What will digital primary care look like in two, five and ten years?
We posed this question to people from across the healthcare industry to give them the chance to share their thoughts and opinions – read on to find out what they had to say.
“The potential for digital primary care to truly transform the way we deliver care to our patients and populations over the next ten years is enormous,” said Dr Nicole Atkinson, GP and NHS Confederation Primary Medical Advisor. “But I’m not always sure, as the NHS and local systems, that we are maximising our efforts to make this a reality. We need to keep asking ourselves, what more needs to be done and can we go further, faster.”
Some of this revolution will be down to getting the basics right, said Nicole, listing key questions to be considered: “Can we develop interoperability between clinical systems to allow at scale working, can we allow access to clinical systems wider than general practice, so that we are truly developing an integrated neighbourhood approach to care delivery? How can we ensure our patients are part of our digital health care delivery, whether that be through online or video consultations or utilising apps to help them monitor and control their long term conditions?”
Nicole provided a vision for the coming years: “Just imagine a future where, just like Alexa for Amazon, a patient can speak to a device and input their blood pressure reading. This could then tell them if this is abnormal and what action is needed (other than call the GP). That is the kind of blue sky thinking and solution I’d love to be seeing for digital primary care of the future. The sky’s the limit, we just need to be brave, bold and create the right conditions to make this happen.”
For Yash Manipatruni, Deputy Director of Enterprise & Technical Architecture at NHS South West London CCG, the future is about digital integration.
“I would see a more seamless digital integration of primary care with secondary care and patients,” said Yash. “GPs should be able to monitor long-term acute conditions through the medical devices provided to the patients, and that information would be recorded against the patient record. The summary of the finding would be presented to the GP for review with any red flags though the usage of machine learning, where middleware digital systems would crunch the number for review by the physician.”
Data would move freely into primary care and vice versa, Yash said, with artificial intelligence and machine learning used to “present a case file to relevant authorities as per caring mechanism”, for all patients referred by social prescribing.
“Primary care data (both summary data and raw data) should be churned through regional population health management platforms, which in turn will link up with national and regional data sets to provide insights to the primary care,” added Yash. Ultimately, “the need for technology equipment would be reduced due to smart devices and all data in cloud, paving way for more free space to create digital surgeries where local social care will be more integrated with primary care.”
Healthcare Gateway commented that they expect primary care to become “significantly more integrated with further interoperability, allowing all the healthcare professionals involved in a patient’s journey a greater coordination of care.
“We expect increased bi-directional data sharing, with rich data from all health and social care settings being available to GPs, and comprehensive GP data being available to other care teams. Furthermore, work being done to respecify read codes to SNOMED CT means that, in the future, organisations will be aligned and conforming to the same national standards, reducing data gaps.”
The next two years should see it become the standard that GPs have the tech “to communicate and collaborative with other services across the system, in order to deliver integrated care,” said Jacob Haddad, CEO and Co-Founder of Accurx.
“As the hub of a patient’s care, GPs regularly interact with everyone from district nursing and cardiology to physios and care homes, but their current routes of communication are outdated and clunky. In two years’ time, dictating letters and calling switchboards should be scarce, in favour of digital communication methods that allow for quick coordination of care between services,” Jacob stated. “This will help save staff time across general practice, alleviating workforce burnout.”
Looking ahead to 2027, Jacob said: “Over the next five years, there needs to be a shift from the one-size-fits-all model of appointments for every single need, to empowering patients and practice staff to choose what method of care is most appropriate, with more care occurring outside of appointments. This can be delivered through online consultations and messaging, which will allow practices to free up time to deliver more care for patients who need to be seen face to face, whilst ensuring continuity of care for those who don’t need to be seen.”
As for the next ten years: “I want to see fewer patients getting on waiting lists in the first place, due to the increased use of remote monitoring and care,” said Jacob. “This can be delivered, for example, through a rolling programme of GP check-ins with vulnerable people and those with long-term conditions, to actively monitor people remotely and reduce admission rates for chronic illnesses.”
Dr Owain Rhys Hughes, an ear, nose and throat surgeon as well as founder and CEO of Cinapsis, predicted that we will see a phasing out of struggling digital systems.
