Blog for Optimity – Mindy Daeschner, Chief Commercial Strategy & Marketing Officer, Doctorlink
General Practice is our number one route into healthcare, but the system as it stands is struggling to keep up with demand. Since the inception of the NHS in 1948, there has been little change to the model of how patients access general practice, and yet, consumer behaviour has changed dramatically. We are now living in the age of consumer convenience with digital services like in retail and banking; surely patients should be treated like consumers too?
The launch of the NHS Long Term Plan brought with it welcome targets for optimising digital services to improve patient outcomes. Alongside it, a raft of digital primary care services have launched answering patient demand for easier access to health services, but are they doing enough to retain users? For example, a quarter of GP at Hand patients reportedly left the service to return to their local GP after one year. At Doctorlink, we believe that for digital services to work, they must function in partnership with the existing health system to support the move to integrated care.
The digital front door
With the ultimate purpose of primary care being to act as a triage for secondary or acute care, GPs, then, are the gatekeepers who preserve and guard the precious resource - the acute or specialist hospital bed. But what happens when our primary care system also becomes over-run?
The rising patient population and increased prevalence of chronic conditions is impacting on demand and putting healthcare providers under immense pressure. GPs find themselves overburdened with administration and are losing the time to do what they love – caring for patients.
The national deficit in the supply of doctors is compounded by experienced GPs leaving the profession (the latest national GP Work Life Survey found that 2 in 5 of the 2,195 GPs surveyed were likely to quit the NHS by 2022) and a minority of newly qualified doctors entering a career in primary care. Fundamentally, GPs choose the profession from the desire to help others – but are increasingly seeking more desirable ‘portfolio careers’ opening up a variety of roles to mix and match with practice work – teaching, specialist care, research, out of hours, pharma, RCGP faculties – and avoiding the admin of general practice.
There is huge potential for technology to help GPs feel more fulfilled by enabling more flexible working conditions and to allow resources to be used in different ways.
Getting the system to work better
Reducing continued pressure on GP surgeries is critical to ensuring the sustainability and effectiveness of the whole primary care system. The answer can’t only be to extend hours, or to build new surgeries as we fundamentally don’t have the workforce available. The key is to enable more efficient access to resources and change the way patients approach their health.
The development of primary care networks (PCN) where GP practices collaborate with community services – such as mental health, social care, pharmacy and physiotherapy – is the first step towards creating a more joined up approach, where patients can be connected to the service they need directly. To support this, the Government and NHS England are looking to recruit 20,000 staff to work alongside GPs in a new ‘bottom-up’ approach.
But how will patients access the right care efficiently? The answer has to be in digital solutions. A ‘Digital Front Door’ to the healthcare system, a clinically approved digital triage, appointment booking, repeat prescriptions and service finder can alleviate clinical and administrative pressure on the system, integrating with existing services to improve the primary care experience for patients. Ultimately it is about having a system which any patient can access, allowing them to obtain the right information and guidance about their condition. The Primary Care Foundation’s research tells us that in the UK 25-50% of GP appointments are not necessary. In areas where the Doctorlink technology has been implemented, we have typically seen a 22% reduction in demand for appointments, so there is emerging evidence that a digital front door reduces the strain on any primary care system, directing the patient to the correct service for their needs, creating efficiency and value in the health system.
Moving consultations online
On top of the appropriate triage of patients aiding demand management, the offering of video consultations is seen as critical for the financial sustainability of practices by retaining patients they might otherwise lose to other online providers (who are predominantly taking low maintenance patients or “cherry picking” away from traditional practice lists). The introduction of video consultations is expected to unlock a number of other advantages too: flexible working for GPs, better utilisation of consultation space across the practice, reduction in infections acquired in the waiting room, and most pertinently patient convenience - in a post Brexit Britain, imagine being able to access your GP from abroad, for free.
Creating a patient movement
Getting patients to view their care differently is critical to making the change work. It took eight years to achieve widespread adoption of online financial services. Healthcare providers needn’t be perturbed by this. A cultural shift is happening with the age of consumerism which just may help transform our services and let clinicians focus on what they like to do – spend more time with patients who really need them.
Optimity response: Dr Niamh Lennox-Chhugani, Healthcare Lead.
Mindy’s experience of transforming primary care shows the potential that could be realised with a digital dimension that augments primary care, enhancing the patient experience and workforce satisfaction.
To deliver on this, systems are going to have to put their money where their mouths are. A recent OECD report examining spending on primary healthcare across OECD countries found that despite commitments by almost all governments to increase the proportion of spending on primary care, spending is around 14% of the total with a slightly higher rate of growth over 10 years than hospitals (2.9% versus 2.4%) and pharmaceuticals but substantially less than long term care.
There are therefore limited resources available to invest in the digital front door for primary care. How do GPs know that what they are investing in offers value for money, will adapt with the changing needs of their practice and different needs of their heterogenous registered population and enable them to share information with other parts of the local system.
There is still relatively little research that tells us about the effect of digital first primary care. The University of York is currently undertaking an evidence synthesis of this topic. Their initial rapid sysnthesis revealed that the value case for a digital first primary care has not yet been demonstrated. This is a bit of a chicken and egg argument – without delivery at scale, the case is hard to make either way and without making the case, delivery at scale is a challenge.
As PCNs establish, I think it is likely that they will find the professional groups that they look to bring in from the wider community workforce are almost as scarce as GPs. Digital channels, carefully chosen and targeted, might be the only answer to primary care keeping its head above water in the context of Integrated Care Systems.