Peering at the close-up extended hand of his patient on the computer screen, Manchester GP Sirfraz Hussain uses Skype consultation to examine her for signs of bruising, before telling her with regret, that she has just tested positive on all seven criteria for Ebola.

Thankfully, this is a staged, training Skype consultation with a junior doctor, but Hussain and his colleagues in the heart of multi-racial Moss Side, strongly believe that Skype is a vital tool being disregarded at the UK’s peril, as the country makes itself ready for a possible Ebola outbreak.

He and his colleagues at Manchester Medical Practice have incorporated Skype consultations as a regular part of what they have been offering their international patient base for 18 months – the only NHS practice in England to do so. They believe other practices should be doing the same.

“We need a national strategy for GPs to access Skype technology and be comfortable using it,” says Hussain, who leads on IT matters at the practice. “At some time in the future there is going to be an outbreak of Ebola that will threaten lives. In the case of such an outbreak we need service readiness and at-a-distance screening, to protect ourselves and the patients. With swine flu that was on the telephone, but now we have Skype.”

This practice feels itself to be on the frontline – as one of Hussain’s colleagues says, “The world is at our doors.” It is an area of serious health deprivation with a 6,000-strong, ethnically-diverse patient list representing virtually every nation, including those currently affected by Ebola.

The catalyst for introducing Skype into the practice emerged as a by-product of the need to find a way of cutting their two to three-week waiting list to see a GP, which was forcing people to walk the five minutes to the A&E at Manchester Royal Infirmary for treatment. The GP partners brought in a new system, using a senior GP to triage a daily walk-in surgery, which found that 50% of patients turning up actually need a consultation with a doctor. They are given a choice of one-to-one, telephone or Skype consultations the same day. The rest are pointed towards relevant advice.

Hussain himself had been convinced of the power of the Skype consultation after an incident with a patient with back pain, who rang his mobile. Frustrated, because he was not able to get to the surgery, the man asked Hussain, whether he had Skype on his mobile and they had an impromptu consultation.

“I could see beautifully what this man could do,” says Hussain. “I got him to touch his toes and all the other exercises, and could see his back perfectly. I realised that here was a technology that we could use to improve the quality of patient care.”

Skype has been embraced since it was introduced at Manchester Medical Practice in January 2013. It is said that 70% of judgments are made on the basis of seeing a person and that this is particularly useful where language is an issue. The focus of medical training is on “observation before palpation”.

After 18 months using Skype, they are becoming adept at using it to observe skin tone, posture, physical cues like signs of self-neglect and what Hussain calls “the meaning behind the words”.

Colleague Faizan Ahmed cites a case of a patient who became concerned about her health while visiting relatives in the Caribbean and asked for a Skype consultation. “As we talked I could see a shingles rash emerging on her face,” he says.

Many cases are far more mundane for people who have difficulty in getting to a surgery – especially in bad weather – like the mother who says her child is terribly ill, but during a Skype consultation the baby can be seen playing happily in the background. Or the older person who underplays their symptoms and requests a simple painkiller, but when viewed by Skype demonstrates clear evidence of weight loss and listlessness – a candidate for further examination.

As a training practice, Manchester Medical’s GPs are also imparting their Skype experience to local medical students and junior doctors. But doctors on the frontline do not believe that enough is being done and quickly enough, to harness the powers of technology. The swine flu epidemic provided some important lessons. Protocols included telephone consultations as a means of reducing the risks of infection. With only aural information to go on, misdiagnoses took place.

Prime minister David Cameron launched a £50m pilot scheme in which 20 sites were selected to look at ways of improving patient care at local surgeries via Skype and telephone consultations. The scheme was extended last week, in a bid to achieve seven-day opening by 2020.

A spokesman for Public Health England, which is in charge of organising the medical response to Ebola, said Skype had not been considered as part of the guidance to frontline services. He said: “Other much more common illnesses than Ebola (such as flu, typhoid fever and malaria) have similar symptoms in the early stages, so proper medical assessment is really important. This would have to be done in a hospital to determine the cause of the illness not via Skype or something similar.”

Frontline clinicians like Dr Hussain and his colleagues insist that the NHS is missing a trick if it ignores the potential of Skype. He says: “It could really come into its own in triaging, to narrow down the serious and milder cases and to arrange their management as symptoms emerge. The key is that it could handle lots of patients.”

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