“Looking ahead, I predict that the digital systems which are failing to deliver promised outcomes for primary care – whether that be because of poor interoperability, failed compliance or a frustrating user experience – will gradually be phased out,” he said. “In their place, the tech solutions that flourish will be the ones that have learnt from the mistakes of those that came before them. Tomorrow’s primary care teams will benefit from digital tools which are fully integrated and interoperable with other systems, and those which have been painstakingly developed and refined to deliver optimised patient outcomes.
“Contending with endless email chains, waiting for hospital switchboard connections, and having to manually upload information to patient records are all examples of time-consuming practices which will eventually become distant memories. As ICS transformation progresses, the demand for tried, tested and regulated digital technologies will only increase. As a result, primary care clinicians will soon all have access to tools which allow them to seamlessly communicate with other services, share relevant data securely in seconds and collaboratively plan the most effective treatment for patients. Many clinicians do already have access to such solutions, but universal access must be pushed for if the future of primary care is to be a bright one.”
The impact of the COVID-19 pandemic on digital patient engagement in primary care was noted by Konrad Dobschuetz, Head of Customer Solutions, (Digital), Health Innovation and BIOME Lead UK at Novartis Pharmaceuticals UK Limited.
COVID brought “proliferation due to high demand,” Konrad said, adding that he expects to see “a concentration in the digital offerings that are there at the moment. One or two, maybe three main providers will emerge that offer the suite of EHR, appointment booking and prescription management in the next two to three years, also driven by the NHS agenda to unify touch points.”
Further on from that, Konrad predicted that we will “also see the NHS having to drive more efficiencies using home monitoring ad diagnostics, keeping even more patients out of a primary care setting. Pharmacies will become even more a pressure valve, for the right or wrong reasons, for GPs and early assessment of patients. In the next ten years, patients will demand more control over their healthcare data, leading to a more democratised approach where patients will own their data rather than the NHS.”
Vijay Magon of CCube Solutions agreed that the pandemic has taught the industry a lot about digital healthcare. “It also taught us that digital health innovations should not be framed as a replacement for face-to-face patient care,” he added. “Such innovations and tools should be offered as part of a wider set of options based on a patient’s preferences and needs. Development of such innovative tools will continue, to combat technical challenges and barriers.
“It is vital that innovators and implementation teams honour their pledges for open standards and interoperability to improve access to relevant data at the point of need. We further welcome the role of NHS England in supporting technology suppliers and the new framework for NHS action on digital inclusion. The funding announced, while greatly appreciated, must also be strictly channelled to address the digital objectives and how it can be accelerated to reach the frontline.”
For Rebecca Ross, Regional Delivery Lead at Isla Care, data visibility, remote services and personal patient responsibility are key components of the future.
“There will be a greater amount of patient data flowing from a range of sources including wearables, smart-scales, tracking apps, diagnostic forms and patient submitted videos and photos,” Rebecca predicted. “This data will all underpin a cohesive ecosystem of remote monitoring, allowing conditions to be supervised more closely than scheduled in-person check-ups could provide. Data will be made visible and useful to clinicians allowing them to triage patient-lists, refer to secondary care with seamless interoperability, and liaise with at-home caring teams to ensure all patients can receive care where and when they need it.
“Patients will also have greater visibility of their medical data, allowing them to have more agency and responsibility for their health, with diet, exercise and condition tracking apps adding to their medical records.”
Additionally, Rebecca said, “Treatment will also become more remote and digitally-led, with many conditions, especially mental health and neurodiversity, being dealt with by prescription digital services like SilverCloud for anxiety and depression and EndeavourX for ADHD.”
Rebecca also highlighted the pandemic, noting that it “pushed the already straining infrastructure of the NHS to breaking point, forcing the conclusion that things cannot continue as they have before. Digital services are not a panacea of revolutionary practices, they simply support bringing the principles of informed diagnosis, clinical surveillance and patient engagement into the 21st century.”
