Interview, NP

Interview: Dr Claire Fuller, Chief Executive Officer at Surrey Heartlands Health and Care Partnership

We recently spoke with Claire Fuller, Chief Executive Officer at Surrey Heartlands Health and Care Partnership, to get her thoughts on digital in primary care, the key skills needed by a digital leader, and her experience with her recent Fuller stocktake.

Claire began by introducing herself and her role.

I’m Chief Executive of Surrey Heartlands and I’m also a GP. I’ve been a GP for twenty-eight years, a very long time!

Last November, Amanda Pritchard asked me to lead a stocktake looking at integrated primary care within ICSs to look at what was working well and why it was working well, and how we could then replicate that around the country.

Did the stocktake meet expectations?

I actually went in with no pre-conceived expectations. As soon as it was announced, my inbox just exploded with people wanting to tell me about the amazing things that are going on in primary care and general practice within their systems. People are very proud of the work that is happening and there is some fantastic work that is going on around the country. I knew that in a sense, but I think I was overwhelmed by the amount of positivity that is out there about general practice and the level of pride people have in their work.

During the stocktake, two things happened; the British Social Attitudes survey came out and showing that more people are dissatisfied with the  NHS than are satisfied, for the first time ever. Soon after the GP survey came out showing a real drop in terms of patient satisfaction with general practice, which was shocking, admittedly, but actually we were able to use that information to shape some of the recommendations in the report.

It became increasingly clear that the things that matter, both to the population and the people working in primary care, are  continuity and access. So although I didn’t go into the stocktake with any expectation I was surprised by how much agreement there was  – that these were the two areas that mattered most. I was also surprised by the level of agreement regarding what we should do to make those things better, both for the professionals and the patients.

Digital primary care: challenges and impact 

I think the biggest challenge is that things don’t work quite as well as we would like them to. It’s still a bit clunky. The interoperability isn’t there, the data doesn’t flow seamlessly.

Digital solutions need to work for patients, and they need to work for practitioners. At the moment, we hear about a lot of technical and amazing solutions to different things – but they are often exclusive to one condition or one small problem that doesn’t address the wider challenges. It’s too narrow. For example, you can be offered a solution for chronic kidney disease, and another for diabetes, and another for something else. I would really love people to start to think more holistically. It’s how you can create those partnerships so that solutions are not about single products, but about creating a solution that works across a whole person.

The area where digital can have the greatest impact, therefore, is in making things easier. The digital impact needs to be enormous in terms of making it easier to look after people well and easier for people to access information and care. The stocktake showed that people care about access and continuity, so digital can play a huge role in enabling improvements there. Digital access cuts down travel barriers and geographical barriers, and then digital solutions need to make sure that this access is joined up.

We need continuity at the point of access, but we also need continuity of data and records. Having that single care record that every healthcare professional providing care to an individual can see is so important.

Digital experiences 

Everyone in general practice became involved in digital transformation overnight when the pandemic arrived. The traditional way of working and of seeing everybody face-to-face altered and we had to reorientate ourselves. We are an Accurx system practice – I couldn’t manage without it, now.

Our experience was that we started off with lots of video consultations, but that trailed off because our WiFi isn’t the best it didn’t work all that well – it didn’t give us a high definition enough visual to get the added visual information that you need. So we started using phone appointments more than video. We do so much more with text messaging now, I use it all the time. I can send patients summaries of discussions from consultations, ask for more information, or photos. As it can be linked straight into the patient record, it’s invaluable in saving time and creating efficiencies.

In terms of how general practice has handled the momentum of digital progress in the wake of the COVID-19 pandemic, I think it’s interesting how things have settled down. We certainly won’t go back to doing everything face-to-face and I can’t imagine anyone else will go back either. There will always be multiple ways of doing things now.

When it comes to transformation, I think the big changes happened at the start of the pandemic and everybody is exhausted now. People haven’t got the headspace for major change at the moment – so many people in general practice are leaving, and the operational pressures are huge. Digital progress has slowed because people are tired and under pressure.

It’s about maintaining our steady state, currently and then building. We’ve got the factors that we know and trust to work, and a lot of change has happened already.

A good digital leader

A good digital leader needs to understand patient care. I think they should probably know more about patient care than they do about digital.

Our Chief Digital Officer, Michael Pantlin has a dual portfolio – he’s also our Chief People Officer. That’s because I wanted to make sure that our digital interventions either improve the working day for staff, or they improve patient care, rather than taking on beautiful but standalone digital projects that don’t have a strong impact on those key aspects.

In my view, a lot of the best digital leaders probably have a clinical background, in terms of understanding how things actually work from the staff and patient perspective, and not just from a technical aspect.

Digital ICS success in three years

Ultimately, everything should be interoperable, though whether three years is quite enough time for that is yet to be seen.

The offer should be consistent across the ICS, people should be digitally-enabled from their own homes to feed into their patient records. Data should flow and be coherent.

Again, it comes back to access and continuity. To look good, you need to be able to describe how you are delivering prevention, integrated urgent care, and chronic complex care, and how digital feeds into each one of those.

Fundamentally, that patient record that can be seen by everybody, including the patient, is the cornerstone. Patients need to be able to hold that record and move with it so that they know that they are getting safe care. One of the biggest gains in patient safety will be around having a single record with a single prescription chart.

Local implementation plans from the stocktake should examine what its recommendations mean in terms of digital strategy – how do recommendations affect you at home, in your place, across the system?

Success means joined-up, seamless care.

Many thanks to Claire for taking the time to share her thoughts.