For our latest Health Tech Trends feature, we’re looking into IT in general practice, exploring the challenges and asking what good looks like for primary care technology.
We contacted individuals from across primary care to get their thoughts and received plenty of answers, focusing on key topics such as access, public perception, infrastructure and more.
Here’s what they had to say.
What are the challenges in primary care IT?
“Legacy IT systems are not fit for the digital health age,” said Imperial College London’s Honorary Research Officer, Fran Husson. “Patients expect better than sub-optimal record architecture.”
Dr Owain Rhys Hughes, NT Surgeon and CEO/Founder of Cinapsis, agreed: “The digital systems underpinning primary care delivery are far too often outdated, inefficient and difficult to use,” he said. “Consequently, they can create more obstacles for clinicians and barriers to care delivery than they help overcome. I watch my GP colleagues grappling with endless email chains, busy phone lines and digital tools that are not properly integrated with existing systems or records. By adding unnecessary layers of complexity to pathway management and collaborative working, GP workload is compounded, the triage process made less accurate, and care backlogs exacerbated.”
The team at The Martin Bell Partnership, consisting of Independent Consultant Martin Bell and his senior associates Lynn Moffat, Lisa Williamson, Peter Gerber and Corina De-Botte, put their heads together to consider the question.
They agreed that existing systems are creating and exacerbating challenges. Among the challenges they highlighted were time pressures in primary care making it difficult to implement new systems; old slow infrastructure; differences in processes and digital skills between practices; workflows suffering as core systems are not refreshed; funding complexities; and good solutions sometimes lacking the transformational change required to support them.
“Challenges equally exist for patients,” Martin added, “and we should look at these challenges from both perspectives.”
They also commented on embedded patient habits which can present a challenge in themselves.
“Whilst many patients might use online shopping, internet banking, book their travel online and so forth,” Martin pointed out, many “still ring to make an appointment.” The recent GP survey results show that when booking an appointment, 85 percent called the telephone line. We must think about “what is preventing that shift” towards digital, Martin said; with the internet the first port of call in many other areas of life, what is holding medical services back?
Paul Bensley, Managing Director of X-on UK, agreed that patient access to GP services is a key challenge. “The challenges in primary care IT have to be seen in the context of the challenges in primary care,” Paul said. “These were set out clearly in Dr Claire Fuller’s stocktake for NHS England in May.” The stocktake found “real signs of genuine and growing discontent” with primary care from the public and from professionals within it, and highlighted that inadequate access was one of the biggest causes of that discontent.
The Fuller report recommended that digital technology be used to address the challenges facing primary care. “So, the challenges in primary care IT are to address those requirements,” continued Paul. “GPs digitised early, and primary care IT has traditionally been seen as being a long way ahead of acute sector IT. Yet the focus of the big GP system providers has been on administrative and clinical systems. Supporting integrated care, modern remote monitoring and patient access has been less of a priority.
“The result is that practices have tried to plug gaps and ended up with over-specialised applications that don’t integrate well with each other or with those core, GP IT systems. For example, a GP may be expected to use different applications to phone patients, send them SMS messages, receive a photo, or start a video call. This causes all sorts of problems, from excessive training overhead, to wasted time, to inconsistent patient experience, as GPs use applications they are familiar with, instead of applications that patients need.”
For Eva Health Technologies, ensuring that the tools and mediums used are the ones best suited to both GPs and patients is vital for primary care, and making this happen is one of the main challenges. “Both clinicians and software providers alike want the best of new ways and old,” they said, and added: “The default one-size-fits all ten minute face-to-face consultation is no more. It’s in the mix, but not the only option. We are better for it. Developing tech tools that support our new ways of working elegantly is the key challenge.”
Jacob Haddad, CEO and Co-founder of Accurx, said that GPs “can only deliver great care if they can communicate and collaborate” with the other services required to provide holistic care. “It’s almost impossible to collaborate if you can only communicate by dictating a letter which takes days to be seen, or by calling a switchboard and waiting to hopefully get through. For the renewed focus on integrated care to succeed, this ability to communicate must be solved as a priority.”