In two years, we’ll “see a wider digital response to the consumerisation of health and care,” said Mike Fuller of InterSystems, “with increased service accessibility and service user inclusion using telehealth for appointments, consultation, prescription refills [and] mobile access of records.” Mike noted that the wide choice of apps available may be “confusing” to patients, and that he expects to see some aggregation apps available too.
“Accessibility will be extended to more regionally-led packaged services for discrete patient cohorts, with more frequent use of virtual hospital ward and remote monitoring with wearable 5G connected devices – for those who need or want it – and can afford it,” Mike continued. “Because funding this change will be a challenge. The commercial and cultural hurdles are probably just as big for ICBs. The ICBs will want to unlock more primary care data to manage distributed patient risk and service provision for preventative and personalised care across the wider health economy, especially for public health use.
“Yet we need far more than data access, we need the standards-based interoperability promised by a universal adoption of the latest editions of HL7 Fast Healthcare Interoperability Resources® with widely fed repositories and standardised reporting. The NHS will need to enforce the use of these standards, because today some industry stakeholders have only ticked the box of compatibility, and several have not understood or implemented adequate clinical safety compliance for DCB0129 and DCB0160, respectively.”
In five years, Mike said, ICBs will need to decide how they can help primary care fund change management and digital transformation, with a need for structural changes that fund both primary care provision and digital systems.
Noting that the current batch of periodic data transfers and application interfaces are “too passive”, Mike said: “What we need is process interoperability to proactively automate care to close the service gaps and stop service users falling through them. The overheads of separate, point-solutions make purchasing decisions easier, with immediate gratification for their direct users. Yet the valuable data generated by these interactions dissipates. There is a whole iceberg of problems below the waterline we ignore. If we want to see more transparency, interoperability, and automation then the multiple regional stakeholders must think in whole-system terms that span the service users’ experience with shared outcomes. We need the ICBs to put social care, mental health, charities and more on par with acute and primary care funding and management.”
Mike added: “We need to use the ‘exhaust data’ generated by the workflows to teach machine learning artificial intelligence to help us make more objective, informed and timely decisions. Yet I’m an optimist, I think some primary care regions will be able to achieve these advances in the next five years, provided we are willing to flip the iceberg.”
When it comes to ten years from now, Mike commented on how recently published insights suggest that “personalised, precision medicine” could be on the horizon. “Perhaps it will take more than ten years for wide adoption, but we can make a start with gender, age, and demographic aligned diagnosis and care pathways with measurable more effective medicines,” he said. “I already daydream that my GP could use augmented reality visual tools supplemented by artificial intelligence and rich clinical decision support systems to diagnosis me faster and more accurately. That they can automatically and easily publish that diagnosis with a personalised care plan based on my epigenetics, lifestyle, and agreed compliance to my approved care circle and patient support groups.
“However, to make these fundamental digital changes we must reset and rethink the role of primary care in the NHS with its funding, and probably redesign what primary care means and does.”
Funding is critical
Tobias Alpsten, CEO and Founder at iPLATO Healthcare, predicted that in two years “the workforce challenge is going to deepen, NHS funding will get tighter while patient demand is going to grow rapidly. For digital, this will mean an end to ‘digitalisation by central decree’ and a return to an emphasis on automation of high-volume processes. Companies with a proven track record of using digital for pathway transformation, cost control and financial savings at a massive scale will be successful in this environment. Companies serving solely the NHS and relying heavily on VC funding to subsidise unsustainable operations will struggle.”
On the question of five to ten years, Tobias said: “All health tech founders that I know are optimists… and so am I. If given the opportunity, we fundamentally believe that we can fix the problems of primary care (and other parts of the service) and create a better future for patients, carers, clinicians and other healthcare professionals. In this – better – future we see an emphasis on prevention at every stage of the journey. For all of us (patients and not-yet-patients), it will mean greater use of data to stratify risk and more frequent testing, both at home and in the community. Predictive modelling and inexpensive diagnostic tools and techniques will lead to early interventions such as minor surgery, vaccinations and behaviour change (most of which will be invented or significantly improved over the next ten years). To reach the required scale and quality, all of this must be underpinned by digital and with a natural home in primary care.”
