For the latest instalment of our interview series, Dr Osman Bhatti, a GP and the Chief Clinical Information Officer (CCIO) for the North East London Clinical Commissioning Group, chats to HTN about upcoming projects, how tech and digital can be utilised across winter, and what’s on his wish list for 2022…
Hi Osman, tell us about your current role and how you became a CCIO?
I’m a GP by background and have been involved with IT in various forms for quite some time. I’ve been CCIO for North East London CCG for three years and, prior to that, I was an IT lead for other CCGs. Then this role came up – it encompasses quite a lot of things.
We’ve got a ‘Digital First’ programme that we work on across North East London and, through it, we’ve got 12 different work streams.
There’s work around a PCN (Primary Care Network) development, remote working, flexible working, dashboards, communications, care homes, pharmacy issues, and data sharing.
Then there’s a different level of input around what’s going on at ICSs (Integrated Care Systems) across London and providing the clinical viewpoint from North East London.
There’s been a lot of projects over the year and a lot of them have been very much focused on trying to deliver digital improvement in primary care, to enable better healthcare, generally.
What else have you been working on?
One of the biggest things we’ve done is around data sharing and how we’ve got a Health Information Exchange (HIE), which is mainly for data sharing across different providers. [For example], if a patient of ours goes into hospital, they (the hospital clinician) can see the GP record with patient consent. If a patient comes to me in primary care, I can see their involvement in secondary care in a reciprocal way.
All that data is easily available – things like blood test results, next appointments in hospital, the latest medication, or letters that are missing. All of that we can pick up, easily.
We’re scaling that up and looking to get more providers in there, such as social care and pharmacies. That’s been quite a major project.
There’s also been quite a lot of work on online consultations and scaling that up. That’s been a challenge. It’s a bit of a double-edged sword due to the fact that there are demand and capacity issues.
We know that demand has increased predominantly over the last year. The capacity isn’t there in primary care. We’ve got additional staff that have come in but we’re still struggling. That’s the elephant in the room, I think – we don’t have the staff to see the patients. Online consultations have helped, although, what is has also done is inadvertently unmask unmet demand.
Before, if you had 100 patients queuing at the door, you would just see them as they queued. If you have patients on telephone lines, you have a set number of lines. If you have online access [however], all of them can send in a message and the inbox just increases. The pressures we were under with capacity have really come to the fore.
We’ve moved away from promoting online consultations to saying, ‘what would work for you as a practice?’, and we’ve introduced tools to get practices to look at their demand and capacity and implement changes that would work for them in their practice.
We have [also] put a lot of resource behind change management and supporting practices at a time of need. All the practices know they have a car to push with square wheels – and we are offering them round wheels – but they don’t have the time to stop and change the wheels. Everyone knows digital innovation will help but we need that head space to change, and that just isn’t there, so we’re trying to provide that through change management support.
Another big success, which has really accelerated over the last year, is online registrations and that’s really captured the national eye because we’re now able to get patients to register with a GP without walking into a practice.
That’s across North East London – so any patient can go to an online portal and register with a GP practice, without visiting that GP practice. That’s something we’ve implemented quite rapidly and has been one of our biggest success stories and now that’s extending into North Central London.
We’ve done it without marketing, so that’s been great. We’re going to start advertising it on local billboards or including the information in new house packs – so when somebody moves into a new house, they get a note to register for an electricity provider, and also one to register for a GP practice by going to a website. Those are the kind of initiatives we’re looking at.
There’s been a lot around remote and flexible working. So, we’ve looked at how we can support practices – it’s not just about handing out laptops, it’s about how we can improve access, by getting people to share, and getting people to have VPN access that’s secure, so there’s security and governance behind it. Also, enabling home working and flexible working, as well. That’s probably going to be the future.
How is tech helping with your winter challenges?
Every winter is a challenge – I don’t think it’s new, it’s just brought to the fore because everyone is talking about it more. But we’ve struggled every winter with demand. It’s a mixture of demand from patients and demands on the staff, as it’s a time when people want to take a break or are off sick, so COVID has just magnified that.
The way we’re looking to help is through trying to improve the out-of-hours provision, so that if a patient contacts the out-of-hours service, at the weekend for example, the providers have access to the full medical record. So, you’re not having to tell your whole story – they can see your problem list, your medications, and they can write back into the record, relatively easily.