The same goes for patients, Jacob added: “With a chronic shortage of GPs and other staff, we will only be able to provide accessible and effective primary care if we protect appointments for more complex needs and discussions, and address routine and simple presentations through technology, such as two-way messaging, for those who are digitally able.”
GP and Founder of GP Automate, Arun Notaney, highlighted workload as the main challenge, noting a need for digital systems to be more forward thinking in terms of taking workload away from practice teams.
Dustyn Saint, GP and Founder of Primary Care IT, agreed. “The tech makes access easier,” he commented, but the challenge is “not having the workforce to support the demand.”
There are three key challenges, according to Henry Stoneley, Associate Director of SomX: interoperability, choice paralysis and a system-wide approach. “So few NHS and third party systems can communicate effectively with one another. Solving that would be huge,” Henry said. “With choice, which is of course no bad thing, the NHS needs to be pushing DTAC more. A single, overarching set of standards, that allows any commissioner to know that the product in front of them is certified as safe to use by the NHS. There are thousands of private sector organisations selling into primary care, and there are definitely differences in the levels of quality and service they can provide. The market giving providers choice is good; the NHS giving providers certified, signed-off choices is better.”
What would good look like for primary care tech?
X-on’s Paul Bensley highlighted the barriers to public satisfaction from the recent GP survey, such as access, and said that “good in primary care tech would look like something that addressed these problems – while also supporting integrated care and reducing the burden on primary care teams. In practical terms, that means communications tools that respond to patient need, combine with patient data, and are deployed consistently and at scale, so the patient experience is the same, whenever and wherever they try to access primary care.” It would also mean “gathering data from these systems to identify issues that might be addressed through remote monitoring or public health interventions, to pick up geographic or infection hot spots, or to identify access challenges and optimise the patient experience.”
Fran Husson from Imperial College suggested that “adoption and use of personal health records to embed multi-care settings and enable patients –and professionals – to have a comprehensive view of the patient persona and full medical history” is key.
For GP Automate Founder Arun Notaney, good looks like solving the workload issue: “automating workload for clinicians to free up time for patient care.”
Eva Health Technologies said: “We need to find ways of making the most of the time of patients, clinicians and providers alike. We need ways to ensure that people reach the consultation as prepared and as primed as possible. A consultation can be ten minutes face-to-face. But it can also be a phone call after the school run or the working day. It’s a follow up text message simply saying, ‘your bloods are back and all reassuringly normal. Wishing you well!’ It’s an online consultation querying the effectiveness of the current inhaler regime. Our tools need to fulfil a very clear need, but we are also discerning users of tech. They must have a modern look and feel that mirrors our experience of tech in the rest of our lives.”
Jacob Haddad from Accurx said that good looks like keeping the momentum on innovation that the beginning of the pandemic saw and “in particular getting simple technology into the hands of frontline staff that genuinely betters their day and allows them to stay connected to their patients, whether they see them face to face or not.”
We need “tech that is supported by change management processes,” said Primary Care IT Founder Dustyn Saint, “with adequate resources for practices to help them implement.”
SomX’s Henry Stoneley said that it’s about having the right leadership, the right software, and the right strategy, emphasising the need for “a health secretary willing to come out and support GPs against the backlash they face from the press [and] DTAC-certified software that conforms to the interoperability standards, and allows data to flow around the system without hindrance. The workforce plan due in the autumn will also be crucial. What is the plan to address the staffing shortfall? What budget sits behind that plan?”
Surgeon and Cinapsis CEO Owain Rhys Hughes that that primary care technologies must facilitate collaboration in a way that meets ICS demand. “To secure the best outcomes for both patients and clinicians, ‘good’ digital tools are those that are built in partnership with the end user, intuitive to use, and both integrated and interoperable with existing systems,” he said. “Tech must be geared to address the specific pain points clinicians are facing: for example, by making it easier for GPs to access timely advice and guidance from specialist colleagues, automating the upload of data to patient records, and exceeding the highest compliance and safety regulations.”