Melissa Morris, CEO at Lantum, agreed that funding is key: “The future of primary care rests completely on how much funding is made available. Only if adequate funding is given to the front door of healthcare, will these issues resolve themselves. That funding needs to be channeled towards recruiting and training more clinicians, investment in better interoperable systems which provide better quality of care, and investment into digital literacy so that the best innovations can be commissioned and used more broadly.
“Investment in the right technologies and digital products not only creates more time to care, but also have the potential to radically improve the quality of lives of those working in primary care, which in turn leads to improved staff retention. If funding is provided in these three areas, the cycle can reverse and become self-perpetuating.”
Dr Tharshini Ramalingam, Board Member at iOWNA Medical, commented that “the challenge facing primary care is to evolve with both medicine and society in a manner that will not compromise care or safety but will enable speed and efficiency.
“Most primary care practices have diversified their workforces with pharmacists, urgent care practitioners and wellbeing practitioners. As healthcare professionals become time-poor, technology has been presented as the answer to a lot of issues. Currently a lot of practices use text messaging services which integrate into patient notes as a very effective method of communication. Online portals to request sick notes, prescriptions and other ‘medical admin’ are already in place but there is a plethora of solutions which are yet to be produced.
“Patients with chronic diseases would benefit from their own personalised health engagement tool. Central to the success of more personalised solutions is an integrated Clinician Patient Engagement System (CPES). These systems facilitate the two-way exchange of information between clinicians and patients, providing the patient with trusted multimedia education about their condition and treatment; and the clinician with monitoring information on health, symptoms and side-effects to inform the patient’s treatment pathway. Behavioural change is something that health technology could affect by prompting small changes in daily routine – whether encouraging patients to walk to boost their wellbeing or facilitate weight loss to practising meditation and gratitude to lessen anxiety.
“As with all technology driven scenarios, the unique selling point is either to free up clinician time by circumventing a specified administration task or to save money by changing a process that is more costly than the technology solution.
“In the private sector, video consultations with GPs is a common occurrence but will this ever replace the traditional doctor-patient model? In five years, I would predict a more joined-up technological ecosphere within the NHS. General practice is already blazing the trail and are light years ahead of secondary care in this regard, with most practices having been truly paperless at least for the last ten years.
“And in ten years – well who knows, perhaps we will be telling Siri all our ails and woes or maybe the transdermal sensors in our watches will be prompting SIRI to tell us to see a healthcare professional!”
Grace Gimson, Founder and CEO of Holly Health, commented: “From an overarching perspective, we see digital innovation as the single strongest chance to save our NHS and unleash its potential in the future. Fortunately, policymakers are seemingly waking up to this fact. In the recent digital strategy for health and social care, self-management and prevention focused innovation was a clear focal point. We hope to see funding, incentives and procurement mechanisms structured to support this as a core pillar of healthcare operations over the coming years.”
Another key theme to Grace is that of quality, not quantity. “Today’s NHS is still some way behind having the skill set to properly assess the most effective, safest and most suitable technologies for patients and clinicians,” she said. “This will require a greater level of leadership and guidance from governance organisations like DTAC and the new NICE digital guidelines, to provide clarity on mandatory standards and what good looks like, building trust and confidence amongst primary care communities.”
Other areas that Grace highlighted were the importance of self-management tools and interventions, and the centrality of medical records using solutions such as the NHS App.
“Overall, digital healthcare solutions are undoubtedly evolving and the opportunity for positive change is vast – at Holly Health, we’re optimistic and excited for the future of a digitally-enabled, person-centred primary care and hope to be a core support for clinicians throughout this decade,” summarised Grace. “We feel over the coming years the drive for primary care will be around quality assurance and quality improvement and demonstrating their ability to measure this and understand how they are delivering on this.”
Firstly, said Dave Mills of the NHS Specialist Think Healthcare Team, “technology will move on to address the usual priorities we hear people talk about… improving patient care, giving patients more choice, and facilitating care across multiple organisations and geographies. Secondly there will be increasing movement in the use of technology to plug the funding and personnel gap in primary care. It’s no secret that there have been funding challenges in primary care for some time, and we’re also struggling to attract and retain key personnel. Technology will increasingly be prioritised to help plug this gap and do more with less.
