Interview, Primary Care News

Interview: Dr Naveed Iqbal on improving prevention in primary care and building tools to support people with learning disabilities

For our latest interview, we spoke to Dr Naveed Iqbal on his experiences in primary care, his interest in building digital tools for people with learning disabilities, hopes for the future, and more.

On his background, role and projects

I work as a GP in East Lancashire, I’m on the Royal College of General Practitioners’ learning disabilities committee, and I’m also the chief executive officer for Suburban Health. We’re a medical software company created and supported by frontline teams, with the aim of facilitating closer relationships to reduce health inequalities.

Over the past two or three years, with digital technology, I’ve noticed that there’s been a lot of focus on helping people who are generally well abled, and less focus on the most vulnerable people, those at risk of being left behind. I’ve always had an interest in working with people with learning disabilities (LD) so that’s my focus. We’re trying to build a digital means to monitor and promote better health for people with LD through digital technology, better connecting those individuals with primary and secondary care.

We worked with Lancaster University to do the user research for people with LD – how they interact with technology, how we can increase their engagement. Research suggests that up to 35 percent of people who are disabled are digitally excluded.

So we’re building an app with them, working with focus groups to get the views of people with LD. At the other end, we’re using a dashboard to look at the data to see how we can work on prevention. We’ve been working on that that for the past year and we’re due to launch the app the next month.

I’m also currently working with NHS England’s Culture and Leadership programme, looking at the use of technology in digital exclusion.

Primary care challenges

I previously worked in accident and emergency, where the difficulties often lie in dealing with problems later down the line. That was why I wanted to work in primary care, to work on prevention. But we’re seeing a similar thing happen in primary care now, with more and more GPs dealing with acute situations that have become more serious than they would have been if they had been picked up quicker.

When you look at people with LD, we can offer support a lot earlier. We are often too late, they end up in A&E, and that’s why we need to spend more time looking at how we can stop this from happening in the first place. It’s a tough area, but it’s something I feel very passionate about.

In a wider sense, there are competing challenges with regards to digital primary care at the moment. When you look at the digital tools that have made it through to primary care, they tend to be aimed towards helping the GP and the practice staff. With the current workforce pressures that primary care is facing, many solutions are focusing on improving efficiency for staff, to help them deal with reducing numbers of GPs paired with increasing numbers of consultations.

We need to satisfy the needs of the frontline clinician – how can we make their lives easier and not increase their workload? That’s one challenge, and because in the past we’ve seen solutions which are designed to help but actually end up increasing the workload, there can be suspicion around new tools. Staff can be wary that these tools will reduce their efficiency and take up their time, ultimately preventing them from spending that time on patients.

But we also need to look at address the needs of the patient – to improve prevention, and empower people at home to take care of their health.

The challenge lies in training and making people more aware of their own health. We have national targeted campaigns around topics like blood pressure, but we’re not targeting the individual. We don’t know who this person is, their life at home, their mental health.

We need our solutions to find a compromise between the two.

NHS culture on digital primary care

Touching on my previous point again, there is still wariness in the workforce when it comes to new tech, which can impede digitation innovation. The advantage of being a GP is that I can have a GP-to-GP discussion about this. I can say: look, I know where you are coming from, I have a similar workload to you. They know that I understand their worries.

With regards to public perception, there’s a challenge there too – primary care staff can come under siege on things like social media, so it’s important that we can develop a trusting relationship with the public or win it back if that trust has been eroded.

Additionally, GP practice income has declined over the years, so there’s the further emphasis of ‘will this technology have an impact on my income?’

Although digital leads have been appointed in healthcare, we’re seeing a bottleneck situation happening. Digital leads in an ICS get flooded with offers of solutions from so many different companies.

In our work around helping with LD, we’ve approached with a wider scope. We worked with people at community level first of all; we are working with charities that focus on supporting people with LD and we’ve got our focus groups, so we’ve approached them to develop our understanding of what the individual needs from the solution. We’ve approached the nurses and the frontline workers to figure out how we can build a digital solution that can help them.  We’ve also talked to people who are not in the digital field to try to alleviate some of that wariness too. It’s about trying to ease that bottleneck a bit.

Hopes for digital primary care in five years’ time… 

Instead of primary care making use of a handful of systems and solutions mostly targeted towards staff, I’d like to see patients empowered at home with equipment that can help them and more knowledge about their health. I’d like to see more focus on prevention, working with people on their lifestyles, and working with local boundary sector charities and even in schools to make digital normal.

This will mean that patients can take more information, digitally, to their doctor appointments, and it will be welcomed – doctors will be equipped with more information for their consultation rather than having to meet someone and get to the root of an issue in ten minutes.

That’s how I want the future to look: digital as the norm, in the hands of the people, monitoring their own health and receiving more personalised care.

That empowerment should be for everyone – when we spoke to our focus group for people with LD, they told us that they know their health problems, although they often don’t get enough credit for that. They said that they want to be able to better communicate with their doctor; unfortunately the telephone triage system makes that difficult because a lot of people with LD struggle to express themselves over the phone. That’s why digital can help them. We always say: if you can get it right for people with LD, you can get it right for lots of other marginalised groups.

It’s not been easy – it’s been very difficult to get funding to move forward with our digital project for people with LD – but I’m hopeful for the future. There are some great frontline leaders who are passionate about helping people with LD, and they are our voice within the big organisations like ICSs – they keep us going.

I think it’s also important to start awarding and incentivising value-based care, looking at outcomes. For example, if a patient has undergone knee hospital, the most important thing is whether they were able to continue living their lives to a good standard afterwards. I don’t think we’re doing that at the moment, we’re rewarding actions instead; referring the patient, for example, or performing the knee surgery. We need to go one step further and look at the bigger picture. Research has shown that this will reduce the number of consultations required, and reduce healthcare costs too. Interestingly, a move towards this is happening in America at the moment through Accountable Care Organisations, and I think we need more of this in the UK as well.

Many thanks to Naveed for sharing his thoughts.