The team from The Martin Bell Partnership wanted to see modern, modular and interoperable systems; “plug and play components that enable less good core components to be switched off and other suppliers to be plugged in”; new offerings to the market; and updated infrastructure and equipment.
Patient expectation should be guided to better understand new ways of delivering services, the team suggested, with education and support available for the public.
Martin agreed that it comes back to workload in the end: “The tech can be as good as you like – if there are not enough GPs, other primary care clinicians, administrators, practice managers etc. the system still won’t work.”
If you could solve one GP IT problem what would it be?
“Interoperability!” said Eva Health Technologies. “It takes a team to look after patients. We need a thriving ecosystem in health tech where the norm is collaboration.”
Cinapsis’s Owain Rhys Hughes agreed. “I believe that it’s imperative for all primary care technology to be fully interoperable – something which was also emphasised in the governments’ recent digital health and social care strategy,” he said. ” Clinicians desperately need tools which enable them to work together in order to tackle the pressures being created by current staff shortages and record-breaking waiting lists. But until the tools being provided to GPs operate in harmony with existing systems, there remains a huge barrier to cross-organisational communication and effective collaboration.
“Introducing tech that is fully interoperable will make it possible for GPs to more easily and efficiently speak to, and securely share data with, their colleagues in both primary and secondary care. This will unlock shared clinical decision-making and more effective triage, ensuring that patients can more directly access the most appropriate form of care. It will become easier for clinicians to organise virtual care delivery where appropriate, speeding up access to treatment and reducing the pressure both on hospital beds and on the system as a whole.”
Interoperability was also the most important problem to fix for Accurx’s Jacob Haddid. “What I’d like to see is the ability for every single NHS organisation and healthcare professional involved in a patient’s care – across primary care but also other care settings too – to be able easily communicate with each other,” he said. “EPRs for trusts are a start, but when the dust settles and these are plumbed together between organisations, there will still be a gaping need for staff to be able to communicate efficiently, across services, so they can deliver high quality and efficient care.”
Henry Stoneley from SomX commented: “The Standards and Interoperability Strategy has set down really solid foundations for the future of digitally integrated health and care – if I had one wish it’s that this works, and that legacy software providers are given a time frame in which to re-engineer their solutions to fit the new standards.”
X-on’s Paul Bensley pointed out that the GP Patient Survey shows that telephone access to GP services is valued by the public. “Therefore, if I could solve one GP IT problem, it would be to make sure that GP practices have the modern, efficient, integrated telephony systems that they need,” Paul stated. “Simple things, like no limit on line and call queue capacity, being able to call a patient back automatically, or to route a call to a reception desk with capacity (perhaps across a primary care network), or to route a patient to a service that they need without going through a GP (perhaps across an integrated care system) reduces patient anxiety and frees up time for staff.
“Crucially, modern cloud telephony also avoids digital exclusion by providing access to appointments and services regardless of the method of access that the patient prefers to use. It ensures that GPs can deliver not just a good service but one that is equitable for all.”
Primary Care IT Founder Dustyn Saint said that he wanted to see “discharge medication from hospitals coming straight into the clinical system for reconciliation” as it would “massively improve patient safety and save hours of clinician time each week.”
Fran Husson of Imperial College brought it back to public health records. “They exist, they are integrated with the NHS log-in and the NHS app, so why wait?” she asked.
GP Automate Founder Arun Notaney said that he would solve the “administration burden of general practice”, reiterating it as a key challenge: “workload is never ending.”
The team from The Martin Bell Partnership noted that it was a tough question with many possible answers. Ultimately, they chose to solve the problem of infrastructure, suggesting a need to “put in place a fully funded, three-year infrastructure refresh” covering networks, computers and more. Martin added that he would “implement a high profile public education programme, starting in schools, colleges, universities, workplaces as well as online and on TV [or] in the media, to truly educate more of the public about what healthcare settings are appropriate for certain needs [and] how they can best use digital.”
Many thanks to our contributors for sharing their thoughts.