“A good example of this is patient access to primary care. Advanced NHS specific cloud telephony platforms such as ‘Think Healthcare’ help to improve the patient experience of contacting their surgery and alter perceptions without there actually being any additional appointment capacity at the other end. This is enabled in part by functionality that allows patients to put the phone down if they find they are in a long queue, go away and carry on with their day, and the phone system automatically rings them back when they get to the front of the queue.”
Dave predicted: “Primary care will increasingly modernise its approach to patient access and adopt the omni-channel methods of modern business. Throughout the pandemic we’ve seen this accelerate with technology deployed for multiple additional communication channels, allowing patients to utilise those that suit them and easing the pressure of trying to squeeze all patients through an old-fashioned phone system with just a handful of lines.”
The current workforce gap within the NHS is expected to at least double over the next four years, according to Louise Wall, Managing Director at e18. Louise said: “The plan to plug the workforce gap will take time to implement and will likely be multifaceted. The solution is likely to comprise two key elements: improved workforce planning and widespread adoption of technology.”
Primary care must adopt technology in the next two years in order to modernise processes, generate efficiencies and improve patient care, Louise continued, adding that “RPA (robotic process automation) is anticipated to save the NHS more than half a million hours in staff time by 2025. We predict that in the next five years most primary care organisations will have adopted automation and will replace BAU processes with digital workers.” This, she said, is expected to reduce administrative burden, improve efficiency, improve staff and patient experience, and improve process assurance, among other benefits.
Louise highlighted that “the widespread nature of burnout in primary care is a concerning trend that must be reversed over the next ten years”, and commented that the NHS needs to develop a roadmap to support staff mental health, and secure a sustainahle future for patients.
Integrated care of the future
“Health systems are starting to break down the silos that exist within primary, secondary, community and mental health – moving towards truly integrated care,” commented Elliott Engers, CEO at Infinity Health. “ICSs and their boards will help to break down some of the long-standing contractual barriers and better align incentives. This will foster greater collaboration between providers. When that happens, technologies like Infinity will need to become the ‘glue’ that connects clinical and operational teams and facilitates safe and efficient care coordination across the entire patient journey.”
Mark England, CEO at HN, highlighted three areas that he envisages accelerating transformation over the next decade. The first is team delivery: “more GP-led rather than GP-delivered, requiring more digital support for both asynchronous and remote collaboration between expanding workforce of new roles.” Next, Mark emphasised the need to become more proactive: “data will need to be used to surface those with rising risks, case-finding the right patients for proactive support and moving away from a purely reactive model.” Finally, he raised the issue of needing more person-centred care. “As the burden of long-term conditions and advancing frailty increase, there will need to be much more support for self-management. As well as the person-centred approach this will involve a new generation of digital tools where the ergonomic and accessibility constraints today will be overcome.”
“In the next two years it’ll hopefully be easier to share information across ICSs, supporting the handover of patient information to different healthcare organisations, including social care and the third sector, providing a more seamless experience for patients,” commented Craig Oates, Managing Director of Doctrin UK.
“In five years, the majority of patients will expect to contact their primary care provider digitally in the first instance and digi-physical care will be the norm. I’d also expect to see patients take more ownership of their care, with improved digital tools that are tailored to the needs of the primary care network and integrated care system population. There’ll also be a more significant shift towards virtual care and remote monitoring than we already see today.”
It’s harder to predict what the digital primary care landscape will look like in ten years, Craig added, “as we’ve seen how quickly things can change. Ultimately, we would like to see the reliance on single electronic patient records across healthcare abolished completely – only happening in exceptional circumstances. All patients will be able to access their entire medical records on their own devices, which have become the core EPR, integrating with clinical systems when needed. This ensures patients have completely seamless care and can be supported across ICSs where needed, without the need to repeat themselves.”
Dr Rich Pratt, Clinical Director at Eva Health Technologies, said: “It’s not about the tech. Or rather, the tech isn’t the end point. It’s the means to get to where we need to go. Good tech makes that journey easier and more enjoyable.”
