don’t see my consultant and I worry about more retinal bleeds being missed although they might be spotted on the OCT. The delays mean that even if something is spotted - and this has happened to me - it seems a long time till the change in treatment. Plus there’s no one to explain or discuss treatment change with and why.
I’m horrified to hear that there are areas of the Uk where a letter isn’t despatched to convey the results. No news is good news is NOT the way to approach Glaucoma screening results. I hope the posters experience is in the minority.
Actually I should add that I don’t rely on the virtual clinics alone. I’ve had to many gaffs or lost or late letters on NHS. I’m lucky that I have a fairly local ophthalmologist with specialist Glaucoma training and state of the art equipment for testing. I pay £16 per mth to see them every 6 mths and have time to discuss the results of the tests and ask questions. This back up helps me feel more confident that nothing will be missed. The stress reduction was also important. I just want to live my life; I don’t want to live it constantly as a glaucoma sufferer.
I feel very sad to say that I no longer have faith in the NHS system alone looking out for me. I can pay for now and give up other things but there’s many out there that may not be able to do this and there may come a time when I can’t either.
Yeah. I encourage husband to get an optometrists private appt once he gets to appt date plus 8 weeks. I don't trust what is happening. The thing is while this is the first missed letter it isn't the first lot of visual field decline because of late appts. I did value the RNIBs ABC campaign and think there does need to be something similar for virtual clinics. There needs to be a patient voice in those guidelines.
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