Fundamentally, we’re also trying to support people in care homes. There’s lots of home monitoring that’s gone into our care homes locally, so people can have their blood pressure and saturations checked remotely, and, potentially, video call their GP. Those are the things we’ve implemented, with a view to having a knock-on effect throughout the year and not just in winter.
I think we under resource educational follow-up and change management – there’s so much change that’s happened and there’s only so many webinars you can attend. So, it’s a matter of refreshing them and having that support, as you need it.
It’s putting immense pressure on our IT support, generally, and I think that’s been a struggle. We’ve also upgraded our machines that our staff use – as many as we can – and we’ve got a programme to make them more resilient for the future, so that you’re not waiting 30 minutes on a morning [to boot up]. We’ve overcome that and, I think, can get it down to under two minutes.
[It’s about] making IT a true enabler – not just a barrier. Just getting the basics right, I think, has helped. In North East London, we have a history of that – making sure the computers work, everyone using the same kind of templates and consistent coding. It’s something we’ve been doing for 10 years or longer, something we’ve consistently gotten right, which means that when we share information and get data out, it’s very accurate. Our COVID dashboards, for example, are accurate, because we coded well.
We’re in a better place than most but we’re still struggling because of the elephant in the room, which is having enough staff.
What advice do you have for any clinicians wanting to become more involved in tech and digital?
There are always digital projects going on, at whatever level – practice, PCN, or ICS level, there are ways to get involved. Certainly, I’ve got trainees involved in projects, even if it’s creating a template or attending a meeting and giving their clinical view – it’s all helpful.
We have also invested in lots of clinical leads, so there are always roles coming up and space not just for individual GPs in their own practice, but also for ICSs to value that they’ve got a wealth of local resource through clinical leads. They just need to backfill their time. That reaps its rewards because it’s an investment well worth having.
For each of our clinical work streams, we have a clinical lead assigned to each. We have a dedicated person who is funded, to help [staff] with their work stream and that’s powerful. For an ICS to invest in clinical leads, I think that’s important, and for people who are interested it’s just about getting involved with local projects or developments – they will always be welcome!
What’s on your wish list for 2022?
It is staff. What we’re doing locally now is introducing a staff bank – rather than advertising generally or trying to get someone from outside the local area. If we’re short of a doctor or nurse, we’re creating a local staff bank. So, if we need something, it goes to the local staff to offer their time first.
Anybody who is free locally, they may know the system and the pathways and the area, so it may be easier for them to come in and work – rather than somebody else who doesn’t know [the system] and then creates more work.
That will be a positive, although it’s probably too early to see if that will have an impact in the next four weeks, or so, but going forward it should help.
Staffing is the biggest thing but also PCN working. I think we’ve cracked it in North East London, in some areas, but it’s not ‘global’. So, I really want to see PCNs working together, across the whole patch, rather than just in some areas. North East London traditionally had seven CCGs, working in three different systems, and we’re coming together as one, from April 2022. Hopefully, that will help us accelerate things a little bit better, from a digital and back-office perspective.
If you could take something away from this year – what’s been the biggest success?
It’s been that we have come a long way – it’s just appreciating the effort and what people have done with change management and engagement. I think we have done a lot of things and people have engaged. It’s easy to just ignore that but, without people engaging, we couldn’t have rolled anything out. They’ve had a lot of trust in digital and that’s highly valued. It’s built us into a better position to roll-out some other innovations next year.
Hopefully that will mean meeting patient demand better, people having a better insight into their own demand and capacity and improving the way we communicate with patients. That also includes things like the NHS App. Rather than patients coming in for a blood test and then phoning up the practice, why can’t they just look up the results and the doctor will have responded to say the results are normal or that they need to repeat it? We’ve started that in places and that’s something we can escalate.
[Also] improving patients’ long-term care. I think, patients with diabetes, hypertension, asthma, COPD – all the long-term conditions which have probably been ignored, to a certain degree, or been difficult to manage during COVID – we need to try and improve that. And we can use digital innovation to do that. For example, getting people to fill in questions beforehand, so it’s a one-stop shop and instead of having several appointments for your diabetes review, you can have one per year. Streamlining a lot of that long-term care will be a good focus for next year.
Having more staff and better computers is always a good wish list, too. We’re all patients in one way or other, we all see it, and it’s about ‘what is that pathway? And how can we improve it?’.
If you’d like to hear more about Osman’s thoughts, specifically on GPDPR, you can still catch up on the video from this summer’s Digital Primary Care conference.