In two years, he expects to see digital and in-person services continue to exist side-by side; the suite of patient-facing apps to support self-management of chronic conditions will be extended; and digital entry points into healthcare will be streamlined to avoid the risk of patient confusion.
In five years, Rich said that he expects a blend of real life and virtual reality diagnostic and treatment offering; a more sophisticated data sharing of specific data for specific purposes; wider access to mental health services via low-level digital interventions; and health surveillance to be empowered by digital technology, probably driven by ICSs as they extend their offering.
Finally, in ten years, Rich said: “We foresee a health system where inequalities are minimised through a comprehensive digital skills and literacy programme starting out in schools” and “the place for AI is now well established, leaving people to focus exclusively on those components of care that are uniquely human.”
One of the main problems is having the ability to update electronic patient discharges and transfers between organisations, said Darren Pudduck, Digital Medicines Principal Pharmacy Technician at Dorset HealthCare. “Although this is moving along it can take days for a GP to manually update the allergy status of a patient or change their medication regime once a patient is discharged with changes to their medications. Mistakes happen during transfer of care and these need to be eliminated.”
He noted that Dorset HealthCare is doing well in this regard: “With the DCR (Dorset Care Record), organisations have the ability to share the latest data regarding a patient. We are also working on our vision for the future with our One Medication Record Project where we will have the ability to input data from third parties and transfer patients electronically between care settings. But more is needed some organisations are much further along and some are far behind so we need a standard to work to with blueprints to follow quickly organisations who are taking the lead.”
Chris Robson of Living With commented: “At the moment, for reasons we all know, primary care is on the back foot. And digital primary care is walking behind that. However, there are many very enthusiastic early adopters of technology who want to get it onto the front foot. Funding, a strategic approach to interoperability and a genuine change in how GPs expect and are expected to resource and use digital assets in their day to day lives is key to success.
“In two years, if the success factors start to be addressed, then the interoperability will be starting to work and there will be real digital hubs across primary care in ICSs. This will begin the process of moving to a better place.”
“We’re on the edge of a huge transformation within healthcare,” noted Fiona Kirk, Clinical Consultant for Ascom UK. “We can see it in the transition that’s already happening to manage the care of many more patients within the primary care sector through remote monitoring, for example. There’s a shift towards prevention over cure, to help curb the rising rates of patients who need to access acute care – where there is an unsustainably high demand on beds and inadequate staffing levels due to low recruitment and poor retention levels.”
Fiona said that the aim now and in the future “will be to support care with preventative management” and “ultimately empowering patients to take responsibility for their own health management, while providing them with a network healthcare support.”
She highlighted some key aspects to take into consideration, including remote monitoring, digital inclusion, staff training and development, changing care pathways, the hurdle of interoperability and the dynamics of an increasingly elderly population with complex comorbidities.
Dr Carey McClellan, CEO and Clinical Director at getUBetter, said that the next two years are “about recovery and supporting patients with digital technology” and supporting the health system whilst it manages pressures with long-term issues such as musculoskeletal conditions. “This is about supporting self-management, helping patients on waiting lists and minimising the impact of long waiting times and deconditioning. There should be no need to wait for access to evidence based self-management and it can be available 24/7.”
In five years, we should be recovering from the current crisis, Carey predicted: “The NHS App and patient control of their information and appointments will become routine. Patients will become used to a single sign-on and direct access to advice, guidance and personalised care… Wider adoption and developments will enable us to find ways to minimise digital exclusion, target more diverse groups of patients and demonstrate our impact on the green net zero agenda.”
In ten years, “digital self-management is mainstream,” Carey said. “Self-management technology is fully integrated to all elements of healthcare. But will it be digital-first technology, where a patient does not see a clinician and it is a replacement, or digitally-enabled technology sitting alongside and working with the health system as part of a hybrid service?”
Robert Harris, Co-Founder and Managing Director of Spirit Primary Care, said that existing legacy systems are no longer sustainable. “Put simply, having largely failed to embrace enabling technology in the past, primary care will have little choice going forwards. That, or close,” he said.
