Can technology help relieve pressure on primary care ?| Dr Shaun O’Hanlon

Dr Shaun O’Hanlon

Technology offers new ways of delivering services that can help clinicians and patients, writes health tech chief medical officer, Dr Shaun O’Hanlon.

The workforce challenge facing the NHS has dominated the headlines in recent months, and the picture is gloomy.

The health service is short of 100,000 staff, with the situation particularly acute in primary care (the latest research predicts a 7,000 GP shortfall by 2023/24).

A workload survey from Pulse magazine found that more than half of GPs are working 11-hour days and seeing one third more patients than they should be. The BBC’s Panorama examined the problem in a recent documentary.

What can technology do to help? I wouldn’t be so naïve as to suggest it’s the panacea, but it can certainly be part of the solution to managing rising demand.

Let’s look at the evidence.

A digital front door to primary care

While issues remain around digital accessibility, nine out of ten households have internet access and 78 per cent of adults use mobile phones or smartphones to access the internet (source: ONS 2018).

This means that digital healthcare services can now play a serious role. It’s not a case of replacing existing services, but more a matter of modernising GP practice so that we can provide a ‘digital front door’ into primary care. This will benefit patients and GPs.

Transactional digital services like online appointment booking and ordering repeat prescriptions are now mainstream, with millions of transactions taking place each month. 

These services put patients in control, remove the hassle of waiting on the phone, and save significant admin time at the practice. Along with text reminders to patients’ phones, they also help to reduce ‘did not attends’ (DNAs) – a huge frustration in an over-capacity healthcare system.

Online triage

But digital healthcare is about much more than transactions, it can also fundamentally reshape how services are delivered and improve the patient experience. Let’s consider online triage, where patients are asked to fill in an online form before being given a GP appointment.

For the patient, this provides an immediate opportunity to document and share their health concerns – no waiting – with a response back typically within 24 hours. There is the reassurance that a GP has assessed their problem and provided advice – and for people who do need to be seen an appointment will be made.

It’s quicker and safer than waiting two weeks to see a GP face to face, and it frees up significant consultation time for GPs. A pilot project in East London found that 75 per cent of patients who completed the form did not need a GP appointment but could be supported in other ways. In turn, this cut waiting times for face-to-face appointments from two weeks to two days.

Video consultations also have a role to play – making GP appointments more convenient for those with mobility issues and reducing the need for home visits or visits to nursing homes for GPs.

More efficient complex care

While digital patient services are important, it is perhaps behind the scenes where technology can deliver the greatest benefits – by joining up information between different practitioners to enable seamless care. 

Interoperable healthcare systems that provide a complete picture at the touch of a button are essential to helping clinicians support the growing number of patients with complex needs and multiple service touchpoints. In Pulse’s workload survey, GPs said that 29 per cent of their patient contacts were ‘very complex’.

The GP Connect initiative from NHS Digital – and the mandating of interoperability among system suppliers – are important steps towards achieving this joined up view.

Greater sharing of information will be critical for the success of the new primary care networks (PCNs). From July 2019, these are tasked with providing more and better neighbourhood-based care, through interdisciplinary working. 

Sharing more information will not only make care more efficient, it will also help to embed and engage new members of the extended workforce. 

Practice pharmacists, physician assistants and emergency care practitioners are transforming how care is delivered by PCNs. Technology can assist in case allocation and support mobile working. Critically, it can also provide point-of-care access to a holistic patient record via interoperable systems or initiatives like the Local Health Care Record Exemplar programme. 

What can you do?

Returning to my opening question, can technology relieve pressure on primary care? Absolutely. The NHS long-term plan recognises the central importance of technology to the future of the entire health service.

But how do we make sure we achieve its potential? I would encourage you to be open to new ways of working, to see technology as your friend and not your enemy, and to seek out tried and tested solutions that deliver proven results – don’t have your head turned by the latest ‘shiny new thing’.

Dr Shaun O’Hanlon is chief medical officer at EMIS Group. Follow him and the organisation on Twitter @drshaun @EMISGroup

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