By Nigel Cullumbine, Chief Operating Officer at NHS Arden & GEM CSU
Primary care is making positive strides when it comes to digitally-enabled healthcare. It’s exciting to hear about successful moves to implement video and online consultations, enable patients to view their records online and the growth of wearables to support self-care. But offering these at scale means thinking ahead about what changes will be needed so that the benefits of technology become widespread and not confined to the most digitally ambitious GPs.
Foundations
Consistent and robust hardware and software form the building blocks for successful collaborative working across sites, which is why we are currently delivering a project to migrate 160 GP sites in Norfolk and Waveney to a unified network model. The programme includes migrating all users onto the Health and Social Care Network (HSCN), updating to Windows 10, upgrading hardware and moving all sites onto a single domain. This essential work will enable innovation in the area to flourish. For example, many practices are already about to roll out online triage and consultations, and all will be well placed to take advantage of other digital services as they become available through the GP IT Futures framework.
At a practical level, practices will save time by sharing resources and procedures, knowing they’re all using the same systems. As practices come together in Primary Care Networks, file sharing will be straightforward and secure because the technology has been planned with future collaboration in mind.
Developing digital diagnostics
Digital diagnostics can – and are – being developed to support clinical decision making. At Arden & GEM, we have developed a stroke tool and a child safeguarding tool, both of which support GPs in identifying those in need or at risk and the appropriate responses. The challenge is in building these tools into existing workflows and processes and ensuring interoperability across disparate systems, particularly as more practices seek to work together.
In our experience, clinical engagement is crucial in designing a tool that is fit for purpose and actively supports assessment rather than adding an additional layer of complexity or challenge. Understanding the clinical systems in which the tools will be built is equally important so that populating the data becomes second nature for clinicians.
Avoiding digital silos
The Fit for the Future report recently published by the Royal College of GPs acknowledges the importance of self-care, both in terms of improving quality of life and outcomes, and reducing the burden on the NHS. Positive progress is being made in many areas, but based on recent research we conducted among commissioners for Mapmyhealth, providing the technology is just one part of the solution.
Treating type-2 diabetes costs the NHS in the region of £11.7 billion a year, with predictions that costs will reach £16.9 billion by 2035 as prevalence increases. NICE requires practices to offer an education programme, be that a traditional solution or a digital one. Despite a range of options being available, just 22% patients take up the offer.
Our research findings highlight that digital solutions need to be delivered alongside face to face approaches, that the programmes must be accessible and data compliant, and must integrate easily with existing practice and pathways. Apps such as Mapmydiabetes offer huge potential to put the patient in control of their health and make more informed decisions, provided the back-end support and structure is there to give clinicians confidence to prescribe these solutions and use them to best effect.
Since the publication of the Five Year Forward View and the more recent Long Term Plan, it has been clear that technology is expected to play a major role in healthcare, both clinically and operationally. As we look to develop new innovations, we should be mindful of the need for stable digital foundations, strong clinical input and the continued importance of face to face engagement with both patients and staff.
