Digital solutions for primary care

Healthcare technology expert Steve Bradley explores the way digital solutions have supported clinicians and patients during COVID-19, and argues that they should remain a mainstay of healthcare provision in the future

The past few months have seen the most significant transformation in primary care in half a century. From telephone triage and video consultations to data sharing, barriers that have been in place for years have been removed.

What happens now is the big question. While there is clearly a need to pause and to assess, it is not time to stop – or to slide back to the inefficiencies of the past. We have an extraordinary opportunity to build on the frenetic changes that have been achieved and to build a primary care model that truly reflects both patient needs and our ability to deliver.

EXTRAORDINARY ACHIEVEMENTS

Digital transformation has been on the agenda for primary care for decades. Electronic repeat (eRepeat) prescriptions, for example, which enable a prescriber to provide 12 months’ prescription authorisation, radically cutting workload, have been available for ten years but adopted by just over 10% of practices. Telephone triage had been deployed in a handful of practices before COVID-19 but has become the default approach for all.

While fewer than 1% of appointments were done via video last year, and 80% in person, BBC analysis reveals GPs have seen just seven in every 100 patients face-to-face because of the coronavirus outbreak, and many patients have embraced ‘self-service’ by signing up for Online Patient Services. For GPs, the shift in patient expectation has been transformative, with reports of doctors managing 70 patients in one morning and needing to see just 14 face-to-face.

The result is not only a more efficient process; it opens the door to a health service that is able to truly prioritise the ill – those who require not only a face-to-face appointment but more time than the standard 5-10 minute consultation. This is one of the most fundamental changes in primary care delivery that we can take forward. Our health requirements are not the same; clinicians both need and want to be able to safely decide to spend more time with some patients and less with others.

DIGITAL FIRST

While patient expectations have shifted during the crisis, it is also clear that many patients have avoided interaction with both primary and secondary care – to the potential detriment of their health. The future management and support of those with long term conditions will require more data and better collaboration – for example apps and digital channels for those patients able to self-care, and the use of database triggers to identify those at most risk to support priority intervention by clinicians.

Resources are going to remain stretched over the coming months and gaps in service delivery will need to be addressed. From vaccinations and cervical smears, to a drop in antidepressant prescriptions, practices will have to take some tough decisions regarding priorities. Using intelligent triggers to target the right people with the right services will be invaluable, but it will also be important to further explore the collaboration that has been vital over recent months. While COVID-19 hot zones may not be required long term, there is an opportunity to explore how practices can work together to better manage demands.

TECHNOLOGY TRANSFORMATION

Some of the achievements of the past few months have been enabled by rapidly deploying technology – such as providing pharmacies with one click access to the Summary Care Record and Real Time Exemption Checking (RTEC), as well as national data sharing through GP Connect to provide a free flow of patient information where it was required. Multiple bodies have worked together incredibly quickly, breaking down bureaucracy and overcoming technical barriers to deliver a solution.

Other aspects of care provision have been more ‘make do and mend’ – such as video consultations via personal mobile phones because GP practices use desktop computers which do not include a camera. Inter-practice communication has also been difficult due to phone systems that cannot be configured to support remote working. Looking ahead, all staff need systems that provide both effective communication and secure data sharing to enable them to work as a team – within and outside the practice.

The ability to work from home has also become important during the past few months and providing clinicians with ways to achieve a better work-life balance could also encourage people back into the NHS. But to achieve this, we need to avoid reintroducing bureaucracy and the historical constraints that have delayed digital innovation, and build on the collaboration that has delivered so much so quickly.