By Gian Celino, Clinical Director
2020 marked the most significant transformation in service delivery in both GP surgeries and pharmacies since the inception of the NHS. It wasn’t planned or expected but the new care service delivery model has affected everyone, from patients to practitioners, administrative staff to suppliers.
But what happens next? Of course, we need to pause and assess. We must give stretched front line staff a chance to regroup and recover. But we cannot stop. We must not slide back to previous inefficiencies. This is an extraordinary opportunity to build on the frenetic – and often overdue - changes that have been achieved. This is the chance to build a primary care model that truly reflects both patient needs and our ability to deliver.
Fast track adoption
Digital transformation has been on the agenda for primary care services for decades. Yet it has taken a pandemic to confirm the value of so many of the digital technologies you have wanted to adopt. Electronic repeat (eRepeat) prescriptions are a great example. eRepeats enable a GP to provide 12 months’ prescription authorisation, radically cutting surgery workload. They have been available for ten years but were adopted by just over 10% of practices.
Telephone triage had been deployed in a handful of practices before Covid-19; but within just a few weeks became the default approach for all and is now standard practice. A huge number of 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. Using telephone triage, instant chat and video calls, GPs can not only console the worried well and direct patients to nurses for blood tests, but also check a child’s rash or assess an individual’s mental health from their demeanour.
Vision of the future
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 five, seven or ten minute appointments. This is one of the most fundamental changes in primary care delivery that we can take forward from the extraordinary achievements of the past few months. 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.
While digital technologies have been fundamental to sustaining health care provision during the Covid-19 outbreak, we need to remember that a significant minority do not have online access. Many of those will be most at risk and vulnerable. Many are at the top of the vaccination list but how will those with long term conditions be supported in an increasingly digital NHS?
Patient expectations shifted during the crisis and many 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. Apps and digital channels can help improve the health of those able to self-care, while database triggers can help clinicians to identify and work with those most at risk.
Resources are without any doubt going to remain stretched for many months to come and there are gaps in service delivery that will need to be addressed. Cervical cancer testing dropped by over 50% in 2020; there was a reduction in anti-depressant prescriptions, despite the well published mental health problems created by the pandemic.
GP practices will have to take some tough decisions regarding prioritising care and services. Intelligent triggers can help GPs to target the right people with the right services. It will also be important to further explore the way services have collaborated over the past year: Covid-19 hot or red zones may not be required long term, but we can learn about the way practices can work together to better manage demands.
Minimising Red Tape
There are also lessons to be learnt from the way technology was delivered during 2020 to support GPs and pharmacies. From NHS strategists to suppliers, we swept aside the red tape that typically leads to months, even years of delay.
The rapid deployment of excellent technology was invaluable. Pharmacies received one click access to the Summary Care Record and Real Time Exemption Checking (RTEC). National data sharing through GP Connect provided a vital free flow of patient information where it was required. These were fantastic examples of the way multiple bodies worked together incredibly quickly, breaking down bureaucracy and overcoming technical barriers to deliver a solution.
Other aspects of care provision have been somewhat more ‘make do and mend’. GPs had to undertake video consultations via personal mobile phones because practices use desktop computers which do not include a camera. Inter-practice communication has also been difficult due to telephone systems that are simply not configurable to support remote working. Looking ahead, all staff need systems that provide both effective communication and excellent, secure data sharing to enable them to work as a team – both within and outside the practice.
The past few months have been extraordinary on many levels. The technology has not been perfect; there have been challenges; but the shift in patient expectation, clinical collaboration and working practices can provide the foundation for a primary care service that supports the needs of both patients and HCPs.
And we already delivering the next step in digital innovation. Shared Care Services build on proven collaboration with patient information, centralised appointments and clinical outcomes available across multi-specialty teams, clusters, federations and primary care networks.
Vision Anywhere, for example, has been built to work at scale with shared patient records in real time. It integrates seamlessly across the local healthcare economy to support patients in multiple settings and locations. Clinicians can record consultations quickly; information can be shared across the health economy; tasks can be managed and prioritised. Using Outcomes Manager there is a single reporting solution across all care settings with integrated pathways for intelligent, joined up data entry, decision support and data analysis. Clusters, Federations and Primary Care Networks have the guided disease management they need to ensure consistent care standards and improved patient outcomes.
We have a chance to drive faster and further improvements in healthcare services for the future but to achieve this we must avoid reintroducing bureaucracy and the historical constraints that have delayed digital innovation. We must build on the collaboration that has delivered so much so quickly.
For more information about how Shared Care Solutions are building on the wave of digital innovation and technology confidence click here.