Historians note that pandemics accelerate innovation. Before any of us had heard about Covid-19 a group of 53 health organisations in the U.S. formed OVID -the Office Visit is a Dinosaur.

They questioned the idea that patients had to come to a clinic, wait in line to see a physician and then getting referred onto a specialist. Power in this process lies with the doctor. There is a high cost for the patient in terms of travel, time and, for some, stigma. The marginal costs are greatest for those from economically disadvantaged backgrounds.

Covid-19 demanded a switch to virtual visits. In the following piece by Douglas Eby and colleagues the benefits to patients and doctors are described. There isn’t much reason to go back to the old model. But unless the system changes -for example payment processes- the dinosaur will live again.

The response to the pandemic in the London Borough of Islington -one of 32 London local authorities and health commissioning groups- showed the potential for innovation. It was clearly dangerous for shielded patients to come into ‘the office’ in this case a GP surgery for examination. And it could be dangerous and impractical for GPs to visit patients at home. Assessment by video became routine. But what about specialist equipment? An oximeter, for example, measures the amount of oxygen in the body and is crucial for decisions about whether to transfer a patient to hospital. The local GPs worked together with voluntary organisations and a social enterprise that generates income for communities using bicycles. The oximeters were delivered by bike to acute patients at home allowing complete assessments to be undertaken within one hour, facilitating GPs to ‘get the right patient the right care at the right time and in the right place’.

The innovation is described in this short piece in the British Medical Journal. Rammya Mathew: Innovation during the pandemic, BMJ 2020; 369 doi: doi.org/10.1136/bmj.m1855 (Published 12 May 2020)

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