“And this doesn’t simply mean playing with a new ‘triage & treat’ system. Implementation has to be deep, far reaching and meaningful. We need to create and foster a cultural environment where organisations and staff see continuing technological transformation as part of BAU, not simply one-off project-based endeavours. We need technology to be fully integrated and interoperable within and between connected practices, but also across PCNs, ICS and whole system. We need agreed standards that allow records to have full read and write protocols from wherever they are accessed. We need to foster a digital maturity mindset within patients to ensure they are comfortable with, and get benefits from, virtual consultations, remote patient monitoring, and AI driven medicines optimisation. And much more.”
In five years, Robert said, “many smaller practices will have closed for recruitment, financial and quality related reasons. Larger groups of practices, with central data and resource management will be usual. A GP partnership role will be seen as no longer desirable.”
In ten years’ time, he expects to see “a small number of large primary care companies [dominating] the landscape. Senior primary care doctors will be ‘consultants’ only treating the most complex cases. Remote monitoring of condition via local and regional data centres will be the norm. Patients will be comfortable having health management programmes maintained and fine-tuned automatically. Wearables will be in widespread use and population health management software will predict with >95 percent accuracy those patients at greatest risk of developing chronic conditions and earlier interventions will save both lives and money.
“This will be the future of primary care and the salvation of the NHS.”
For Mark Burton, Health Sector Lead UK at Virgin Media O2 Business, the biggest challenges will emerge in the short-term, over the next two to five years, as a ‘new normal’ emerges for population health.
“The challenge will be around regional systems investing in reliable, future proof and digitally enabled infrastructure, capable of meeting the needs of a fast-developing digital care ecosystem and ensuring the weakest ‘digitally capable’ links in the chain are strengthened,” commented Mark.
Over the next decade, Mark predicts that machine learning, AI and Internet of Things (IoT) will advance, meaning that “preventative care and patient triage may look very different. This will be further supported by an increasingly digitally experienced population.”
Mark noted that it’s important to keep digital inclusion in mind as tech-enabled healthcare isn’t suitable for all groups, but expects digital primary care to continue to evolve at pace.
“With the development of ICSs across the regions, as well as cloud-based EPRs or patient owned records, it might be possible to gain remote access for routine primary care appointments anywhere across an ICS group,” he said. “Indeed, why stop there? Perhaps one day all patients would have an initial virtual consultation anywhere in the country. However, it’s important to remember that at some point in the healthcare journey, the need for ‘hands-on’ patient care will remain, provided by expert healthcare professionals. “
Martin Bell, Director at The Martin Bell Partnership, explained that the future of digital primary care is “inexorably linked” to the future of primary care.
“There is a real danger that if the current challenges facing primary care are not addressed, that primary care as we know it will not exist in a decade,” he commented. There are many challenges which need to be addressed.
“Of course, digital has a role a play in this, a big role,” Martin continued. “We have seen some growth in video consultations being used as a tool, although in reality, it is very limited. We have seen more growth in online consultations, although again, the variable implementation of these and in some cases software limitations may add to workload pressures rather than reducing.”
Ultimately, Martin said, “We can have whatever primary care system we want over the next decade, and we can have whatever digital technologies we want that will enhance the space in there as well. The key question is will we?”
He highlighted “funding alone is not the answer. We need a central NHS England leadership committed to and understanding of primary care – not just GPs, but dentistry and other local, primary services. We need it funded, but we need to decide the values we want around it.” Martin emphasised the need for continuity of care, lifelong relationships, locally owned partnerships and the protection of patients, including the vulnerable and disadvantaged who need it most.
“We can then wrap digital around that to ease workload, increase efficiency, remove administrative burdens,” he said. “We need to scale and penetrate the ‘stuff that works’ everywhere, and drop the stuff that does not work. Less focus on overly complicated frameworks, more focus on asking ‘does this add positive value to what primary care is doing?’”
Exploring the role of mental health support in digital primary care over the next five to ten years, Jeremy Christey, Mental Health Services Clinical Lead at Ascenti, said: “The privacy of the data disclosed in mental health consultations means that security has to be baked in from the outset for all initiatives. The capacity to use data (real or synthetic) in research and even further downstream, means that informed consent and recall of data for retrospective withdrawal of permissions become live issues.
“Before I go on the clinical issues that tech may help with, I want to say that we do certainly need it, but probably not in the disruptive vision of the usual incubator’s pitch deck. In mental health people die if you do not get it as right as you can. Clinically we try and do the right thing first time, and definitely do not discard those who do not fit our model.”
Jeremy continued, “We do have a clinical problem in mental health, as treatment effect sizes are not rising, and also we have a data crisis which means that the field is unable to proceed in ML training and is ten years behind. The siloed approaches means that practitioners in mental health can be the effective luddites (with some justification) – no one is going to observe sessions, as unnecessary intrusion is to be avoided as it ruins the magic. However, these clinicians can present the mental health field with problems… and tech start-ups offering mental health ‘interventions’ with no efficacy or effectiveness data whatsoever present major problems too.
“So what is going to happen to mental health in the next five to ten years? Well, we need some good privacy assurances to allow us to get the data. We will need to use the best AI in the room (the clinician), as best we can, and this may well be using AI to augment and assist them. Finally, we will need to be clever about how tech can allow people to have access to help which will assist them with a tiered offer of intervention, and clear the way to allow the people with serious mental health problems to access services.”
Dr Peter Fish, CEO of Mendelian, said: “Over the next few years, it will be essential to see a range of cutting-edge technologies being trialled to assist clinicians in delivering high quality care to every patient across the entire scope of primary care – from patient interaction, diagnosis, management and referrals.
“In the next two years, I’m expecting to see tech solutions optimising a fair deal of primary care’s administrative aspects – scheduling, communication, patient education et cetera. Yet we will also hopefully see some digital tools making a clinical impact with remote monitoring, objective symptom collection, diagnosis and actual health management.
“Beyond this, in the next five to ten years, I am expecting to see far more of these cutting-edge advances – including routine use of big data, AI and machine learning, as this becomes part of the fabric of primary care. We will see increased efficiencies, and more targeted, personalised care which will ultimately improve and save more lives.”
The increased demand stemming from the pandemic will see digital primary continue to evolve, said Halina Batsishcha, Healthcare IT Consultant at ScienceSoft. “Digital primary care will also continue to be the core of care delivery and care coordination, acquiring the form of hybrid virtual/face-to-face healthcare. It will place utmost importance on patient needs, aiming at improving the quality of care, personalising healthcare services and treatment options, increasing patient satisfaction, and reaching as many patients as possible.”
Halina shared some of the changes she expects to see, including further growth in popularity of virtual visits; improved chronical disease management and remote patient monitoring; better coordination between primary and speciality care providers due to improved secure access to health records and real-time data; patient owned medical records; increased adoption of digital primary care due to growing technical literacy among wider segments of the population; and tighter data security standards.
Liz Ashall-Payne, founding CEO of ORCHA, commented: “To understand the future, we need to look to the past. Up until the late 1990s, the primary route to our banks was to pop into the local branch on the high street. Today, we reach for our keyboard – or our mobile phone app and we think nothing of it. This level of change is coming to primary care. I’m not saying it will be easy, but it is coming, and it must, because the NHS needs a revolution and digital is the answer.
“Within a decade, GPs will be prescribing health apps just like they do medicines. Sophisticated digital health tools will be helping people self-manage complex and long-term conditions from home, freeing up primary care time.”
She predicted: “Every citizen will have an online health vault, containing exercise regimes, dietary information, heart rate, steps taken, sleep patterns and menstrual cycles plus information on mental wellbeing and long-term conditions. This data, wholly owned and managed by each individual rather than by a government-led health service, will be instantly accessible and interoperable with NHS systems. The information on each human being will be so rich, that primary care staff will have an incredibly full picture of people’s health and even be able to predict the likelihood of stroke or heart attack, for example. We’re already on the way there, with FitBit and Patients Know Best, for example.
“The absolute cornerstone of all this change is trust – and ensuring our digital health products are good quality, so that doctors will prescribe them and patients will benefit from them, isn’t a challenge for the next decade, we have to crack this now.”
Many thanks to everyone who provided a comment.
